A new CT dynamic maneuver “Mouth Opened with Tongue Extended” can improve the clinical TNM staging of oral cavity and oropharynx squamous cell carcinomas

• Published in: Oral oncology Vol. 94; pp. 41 - 46
• Main Authors: Bron, Guillaume, Scemama, Ugo, Villes, Virginie, Fakhry, Nicolas, Salas, Sebastien, Chagnaud, Christophe, Bendahan, David, Varoquaux, Arthur
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2019; Elsevier
• Subjects: Bioengineering; Computed tomography; Dynamic maneuver; Female; Humans; Life Sciences; Magnetic Resonance Imaging - methods; Male; Middle Aged; Mouth Neoplasms - diagnostic imaging; Mouth Neoplasms - pathology; Neoplasm Staging - methods; Oral cancer; Oral cavity; Oropharyngeal Neoplasms - diagnostic imaging; Oropharyngeal Neoplasms - pathology; Oropharynx; Retrospective Studies; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - diagnostic imaging; Squamous Cell Carcinoma of Head and Neck - pathology; Staging; TNM; Tomography, X-Ray Computed - methods; Oral cancer; PACS; Staging; MRI; CNR; CTconv; DLP; HPV; TNM; Gy; UH; Computed tomography; Dynamic maneuver; SPSS; ooSCC; VIBE; Squamous cell carcinoma; CTmote; RECIST; IRSN; TSE; AIDR; Oropharynx; FOV; ROI; Oral cavity; CT; TE; HNSCC; TR
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2019.04.023

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•CT and/or MRI are mandatory for oral carcinoma’s treatment planning including surgery.•Kinetic and metal artifacts can make CT or MRI exams uninterpretable.•Low artifacts rates are seen on MOTE CT dynamic maneuver.•cTMN assessment performance and reproducibility of MOTE CT are comparable to MRI.•We recommend combination of MRI and CT with MOTE as optimal for cTNM assessment.
Cross sectional imaging is mandatory for oral cavity and oropharynx head and neck squamous cell carcinoma's (ooSCC) local extension and TNM staging. However a complex anatomy and frequent dental metallic artifacts make it difficult. This study assesses the clinical benefit of “Mouth Open with Tongue Extended” dynamic maneuver at CT (CTmote) as compared to the conventional CT (CTconv) and MRI.
Retrospectively, 58 patients with histologically proven ooSCC (oral cavity: 34; oropharynx: 24) were included in the study. All had endoscopy with biopsies, MRI, CTconv and an CTmote acquisitions. Data were splitted in 3 datasets and 2 independent radiologists performed readings blindly. Gold standard was pTNM in 31% of cases; otherwise cTNM obtained at multidisciplinary team meeting with endoscopy and mapping biopsies were used.
CTmote was feasible for all patients including those already treated by surgery or radiotherapy. Exact TNM staging was obtained in 68%, 83%, 83% for CTconv, CTmote and MRI respectively. The best exam ratings at paired wise comparisons were 3%, 47%, 50% for CTconv, CTmote and MRI respectively. CTmote and MRI observer agreements, image quality and confidence ratings, were comparable and higher compared to CTconv (p < 0.001).
CTmote improves oral cavity and oropharynx tumour stage assessment compared to CTconv with performances close to those of MRI examination. In clinical practice, combining both CT with MOTE maneuver and MRI seems to be the optimal imaging strategy for local staging.