Head and neck malignant lymphoma and squamous cell carcinoma discernment, is DWI conclusive?

Abstract

Background Differentiation between head-and-neck malignant lymphoma and squamous cell carcinoma is crucial as their management is radically different, and this retrospective study aims at demonstrating the value of DWI-MRI for their discrimination. Forty-four patients with pathologically proved untreated head-and-neck ML and SCC (22 ML and 22 SCC) were included in the study, and they underwent conventional MRI imaging (T1WI and T2WI) with DW-MRIs at standard and high b-values with corresponding ADC maps which were generated along with a reference of the ADC values taken at the spinal cord and cerebrospinal fluid as an internal control. The sensitivity and specificity at the optimum cutoff point as well as the area under the receiver operating characteristic (ROC) curve were used for evaluation of diagnostic performance of DW-MRI at b 1000, b 1500, b 2000 s/mm2. Results The mean SCC ADC values were much higher than ML at standard (b 1000) and high b-values (b 1500 and b 2000). ROC curve analysis for the ADC values of SCC and ML at b 1000, b 1500 and b 2000 s/mm2 showed that the ADC cutoff values are > 0.83, > 0.75 and > 0.67 × 10−3 mm2/s, respectively, with diagnostic accuracy 95.5%. Conclusions As to sum up, we can safely say that we can fully rely on DWI MRI in differentiation between HNSCC and ML whether using standard or high b-values, as well as in discrimination of different histological grades of HNSCC as it revealed impressive results, which confer us to do without contrast in such cases.