Diffusion-weighted MRI in head and neck cancer
Robert Hermans and Vincent Vandecaveye
Department of Radiology, University Hospitals Leuven, Belgium
Corresponding author.
Corresponding address: Robert Hermans, MD, PhD, Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Accepted June 22, 2007.
Abstract
Diffusion-weighted magnetic resonance imaging (MRI) is an imaging technique showing molecular diffusion. Cell size, density and integrity influence the signal intensity seen on diffusion-weighted images. This technique is a helpful complementary tool to distinguish tumoral from non-tumoral tissue, and has several interesting applications in the evaluation of head and neck cancer.
Keywords: Diffusion-weighted magnetic resonance imaging, head and neck cancer
Hypercellular tissue, such as occurring within malignant tumours, will show low ADC values. Non-tumoral tissue changes such as oedema, inflammation, fibrosis, and necrosis are expected to show low cellularity, in strong contrast with viable tumour. This results in a high ADC. An inverse correlation between the ADC value and tumour cellularity in experimental models has been shown, and this has been clinically validated[3,4].
In the head and neck region, DWI may have several possible applications. The localisation and extent of primary squamous cell cancer, one of the most common types of malignant disease in this region, is usually well defined by CT or conventional MRI. However, the characterisation of neck lymph nodes remains a difficult issue with anatomy-based imaging methods, and DWI may be of particular value in this regard. Differentiation of treatment-induced tissue changes, especially after (chemo)radiotherapy, and persistent or recurrent cancer, is another area in which DWI may be very helpful. As DWI allows differentiation between inflammatory tissue and neoplastic tissue, another possible application could be the monitoring of tumour response during radiotherapy: this could have prognostic importance and possibly influence the management of the patient. Furthermore, DWI can also be used as a whole body imaging sequence, to exclude or confirm metastatic disease or a second primary tumour.
References
1. Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology. 1986;161:401–7. [PubMed]
2. Koh DM, Padhani AR. Diffusion-weighted MRI: a new functional clinical technique for tumour imaging. Br J Radiol. 2006;79:633–5. [PubMed]
3. Chenevert TL, Meyer CR, Moffat BA,, et al. Diffusion MRI: a new strategy for assessment of cancer therapeutic efficacy. Mol Imaging. 2002;1:336–43. [PubMed]
4. Ross BD, Moffat BA, Lawrence TS,, et al. Evaluation of cancer therapy using diffusion magnetic resonance imaging. Mol Cancer Ther. 2003;2:581–7. [PubMed]
5. Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van CM. Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med. 2004;22:275–82. [PubMed]
6. Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 2006;16:1468–77. [PubMed]
7. Sumi M, Sakihama N, Sumi T,, et al. Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol. 2003;24:1627–34. [PubMed]
8. Vandecaveye V, De Keyzer F, Vander Poorten V,, et al. Evaluation of the larynx for tumour recurrence by diffusion-weighted MRI after radiotherapy: initial experience in four cases. Br J Radiol. 2006;79:681–7. [PubMed]
9. Vandecaveye V, De Keyzer F, Nuyts S,, et al. 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. 2007;67:960–71. [PubMed]
10. Habermann CR, Gossrau P, Graessner J,, et al. Diffusion-weighted echo-planar MRI: a valuable tool for differentiating primary parotid gland tumors? Rofo. 2005;177:940–5. [PubMed]
11. Thoeny HC. Imaging of salivary gland tumours. Cancer Imaging. 2007;7:52–62. [PubMed]
12. Motoori K, Yamamoto S, Ueda T,, et al. Inter- and intratumoral variability in magnetic resonance imaging of pleomorphic adenoma: an attempt to interpret the variable magnetic resonance findings. J Comput Assist Tomogr. 2004;28:233–46. [PubMed]
Robert Hermans and Vincent Vandecaveye
Department of Radiology, University Hospitals Leuven, Belgium
Corresponding author.
Corresponding address: Robert Hermans, MD, PhD, Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Accepted June 22, 2007.
Abstract
Diffusion-weighted magnetic resonance imaging (MRI) is an imaging technique showing molecular diffusion. Cell size, density and integrity influence the signal intensity seen on diffusion-weighted images. This technique is a helpful complementary tool to distinguish tumoral from non-tumoral tissue, and has several interesting applications in the evaluation of head and neck cancer.
Keywords: Diffusion-weighted magnetic resonance imaging, head and neck cancer
Hypercellular tissue, such as occurring within malignant tumours, will show low ADC values. Non-tumoral tissue changes such as oedema, inflammation, fibrosis, and necrosis are expected to show low cellularity, in strong contrast with viable tumour. This results in a high ADC. An inverse correlation between the ADC value and tumour cellularity in experimental models has been shown, and this has been clinically validated[3,4].
In the head and neck region, DWI may have several possible applications. The localisation and extent of primary squamous cell cancer, one of the most common types of malignant disease in this region, is usually well defined by CT or conventional MRI. However, the characterisation of neck lymph nodes remains a difficult issue with anatomy-based imaging methods, and DWI may be of particular value in this regard. Differentiation of treatment-induced tissue changes, especially after (chemo)radiotherapy, and persistent or recurrent cancer, is another area in which DWI may be very helpful. As DWI allows differentiation between inflammatory tissue and neoplastic tissue, another possible application could be the monitoring of tumour response during radiotherapy: this could have prognostic importance and possibly influence the management of the patient. Furthermore, DWI can also be used as a whole body imaging sequence, to exclude or confirm metastatic disease or a second primary tumour.
References
1. Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology. 1986;161:401–7. [PubMed]
2. Koh DM, Padhani AR. Diffusion-weighted MRI: a new functional clinical technique for tumour imaging. Br J Radiol. 2006;79:633–5. [PubMed]
3. Chenevert TL, Meyer CR, Moffat BA,, et al. Diffusion MRI: a new strategy for assessment of cancer therapeutic efficacy. Mol Imaging. 2002;1:336–43. [PubMed]
4. Ross BD, Moffat BA, Lawrence TS,, et al. Evaluation of cancer therapy using diffusion magnetic resonance imaging. Mol Cancer Ther. 2003;2:581–7. [PubMed]
5. Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van CM. Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med. 2004;22:275–82. [PubMed]
6. Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 2006;16:1468–77. [PubMed]
7. Sumi M, Sakihama N, Sumi T,, et al. Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol. 2003;24:1627–34. [PubMed]
8. Vandecaveye V, De Keyzer F, Vander Poorten V,, et al. Evaluation of the larynx for tumour recurrence by diffusion-weighted MRI after radiotherapy: initial experience in four cases. Br J Radiol. 2006;79:681–7. [PubMed]
9. Vandecaveye V, De Keyzer F, Nuyts S,, et al. 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. 2007;67:960–71. [PubMed]
10. Habermann CR, Gossrau P, Graessner J,, et al. Diffusion-weighted echo-planar MRI: a valuable tool for differentiating primary parotid gland tumors? Rofo. 2005;177:940–5. [PubMed]
11. Thoeny HC. Imaging of salivary gland tumours. Cancer Imaging. 2007;7:52–62. [PubMed]
12. Motoori K, Yamamoto S, Ueda T,, et al. Inter- and intratumoral variability in magnetic resonance imaging of pleomorphic adenoma: an attempt to interpret the variable magnetic resonance findings. J Comput Assist Tomogr. 2004;28:233–46. [PubMed]
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