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Research ArticleHead and Neck Imaging
Open Access

T2-Weighted MR Imaging Early after Chemoradiotherapy to Evaluate Treatment Response in Head and Neck Squamous Cell Carcinoma

A.D. King, C.K. Keung, K.-H. Yu, F.K.F. Mo, K.S. Bhatia, D.K.W. Yeung, G.M.K. Tse, A.C. Vlantis and A.T. Ahuja
American Journal of Neuroradiology June 2013, 34 (6) 1237-1241; DOI: https://doi.org/10.3174/ajnr.A3378
A.D. King
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., C.K.K., K.S.B., D.K.W.Y., A.T.A.)
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C.K. Keung
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., C.K.K., K.S.B., D.K.W.Y., A.T.A.)
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K.-H. Yu
dState Key Laboratory in Oncology in South China (K.-H.Y., F.K.F.M.), The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong, China.
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F.K.F. Mo
dState Key Laboratory in Oncology in South China (K.-H.Y., F.K.F.M.), The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong, China.
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K.S. Bhatia
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., C.K.K., K.S.B., D.K.W.Y., A.T.A.)
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D.K.W. Yeung
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., C.K.K., K.S.B., D.K.W.Y., A.T.A.)
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G.M.K. Tse
bAnatomical and Cellular Pathology (G.M.K.T.)
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A.C. Vlantis
cOtorhinolaryngology, Head and Neck Surgery (A.C.V.)
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A.T. Ahuja
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., C.K.K., K.S.B., D.K.W.Y., A.T.A.)
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Abstract

BACKGROUND AND PURPOSE: T2-weighted MRI shows potential in early posttreatment assessment of the primary tumor. Residual masses composed entirely of low T2-signal scar tissue suggest local control and those ≥1 cm of similar signal to untreated tumor suggest local failure. The purpose of this study was to investigate the diagnostic accuracy of T2-weighted MR imaging early after chemoradiotherapy for identifying primary tumor treatment failure in squamous cell carcinoma of the head and neck.

MATERIALS AND METHODS: At 6 weeks after treatment, T2-weighted MR images of 37 primary tumors in 37 patients were assessed. Residual masses were divided into 3 patterns: pattern 1 = scar tissue only (flat-edged/retracted mass of low T2 signal intensity); pattern 2 = mass without features described in pattern 1 or 3; and pattern 3 = any pattern that included an expansile mass ≥1 cm of intermediate T2 signal intensity (similar grade of signal intensity to the untreated tumor). T2 patterns were analyzed for local outcome (Fisher exact test) and time to local failure (univariate and multivariate analysis of T2 pattern, age, T stage, and tumor size by use of the Cox regression model).

RESULTS: Residual masses after treatment were present in 34 (92%) of 37 patients. Local failures occurred in residual masses with pattern 1 in 0 (0%) of 14 patients; pattern 2 in 6 (55%) of 11 patients; and pattern 3 in 9 (100%) of 9 patients. Significant associations were found between local control and pattern 1 (P = <.0001; sensitivity, 74%; specificity, 100%; PPV, 100%; NPV, 75%; accuracy, 85%), and between local failure and pattern 3 (P = <.0001; sensitivity, 60%; specificity, 100%; PPV, 100%; NPV, 76%; accuracy, 82%). Pattern 2 showed no significant associations with local outcome. Univariate analysis of time to local failure showed that the T2 pattern was significant (P < .0001) and remained significant on multivariate analysis.

CONCLUSIONS: T2-weighted MR imaging is a potential tool for early posttreatment assessment of primary HNSCC treatment response. Awareness of correlation of the T2 pattern of any residual mass with treatment outcome at the primary site may contribute to patient treatment.

ABBREVIATIONS:

CI
confidence interval
CRT
chemoradiotherapy
HNSCC
head and neck squamous cell carcinoma
NPV
negative predictive value
PPV
positive predictive value
  • © 2013 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 34 (6)
American Journal of Neuroradiology
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A.D. King, C.K. Keung, K.-H. Yu, F.K.F. Mo, K.S. Bhatia, D.K.W. Yeung, G.M.K. Tse, A.C. Vlantis, A.T. Ahuja
T2-Weighted MR Imaging Early after Chemoradiotherapy to Evaluate Treatment Response in Head and Neck Squamous Cell Carcinoma
American Journal of Neuroradiology Jun 2013, 34 (6) 1237-1241; DOI: 10.3174/ajnr.A3378

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T2-Weighted MR Imaging Early after Chemoradiotherapy to Evaluate Treatment Response in Head and Neck Squamous Cell Carcinoma
A.D. King, C.K. Keung, K.-H. Yu, F.K.F. Mo, K.S. Bhatia, D.K.W. Yeung, G.M.K. Tse, A.C. Vlantis, A.T. Ahuja
American Journal of Neuroradiology Jun 2013, 34 (6) 1237-1241; DOI: 10.3174/ajnr.A3378
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