Radiotherapy-induced changes in the soft tissues of the neck hamper the early detection of persistent or recurrent tumour by clinical examination and imaging procedures. Diffusion-weighted (DW) MRI is a non-invasive technique capable of probing tissue properties by measuring the movement of water. The purpose of the ongoing study is to examine the usefulness of DW-MRI for differentiation of persistent or recurrent tumour from post-radiotherapeutic sequelae or complications. Four patients, suspected of tumour recurrence after radiotherapy for laryngeal squamous cell carcinoma, were examined using a DW-MRI sequence on a clinical 1.5 T MR system prior to surgery. In two patients, the DW-MRI images showed an asymmetric hyperintense lesion on b1000 images with low apparent diffusion coefficient (ADC)-value, compatible with tumour on histopathology. All surrounding tissue presented high ADC values and absent signal on the b1000 images, histopathologically correlating to post-radiotherapeutic changes. The images of the third and fourth patient showed absent or minimal symmetric hyperintensity of the laryngeal soft tissues on the b1000 images and high ADC-values. In these cases, the histopathological diagnosis of radionecrosis was made and no tumour was found. In all four cases, differentiation of tumoral tissue from radiotherapy-induced tissue alterations was possible with DW-MRI.
The case of a 49-year-old transgender individual with a history of bilateral silicone breast implants and a right lung mass proven by biopsy to be a non-small cell lung cancer is presented. In addition to the primary malignancy, a positron emission tomography/computed tomography scan showed contralateral hypermetabolic adenopathy in the left axilla that was suggestive of nodal metastatic disease. Additional imaging and histological examination of the lymph nodes indicated silicone breast implant leakage and silicone adenitis as the underlying cause of the hypermetabolic axillary lymph node.
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