Spectral CT Imaging of Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: Evaluation of Image Quality and Status of Lymph Nodes

Abstract

PurposeThe purpose of this study was to evaluate image quality and status of lymph nodes in laryngeal and hypopharyngeal squamous cell carcinoma (SCC) patients using spectral CT imaging.Materials and MethodsThirty-eight patients with laryngeal and hypopharyngeal SCCs were scanned with spectral CT mode in venous phase. The conventional 140-kVp polychromatic images and one hundred and one sets of monochromatic images were generated ranging from 40 keV to 140 keV. The mean optimal keV was calculated on the monochromatic images. The image quality of the mean optimal keV monochromatic images and polychromatic images was compared with two different methods including a quantitative analysis method and a qualitative analysis method. The HU curve slope (λHU) in the target lymph nodes and the primary lesion was calculated respectively. The ratio of λHU was studied between metastatic and non-metastatic lymph nodes group.ResultsA total of 38 primary lesions were included. The mean optimal keV was obtained at 55±1.77 keV on the monochromatic images. The image quality evaluated by two different methods including a quantitative analysis method and a qualitative analysis method was obviously increased on monochromatic images than polychromatic images (p<0.05). The ratio of λHU between metastatic and non-metastatic lymph nodes was significantly different in the venous phase images (p<0.05).ConclusionThe monochromatic images obtained with spectral CT can be used to improve the image quality of laryngeal and hypopharyngeal SCC and the N-staging accuracy. The quantitative ratio of λHU may be helpful for differentiating between metastatic and non-metastatic cervical lymph nodes.

The clinical diagnostic value of target biopsy using narrow‐band imaging endoscopy and accurate laryngeal carcinoma pathologic specimen acquisition

“…Computerized tomography and laryngoscopy are the main laryngeal cancer diagnostic and staging modalities. Computerized tomography clearly reveals the anatomic relationship between the tumour and surrounding normal tissues, as well as lymph node metastasis . With NBI laryngoscopy, typical lesions can be acquired according to IPCL morphology, and different laryngeal diseases, including carcinomas, benign tumours, polyps and inflammation, can be identified .…”

“…However, serum marker examination is not the first option because of the long diagnostic period for laryngeal carcinoma. Imaging examinations, including magnetic resonance imaging (MRI) and computerized tomography (CT), provide the best opportunity to determine the tumour range, the anatomical relationship between the tumour and surrounding normal tissues, and the presence or absence of lymph node metastasis . However, CT and MRI cannot detect early‐stage laryngeal carcinoma.…”

Management of clinically negative nodes (N0) in supraglottic laryngeal carcinoma: A systematic review

“…Besides, the current clinical examination method has limitations, which are the main reasons of treatment failure (Parmar et al, 1998). Ji et al (2001) and Li et al (2013) found that cN0 cervical lymph nodes in supraglottic carcinoma metastasis were mainly located in areas II, III, IV, which accounted for 96% of cases, and areas I and IV were rarely involved. In 1999, the Brazilian Head and Neck Cancer Group published the results of a randomized study of 132 cases of selective neck dissection vs modified radical neck dissection in the management of cN0 supraglottic and transglottic carcinomas, which showed that the two groups' cervical lymph node metastasis rates were 4.8 and 2.5%, respectively.…”

Differentiation of malignant cervical lymphadenopathy by dual-energy CT: a preliminary analysis

“…Dual-energy computed tomography (DECT) with the latest gemstone detector allows for reconstruction of virtual monochromatic images and material decomposition images 8 9 10 11 12 and provides multiple quantitative parameters that have been used for the diagnosis of lymph node metastasis for several types of tumours 12 13 14 15 . However, to our knowledge, the value of DECT for the preoperative diagnosis of cervical nodal metastasis in patients with different malignant carcinomas has not been well evaluated.…”