Background: Diffusion-weighted magnetic resonance imaging (DW-MRI) has the ability of tissue characterization and can differentiate between benign and malignant tissues, including differentiation between benign post-radiotherapy changes and residual or recurrent malignancy.
Objective: This study aimed to assess the role of diffusion-weighted magnetic resonance imaging in the evaluation of laryngeal and hypopharyngeal cancer as an initial diagnosis and the post-treatment surveillance protocol.
Patients and methods: This study was a cross-sectional analytical study including twenty-five patients who presented with laryngeal or hypopharyngeal masses, thirteen cases were pretreatment cases, and twelve cases were post-treatment cases after completion of treatment. Seven cases had a hypopharyngeal origin, and eighteen cases had a laryngeal origin. The patients were assessed using history taking, a telescopic examination of the larynx and hypopharynx, computed tomography scanning, and diffusion-weighted magnetic resonance imaging on the neck. Direct laryngoscopic examination and biopsy taking from suspicious lesions were done. Biopsies were subjected to histopathological examination with a correlation between pathological and DW- MRI radiological results.
Results: DW-MRI had a 100% sensitivity, 82.4 % specificity, and 88% accuracy compared to histopathological findings of biopsies from the studied group. There was a non-significant difference between DW-MRI and biopsy findings for either pretreatment or post-treatment cases of both laryngeal and hypopharyngeal origin of the lesions (p-value > 0.05 for all).
Conclusion: DW-MRI is a sensitive tool for detecting laryngeal and hypopharyngeal cancers in new cases and excluding tumor residual after chemo-radiotherapy in cases with suspicious lesions after completion of treatment.

https://ejhm.journals.ekb.eg/article_168261_12ec2216ee42901a9fff2da5b62eb842.pdf

Role of Diffusion-Weighted Magnetic Resonance Imaging in Laryngeal and Hypopharyngeal Cancer in Comparison to Histopathological Finding

Background: The diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) map and the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) constitute the functional MRI technique with many oncological applications as it can define tissue microstructure and characterize the post-treatment changes from a recurrent tumor in treated head and neck squamous cell carcinoma (HNSCC). Objective: To evaluate the role of the DWI, ADC map and DCE-MRI for characterization of post-treatment changes and recurrent tumors in patients with treated HNSCC. Patients and Methods: Forty-five patients with treated HNSCC were included in this study with mean ages of 59 ± 7.5 years. The patients underwent pre and post-contrast head and neck MRI, DWI with ADC map and DCE-MRI, each study diagnosis was then compared to the patient outcome. Results: The sensitivity and specificity of the qualitative DWI (DW-MRI) (87.5% and 82.8% respectively) were higher than the conventional MRI (75% and 75.9% respectively). The ADC cut-off point for the diagnosis of HNSCC recurrence was 1.095 x10-3 mm2/s with sensitivity and specificity of 87.5%, 86.2% respectively. The DCE- MRI revealed a significant difference in the type of time intensity curve (TIC) between post-treatment changes and recurrent lesion (p-value < 0.0001). Conclusion: The DWI, ADC and the DCE-MRI can be used as a synchronized tool for the differentiation between post-treatment changes and recurrent tumor in treated HNSCC patients.

https://ejhm.journals.ekb.eg/article_137142_afaa182ab049a983b2f088a29ca7dff6.pdf

The Role of Functional MRI in The Evaluation of The Treated Head and Neck Squamous Cell Carcinoma

Abstract Head and neck cancer management requires multidisciplinary approach in which radical surgery with or without flap reconstructions and neck dissection, along with radiotherapy (RT)/chemoradiotherapy (CRT) serve as the key components. Neoadjuvant chemotherapy (NACT) and immunotherapy are used in selected cases based on the institutional preference. Knowledge of expected posttreatment changes on imaging is essential to differentiate it from recurrence. In addition, awareness of various posttreatment complications is imperative for their early detection on imaging. Distorted anatomy after treatment poses diagnostic challenge, hence, proper choice of imaging modality and appropriate timing of scan is pertinent for accurate posttreatment evaluation. In this article, we have provided a comprehensive review on expected imaging appearances post RT/CRT and after major types of head and neck squamous cell carcinoma (HNSCC) surgeries. In addition, we have extensively reviewed the imaging appearances of various posttreatment complications, and recurrences at the primary and lymph nodal sites. We have also delved into the patterns of recurrence in human papillomavirus (HPV) positive HNSCC in this article. Furthermore, we have provided flowcharts and discussed recommendations on the site-specific and treatment related imaging modalities to be used along with their appropriate timing, for adequate evaluation of HNSCC after treatment. We have also reviewed posttreatment reporting of imaging findings using Neck Imaging Reporting and Data Systems (NIRADS) and Hopkins criteria. In addition, we have also touched upon the role of advanced imaging techniques for posttreatment HNSCC evaluation. 

Comprehensive Review of Post-treatment Imaging in Head and Neck Cancers: From expected to unexpected and beyond

Differentiating Post-treatment Changes from Tumor Recurrence in the Oral Cavity and Oropharynx

The aim of this prospective cohort study is to substantiate the added value of diffusion-weighted magnetic resonance imaging (DW-MRI) over conventional MRI assessment in the differentiation between locoregional recurrence/residual tumour and post-treatment benign changes in patients with non-lymphoid head and neck malignancies. Thirty adult patients, each with a suspicious lesion on post-treatment imaging scans at the primary site of a previously treated non-lymphoid head and neck malignancy, were evaluated by MRI and diffusion-weighted imaging (DWI). The apparent diffusion coefficient (ADC) values of the lesions were calculated. Diffusion-weighted MRI yielded an accuracy of 90%, a sensitivity of 88.9%, a specificity of 91.7%, a positive predictive value of 94.1% and a negative predictive value of 84.6%. The mean ADC value of the lesions was lower in the “locoregional recurrence/residual tumour” group (1.08 × 10−3 mm2/s) compared to the “post-treatment benign changes” group (1.95 × 10−3 mm2/s); P < 0.001. An ADC cutoff value of 1.43 × 10−3 mm2/s achieved the same accuracy as the visual assessment by DW-MRI. Incorporating the DWI sequence into the post-treatment imaging assessment protocol brings a substantial added value to conventional MRI assessment in patients with non-lymphoid head and neck malignancies. This valuable merit of DW-MRI can help avoid or, at least, largely minimize unnecessary or unfeasible tissue sampling. An ADC cutoff value of 1.43 × 10−3 mm2/s can also be utilized to aid in the assessment process.

/pdf/post-treatment-benign-changes-versus-recurrence-in-non-5c8ylih4jt.pdf

Post-treatment benign changes versus recurrence in non-lymphoid head and neck malignancies: can diffusion-weighted magnetic resonance imaging end up the diagnostic challenge?

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Post-treatment benign changes versus recurrence in non-lymphoid head and neck malignancies: can diffusion-weighted magnetic resonance imaging end up the diagnostic challenge?