Journal Article

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

Combescure, Christophe, Becker, Minerva, Dulguerov, Nicolas, Delattre, Bénédicte M A, Rager, Olivier, Zaidi, Habib, Becker, Christoph D, Caparrotti, Francesca, Pusztaszeri, Marc, Katirtzidou, Eirini, Osman Ratib, Varoquaux, Arthur D, Dulguerov, Pavel, Burkhardt, Karim

2018

Overview

PurposeTo 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 methodsThis 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.ResultsThe 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).ConclusionFDG-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.

• Publisher: Springer Nature B.V
• Subject: Benign / Clustering / Complementarity / Complications / Data processing / Head & neck cancer / Histology / Histopathology / Hospitals / Lesions / Magnetic resonance imaging / Medical diagnosis / Medical imaging / Metabolism / Morphology / Otolaryngology / Patients / Positron emission / Positron emission tomography / Radiation / Radiation effects / Squamous cell carcinoma / Statistical analysis / Surgery / Therapy / Tumors