Comparison of diffusion-weighted MR imaging and 18F Fluorodeoxyglucose PET/CT in detection of residual or recurrent tumors and delineation of their local spread after (chemo) radiotherapy for head and neck squamous cell carcinoma

Abstract

To compare the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) and fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) in detection of residual or recurrent tumors and their local extension in patients with head and neck squamous cell carcinoma after treatment with (chemo) radiotherapy (CRT). Method: Twenty-five patients (17 men, 8 women, median age 64 years, range 49-79) who underwent surgical salvage for residual or recurrent tumors after CRT were included. The histopathologic analysis after the surgical salvage served as the gold standard. Results: Both DW-MRI and 18 F-FDG PET/CT had a sensitivity of 92 % (23/25) in the detection of residual or recurrent tumors. MRI had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting perineural spread of 62 % (5/8), 88 % (15/17), 71 % (5/7) and 83 % (15/18), respectively; in comparison, PET/CT did not detect any cases of perineural spread. The sensitivity, specificity, PPV and NPV of MRI in detecting muscle infiltration was 75 % (9/12), 77 % (10/13), 75 % (9/12) and 77 % (10/13) respectively, while the values for 18 F-FDG PET/CT were 58 % (7/12), 69 % (9/13), 64 % (7/11) and 64 % (9/14). Conclusions: DW-MRI-and 18 F-FDG PET/CT-imaging have an identical detection rate of residual or recurrent tumors after (chemo) radiotherapy. MRI has a higher sensitivity in detecting local perineural spread, has a better accuracy in the detection of muscle infiltration and more accurately correlates the lesion size to the histopathologic specimen.

Does PET scan have any role in the diagnosis of perineural spread associated with the head and neck tumors?

“…2020 16 Park et al 2020 17 Sarma et al 2021 18 Linz et al 2021 19 Type of study and p-value of 0.0013. We obtained the pooled sensitivity of 91.7%, pooled specificity of 92.35%, positive predictive value (PPV) of 92.27%, negative predictive value (NPV) of 91.13%, the positive likelihood ratio of 7.45, negative likelihood ratio of 0.28, disease prevalence of 95.8%, and accuracy of 91.5%, as reported in Table 3.…”

“…Demographic summary of the patients and event data of the included studies are summarized in Table 1. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Two authors (XN and JZ) scanned the relevant sources for related studies separately. Mainly, the full-texts articles of the sources were collected, and abstracts were used to obtain sufficient information for the meta-analysis.…”

“…Among these, the use of 18 F-FDG PET (PET with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG)) is highly recommended in various studies due to its high sensitivity for detecting perineural spread and recurrent metastatic tumors. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] For example, Schroeder et al reported that MRI and 18 F-FDG PET have identical detection rates of recurrent metastatic tumors. 16 Similarly, Lee et al reported that the application of 18 F-FDG PET in clinical diagnosis could enhance the tumor detection rate in head and neck cancers.…”

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] For example, Schroeder et al reported that MRI and 18 F-FDG PET have identical detection rates of recurrent metastatic tumors. 16 Similarly, Lee et al reported that the application of 18 F-FDG PET in clinical diagnosis could enhance the tumor detection rate in head and neck cancers. 20 In contrast to these studies, Hanna et al concluded that MRI has higher sensitivity and specificity for perineural spread and malignant tumor detection.…”

Perineural spread in head and neck malignancies: imaging findings - an updated literature review

“…Furthermore, Baulch et al in a study about 3T MRI evaluation of large nerves PNS determined a sensitivity of 95% and a specificity of 84% for the 3T MRI [ 33 ]. In a recent study, Schroeder et al concluded that 1.5 T MRI has a sensitivity of 62% and a specificity of 88%, for detecting PNS in a cohort of patients with H and N SCCa [ 42 ].…”