Filippo Crimì1, Daniele Borsetto2, Roberto Stramare1, Roberto Di Carlo3, Enzo Emauelli3, Piero Nicolai3, Carmelo Lacognata4, Pietro Zucchetta5, Giulia Oliveri3, Arcangelo Merola1, Valentina Bodanza5, Laura Albertoni6, Cristina Campi7, Diego Cecchin5. 1. Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy. 2. Guy's and St Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK. daniele.borsetto@gmail.com. 3. Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy. 4. Radiology Unit, University-Hospital of Padova, Padua, Italy. 5. Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy. 6. Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy. 7. Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy.
Abstract
OBJECTIVE: To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [18F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard. METHODS: We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [18F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [18F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard. RESULTS: Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%). CONCLUSIONS: Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.
OBJECTIVE: To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [18F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard. METHODS: We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [18F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [18F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard. RESULTS: Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%). CONCLUSIONS: Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.
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