Diffusion-Weighted Imaging (DWI) derived from PET/MRI for lymph node assessment in patients with Head and Neck Squamous Cell Carcinoma (HNSCC)

Abstract

Background To determine the usefulness of Diffusion Weighted Imaging (DWI) derived from PET/MRI in discriminating normal from metastatic lymph nodes and the correlation between the metastatic lymph nodes with the grade and the localization of the primary tumor. Methods Retrospective study of 90 lymph nodes from 90 subjects; 65 patients who had proven histopathological metastatic lymph nodes from (HNSCC) who had undergone 18 F- PET/MRI for clinical staging and assessment and twenty-five lymph nodes were chosen from 25 healthy subjects. Apparent Diffusion Coefficient (ADC) map was generated from DWI with b values (0 and 800 s/mm 2 ). ADC values of the metastatic lymph nodes were calculated and compared to the normal lymph nodes ADC values, ROC was used to determine the best cut-off values to differentiate between the two group. Metastatic lymph nodes ADC mean values were compared to primary tumor grade and localization. Results ADCmean value of the metastatic lymph nodes in the overall sample (0.899 ± 0.98*10 − 3 mm 2 /sec) was significantly lower than the normal lymph nodes’ ADCmean value (1.267 ± 0.88*10 − 3 mm 2 /sec); ( P = 0.001). The area under the curve (AUC) was 98.3%, sensitivity and specificity were 92.3 and 98.6%, respectively, when using a threshold value of (1.138 ± 0.75*10 − 3 mm 2 /sec) to differentiate between both groups. Significant difference was found between metastatic lymph nodes (short-axis diameter < 10 mm), ADCmean (0.898 ± 0.72*10 − 3 mm 2 /sec), and the benign lymph nodes ADCmean, ( P = 0.001). No significant difference was found between ADCmean of the metastatic lymph nodes < 10 mm and the metastatic lymph nodes > 10 mm, ADCmean (0.899 ± 0.89*10 − 3 mm 2 /sec), ( P = 0.967). No significant differences were found between metastatic lymph nodes ADCmean values and different primary tumor grades or different primary tumor localization, ( P > 0.05). Conclusion DWI-ADC is an effective and efficient imaging technique in differentiating between normal and malignant lymph nodes, and might be helpful to discriminate sub-centimeters lymph nodes. Trial registration The trial is registered in clinical trials under ID: NCT04360993 , registration date: 17/04/2020.

Correlation between Tissue Cellularity and Metabolism Represented by Diffusion-Weighted Imaging (DWI) and 18F-FDG PET/MRI in Head and Neck Cancer (HNC)

“…The work strategy and procedure have been published elsewhere [11,12,21]. In brief, the examinations were conducted in a dedicated PET/MRI (3 T) equipment (Biograph mMR, Siemens AG, Erlangen, Germany).…”

“…PET/MRI parameters were also included (ADC, SUV, TLG, and MTV). MRI sequences were T2-weighted TSE turbo inversion recovery magnitude (TIRM) (TR/TE/TI 3300/37/220 ms, FOV: 240 mm, slice thickness: 3 mm, 224 × 320) coronal plan, T1-weighted turbo spin-echo (TSE) (TR/TE 800/12 ms, FOV: 200 mm, slice thickness: 4 mm, 224 × 320), and T1-weighted TSE Dixon fat suppression (FS) (TR/TE 6500/85 ms, FOV: 200 mm, slice thickness: 4 mm, 256 × 320) transversal and were acquired without an intravenous contrast agent [11,12,21].…”

“…All methods of image analysis were previously published [11,12,21]. In short, a fixed 2.5 threshold of SUV was used for tumor SUVmax for both MTV and TLG, as proposed by Pak et al [13].…”

How is neck dissection performed in Oral and Maxillofacial Surgery? Results of a representative nationwide survey among university and non-university hospitals in Germany

“…On the other hand, comparing CT/MRI vs. PET-CT scans, it was demonstrated that FDG-PET-CT is superior to CT/MRI imaging to detect occult neck metastases [ 9 ]. Heusch et al further illustrated that FDG-PET MRI scan combined with diffusion-weighted imaging (DWI) is not superior to ultrasound and FDG-PET-CT scans in the detection of cervical lymph node metastases [ 42 , 43 ]. In this survey, the most frequently used imaging technique for staging the head and neck in OSCC was CT, followed by ultrasound and MRI scans.…”

Apparent diffusion coefficient (ADC): A potential in vivo biological surrogate of the incidentally discovered bone lesions at 3T MRI

“…Beyond its original neuro-imaging applications, DW has been clinically exploited in oncologic and body imaging thanks to its simplicity, radiation-free nature, needless contrast administration, and convenience as well as outstanding sensitivity and specificity [6] , [20] , [21] . It has been clinically validated for screening of infiltrative primary and secondary osseous lesion as well as for assessing the response to chemotherapy using the whole body–diffusion weighted MR imaging (WB-DW MRI) [22] , [23] .…”