Measurement variations of MRI and CT in the assessment of tumor depth of invasion in oral cancer: A retrospective study

Abstract

In oral squamous cell carcinoma (OSCC), depth of invasion (DOI) is an important predictive, prognostic, and staging parameter. While it is known that DOI can be estimated from preoperative imaging, an analysis of measurements variations according to imaging modality and to depth of tumor itself is lacking. The aim of the study was to assess the accuracy of imaging-based estimation of DOI in relation with the tumor histological DOI. Methods: We retrospectively reviewed 121 patients with OSCC treated at University Hospital Zurich. The radiologic DOI of CT, T1-weighted, and T2-weighted MRI were compared with histological DOI. Frequency of relevant imaging artifacts was assessed as well. Results: A total of 110 CT (90.9 %) and 90 MRI (74 %) were analyzed. Both modalities were available for 79 patients (65.3 %). The median histological depth of invasion was 9 mm (IQR 4.5-14). The median depth of invasion was 14 mm (IQR 10-20) on CT, 13 mm (IQR 8.25-18) on T1-weighted MRI, and 13 mm (IQR 9-18.75) on T2-weighted MRI. All diagnostic modalities tended towards an overestimation of the histopathologic DOI from about 5-15 %. This trend was most pronounced for thin tumors, for which both CT and MRI lead to upstaging in over 50 % of the cases. For 25 (22.7 %) patients, dental scattering on CT rendered DOI not estimable. For MRI, 18 patients (20 %) had artifacts (blooming, motion artifacts) rendering DOI not estimable. Conclusion:CT and MRI measurements of DOI in OSCC lead to an overestimation of histological DOI, especially in tumors with DOI<5 mm, with upstaging by imaging in over 50 % of the cases. Artifacts were present in more than 20 % of performed images.

Comparative study on efficacy and safety of ultrasound guided transoral and transcutaneous core needle biopsy in patients with oral masses

“…Several imaging modalities, including computed tomography (CT) and magnetic resonance imaging (MRI), have been used to analyze the oral lesions [ 8 ]. Each method has its unique advantages.…”

“…Each method has its unique advantages. However, the usage of them in the diagnosis of oral lesions are still limited [ 8 ]. CT scanning is usually inaccurate because of beam-hardening artifacts from dental fillings and implants [ 8 , 9 ].…”

“…However, the usage of them in the diagnosis of oral lesions are still limited [ 8 ]. CT scanning is usually inaccurate because of beam-hardening artifacts from dental fillings and implants [ 8 , 9 ]. MRI can reveal the dimensions of submucosal tumors accurately, but it cannot be available rapidly and need more examination time.…”

“…MRI can reveal the dimensions of submucosal tumors accurately, but it cannot be available rapidly and need more examination time. Moreover, MRI will lead to obvious motion artifacts [ 8 , 9 ]. Although standard incisional biopsy is the gold standard for diagnosing oral lesions, it has been limited in some malignant non-homogeneous oral lesions because inadequate specimens and false-negative pathological readings are frequently encountered [ 10 – 12 ].…”

Preoperative Prediction of the Aggressiveness of Oral Tongue Squamous Cell Carcinoma with Quantitative Parameters from Dual-Energy Computed Tomography

“…Moreover, different protocols, variabilities in analysis procedures, and image artifacts of functional MRI influence the accuracy and repeatability. Conventional CT can rely on morphological information to partially assess tumor extension ( 14 , 19 , 20 ) and lymph node metastasis ( 21 ). However, the morphologic criterion of cervical node metastasis in conventional CT cannot accurately assess the status of cervical nodes without sufficient specificity ( 21 ).…”