Local recurrence of squamous cell carcinoma of the head and neck after radio(chemo)therapy: Diagnostic performance of FDG-PET/MRI with diffusion-weighted sequences

• Published in: European radiology Vol. 28; no. 2; pp. 651 - 663
• Main Authors: Becker, Minerva, Varoquaux, Arthur D., Combescure, Christophe, Rager, Olivier, Pusztaszeri, Marc, Burkhardt, Karim, Delattre, Bénédicte M. A., Dulguerov, Pavel, Dulguerov, Nicolas, Katirtzidou, Eirini, Caparrotti, Francesca, Ratib, Osman, Zaidi, Habib, Becker, Christoph D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2018; Springer Nature B.V; Springer Verlag
• Subjects: Adult; Aged; Benign; Biochemistry, Molecular Biology; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Chemotherapy; Clustering; Complementarity; Complications; Data processing; Diagnostic Radiology; Diagnostic systems; Diffusion Magnetic Resonance Imaging - methods; Female; Fluorodeoxyglucose F18 - pharmacology; Head & neck cancer; Head and Neck; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - therapy; Histology; Histopathology; Hospitals; Humans; Imaging; Internal Medicine; Interventional Radiology; Lesions; Life Sciences; Magnetic resonance imaging; Male; Medical diagnosis; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Morphology; Neoplasm Recurrence, Local - diagnosis; Neuroradiology; Otolaryngology; Patients; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Prospective Studies; Radiation; Radiation effects; Radiology; Radiopharmaceuticals - pharmacology; Salvage; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck; Statistical analysis; Surgery; Tomography; Tumors; Ultrasound; Neoplasm recurrence, local; Multimodal imaging; Magnetic resonance imaging; Head and neck neoplasms; Imaging, hybrid
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-4999-1

Purpose
To determine the diagnostic performance of FDG-PET/MRI with diffusion-weighted imaging (FDG-PET/DWIMRI) for detection and local staging of head and neck squamous cell carcinoma (HNSCC) after radio(chemo)therapy.
Materials and methods
This was a prospective study that included 74 consecutive patients with previous radio(chemo)therapy for HNSCC and in whom tumour recurrence or radiation-induced complications were suspected clinically. The patients underwent hybrid PET/MRI examinations with morphological MRI, DWI and FDG-PET. Experienced readers blinded to clinical/histopathological data evaluated images according to established diagnostic criteria taking into account the complementarity of multiparametric information. The standard of reference was histopathology with whole-organ sections and follow-up ≥24 months. Statistical analysis considered data clustering.
Results
The proof of diagnosis was histology in 46/74 (62.2%) patients and follow-up (mean ± SD = 34 ± 8 months) in 28/74 (37.8%). Thirty-eight patients had 43 HNSCCs and 46 patients (10 with and 36 without tumours) had 62 benign lesions/complications. Sensitivity, specificity, and positive and negative predictive value of PET/DWIMRI were 97.4%, 91.7%, 92.5% and 97.1% per patient, and 93.0%, 93.5%, 90.9%, and 95.1% per lesion, respectively. Agreement between imaging-based and pathological T-stage was excellent (kappa = 0.84,
p
 < 0.001).
Conclusion
FDG-PET/DWIMRI yields excellent results for detection and T-classification of HNSCC after radio(chemo)therapy.
Key points
•
FDG-PET/DWIMRI yields excellent results for the detection of post-radio(chemo)therapy HNSCC recurrence.
•
Prospective one-centre study showed excellent agreement between imaging-based and pathological T-stage.
•
97.5% of positive concordant MRI, DWI and FDG-PET results correspond to recurrence.
•
87% of discordant MRI, DWI and FDG-PET results correspond to benign lesions.
•
Multiparametric FDG-PET/DWIMRI facilitates planning of salvage surgery in the irradiated neck.