Abstract
In the head and neck, squamous cell carcinoma is one of the most common tumour types. Currently, the primary imaging modalities for initial locoregional staging are computed tomography and—to a lesser extent—magnetic resonance imaging, whilst [18F]fluorodeoxyglucose (FDG) positron emission tomography has additional value in the detection of subcentimetric metastatic lymph nodes and of tumour recurrence after chemoradiotherapy (CRT). However, dependency on the morphological and size-related criteria of anatomical imaging and the limited spatial resolution and FDG avidity of inflammation in metabolic imaging may reduce diagnostic accuracy in the head and neck. Diffusion-weighted magnetic resonance imaging (DWI) is a noninvasive imaging technique that measures the differences in water mobility in different tissue microstructures. Water mobility is likely influenced by cell size, density, and cellular membrane integrity and is quantified by means of the apparent diffusion coefficient. As such, the technique is able to differentiate tumoural tissue from normal tissue, inflammatory tissue and necrosis. In this article, we examine the use of DWI in head and neck cancer, focussing on technique optimization and image interpretation. Afterwards, the value of DWI will be outlined for clinical questions regarding nodal staging, lesion characterization, differentiation of post-CRT tumour recurrence from necrosis and inflammation, and predictive imaging towards treatment outcome. The possible consequences of adding DWI towards therapeutic management are outlined.
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Ang KK, Harris J, Garden AS et al (2005) Concomitant boost radiation plus concurrent cisplatinum for advanced head and neck carcinomas: radiation Therapy Oncology Group phase II trial 99-14. J Clin Oncol 23:3008–3015
Kaanders JH, Pop LA, Marres HA et al (2002) ARCON: experience in 215 patients with advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 52:769–778
El-Deiry M, Funk GF, Nalwa S et al (2005) Long-term quality of life for surgical and nonsurgical treatment of head and neck cancer. Arch Otolaryngol Head Neck Surg 13:879–885
Castelijns JA, van den Brekel MW (2002) Imaging of lymphadenopathy in the neck. Eur Radiol 12:727–738
Zbären P, Caversaccio M, Thoeny HC, Nuyens M, Curschmann J, Stauffer E (2006) Radionecrosis or tumor recurrence after radiation of laryngeal and hypopharyngeal carcinomas. Otolaryngol Head Neck Surg 135:838–843
Ng SH, Yen TC, Chang JT et al (2006) Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol 24:4371–4376
McCollum AD, Burrell SC, Haddad RI et al (2004) Positron emission tomography with 18F-fluorodeoxyglucose to predict pathologic response after induction chemotherapy and definitive chemoradiotherapy in head and neck cancer. Head Neck 26:890–896
Ross BD, Moffat A, Lawrence TS et al (2003) Evaluation of cancer therapy using diffusion magnetic resonance imaging. Mol Cancer 2:581–587
Yoshikawa K, Nakata Y, Yamada K, Nakagawa M (2004) Early pathological changes in the parkinsonian brain demonstrated by diffusion tensor MRI. J Neurol Neurosurg Psychiatry 75:481–484
Eastwood JD, Lev MH, Wintermark M et al (2003) Correlation of early dynamic CT perfusion imaging with whole-brain MR diffusion and perfusion imaging in acute hemispheric stroke. Am J Neuroradiol 24:1869–1875
Wang J, Takashima S, Takayama F et al (2001) Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging. Radiology 220:621–630
Le Bihan D, Breton E, Lallemand D, Aubin ML et al (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168:497–505
Melhem ER, Itoh R, Jones L et al (2000) Diffusion tensor imaging of the brain: effect of diffusion weighting on trace and anisotropy measurements. Am J Neuroradiol 21:1813–1820
Thoeny HC, De Keyzer F, Vandecaveye V et al (2005) Effect of vascular targeting agent in rat tumor model: dynamic contrast-enhanced versus diffusion-weighted MR imaging. Radiology 237:492–499
Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. Am J Neuroradiol 188:1622–1635
Vandecaveye V, De Keyzer F, Hermans R (2008) Diffusion-weighted magnetic resonance imaging in neck lymph adenopathy. Cancer Imaging 30:173–180
De Foer B, Vercruysse JP, Bernaerts A et al (2008) Detection of postoperative residual cholesteatoma with non-echo-planar diffusion-weighted magnetic resonance imaging. Otol Neurotol 29:513–517
Srinivasan A, Dvorak R, Perni K, Rohrer S, Mukherji SK (2008) Differentiation of benign and malignant pathology in the head and neck using 3 T apparent diffusion coefficient values: early experience. Am J Neuroradiol 29:40–44
Padhani AR, Liu G, Koh DM et al (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11:102–125
Sun X, Wang H, Chen F et al (2009) Diffusion-weighted MRI of hepatic tumor in rats: comparison between in vivo and postmortem imaging acquisitions. J Magn Reson Imaging 29:621–628
Roth Y, Tichler T, Kostenich G et al (2004) High-b-value diffusion-weighted MR-imaging for pre-treatment prediction and early monitoring of tumor response to therapy in mice. Radiology 232:685–692
Le Bihan D, Breton E, Lallemand D et al (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168:497–505
Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282
Vandecaveye V, De Keyzer F, Nuyts S et al (2007) Detection of head and neck squamous cell carcinoma with diffusion weighted MRI after (chemo)radiotherapy: correlation between radiologic and histopathologic findings. Int J Radiat Oncol Biol Phys 67:960–971
Vandecaveye V, Dirix P, De Keyzer F et al (2010) Predictive value of diffusion-weighted magnetic resonance imaging during chemoradiotherapy for head and neck squamous cell carcinoma. Eur Radiol 20:1703–1714
Sibon I, Ménégon P, Orgogozo JM et al (2009) Inter- and intraobserver reliability of five MRI sequences in the evaluation of the final volume of cerebral infarct. J Magn Reson Imaging 29:1280–1284
De Bondt RB, Hoeberigs MC, Nelemans PJ et al (2009) Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma. Neuroradiology 51:183–192
Vandecaveye V, De Keyzer F, Vander Poorten V et al (2009) Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology 251:134–146
Perrone A, Guerrisi L, Izzo L, et al (2009) Diffusion-weighted MRI in cervical lymph nodes: Differentiation between benign and malignant lesions. Eur J Radiol. doi:10.1016/j.ejrad.2009.07.039
Holzapfel K, Duetsch S, Fauser C, Eiber M, Rummeny EJ, Gaa J (2009) Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol 72:381–387
Kim S, Loevner L, Ouon H et al (2009) Diffusion-weighted magnetic resonance imaging for predicting and detecting early response to chemoradiation therapy of squamous cell carcinomas of the head and neck. Clin Cancer Res 15:986–994
Abdel Razek AA, Kandeel AY, Soliman N et al (2007) Role of diffusion-weighted echo-planar MR imaging in differentiation of residual or recurrent head and neck tumors and posttreatment changes. Am J Neuroradiol 28:1146–1152
King AD, Ahuja AT, Yeung DK et al (2007) Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MR imaging. Radiology 245:806–813
Razek A, Soliman N, Elkhamary S, Alsharaway M, Tawfik A (2006) Role of diffusion-weighted MR imaging in cervical adenopathy. Eur Radiol 16:1468–1477
Sumi M, van Sakihama N, Sumi T et al (2003) Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. Am J Neuroradiol 24:1627–1634
Maeda M, Kato H, Sakuma H, Maier SE, Takeda K (2005) Usefulness of the apparent diffusion coefficient in line scan diffusion-weighted imaging for distinguishing between squamous cell carcinomas and malignant lymphomas of the head and neck. Am J Neuroradiol 26:1186–1192
Sumi M, Van Cauteren M, Nakamura T (2006) MR microimaginig of benign and malignant nodes in the neck. Am J Roentgenol 186:749–757
King AD, Tse GM, Ahuja AT et al (2004) Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging and US. Radiology 230:720–726
Muenzel D, Duetsch S, Fauser C et al (2009) Diffusion-weighted magnetic resonance imaging in cervical lymphadenopathy: report of three cases of patients with Bartonella henselae infection mimicking malignant disease. Acta Radiol 50:914–916
Suoglo Y, Erdamar B, Katircioglu OS, Karatay MC, Sunay T (2002) Extracapsular spread in ipsilateral and contralateral neck metastases in laryngeal cancer. Ann Otol Rhinol Laryngol 111:447–454
Capote A, Escorial V, Munoz-Guerra MF, Rodriguez-Campo FJ, Gamallo C, Vanal L (2007) Elective neck dissection in early stage oral squamous cell carcinoma—does it influence recurrence and survival? Head Neck 29:3–11
Dirix P, Vandecaveye V, De Keyzer F et al (2009) Diffusion-weighted MRI for nodal staging of head and neck squamous cell carcinoma: impact on radiotherapy planning. Int J Radiat Oncol Biol Phys 76:761–766
Gregoire V, Coche E, Cosnard G, Hamoir M, Reychler H (2000) Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience. Radiother Oncol 56:135–150
Kagei K, Shirato H, Nishioka T et al (2000) Ipsilateral irradiation for carcinomas of tonsillar region and soft palate based on computed tomographic simulation. Radiother Oncol 54:117–121
Bussels B, Maes A, Hermans R, Nuyts S, Weltens C, Van den Bogaert W (2004) Recurrences after conformal parotid-sparing radiotherapy for head and neck cancer. Radiother Oncol 72:119–127
Kato H, Kanematsu M, Tanaka O et al (2009) Head and neck squamous cell carcinoma: usefulness of diffusion-weighted MR imaging in the prediction of a neoadjuvant therapeutic effect. Eur Radiol 19:103–109
Galbán CJ, Mukherji SK, Chenevert TL et al (2009) A feasibility study of parametric response map analysis of diffusion-weighted magnetic resonance imaging scans of head and neck cancer patients for providing early detection of therapeutic efficacy. Transl Oncol 18:184–190
Brizel DM, Prosnitz RG, Hunter S et al (2004) Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 58:1418–1423
Machtay M, Moughan J, Trotti A et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26:2582–2589
Yom SS, Machtay M, Biel MA et al (2005) Survival impact of planned restaging and early surgical salvage following definitive chemoradiation for locally advanced squamous cell carcinomas of the oropharynx and hypopharynx. Am J Clin Oncol 28:385–392
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Vandecaveye, V., De Keyzer, F., Dirix, P. et al. Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology 52, 773–784 (2010). https://doi.org/10.1007/s00234-010-0743-0
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DOI: https://doi.org/10.1007/s00234-010-0743-0