Article Figures & Data
Figures
- FIG 1.
Initial staging of a right maxillary squamous cell carcinoma in an 84-year-old woman. A, Axial T1-weighted spin-echo (SE) sequence. B, Axial T1-weighted fat-saturated sequence. C, Fusion between axial T1WSE sequence. C, 3D T1-weighted fat-saturated SE postcontrast sequence, axial plane. D, Fusion between axial T1-weighted SE sequence and 18F-FDG-PET. Both T1-weighted FDG-PET/MR imaging with and without gadolinium showed right hard palate invasion. The anterior tumor margin (arrow) was difficult to define on both contrast-free and postcontrast T1WI (B and D). PET imaging allowed clarification of the lesion margins (A and C).
- FIG 2.
Initial staging of right adenoid cystic carcinoma of a minor salivary gland (palate) in a 55-year-old man. A, Axial FDG-PET. B, Axial T2-weighted spin-echo (SE) sequence. C, Axial T1-weighted SE sequence. D, 3D T1-weighted fat-saturated SE postcontrast sequence. On both T1-weighted and T2-weighted MR imaging (B and C), thickening of the trigeminal nerve is present, with a loss of signal of the fatty tissue in the pterygopalatine fossa, strongly suggestive of perineural spread of the tumor. On the T1-weighted postgadolinium sequence (D), high enhancement of the trigeminal nerve is visible (arrow). There is no significant perineural 18F-FDG uptake (A); only slight uptake is discernable when guided by MR imaging findings.
- FIG 3.
Local extension of a mandibular gingiva tumor in a 71-year-old woman. A, Axial contrast-free T1-weighted. B, Axial 18F-FDG-PET image. C, 3D T1-weighted spin-echo (SE) contrast-enhanced sequence, axial plane. D, Fusion between axial T1-weighted and 18F-FDG-PET. Both contrast-free and gadolinium-enhanced T1W MR imaging showed right vestibular invasion. Although bone invasion remained doubtful because of dental artifacts on MR alone, high FDG uptake includes a portion of the mandibular bone with margins that are clearly visible on the fusion images between PET and T1-weighted MRI, demonstrating bone involvement (arrow), which was pathologically confirmed.
Tables
Total Number of Subjects (%) Number of Subjects with T1–T2 Lesions (%) Histologic type Squamous cell carcinoma 23 (77%) 8 (80%) Adenoid cystic carcinoma 4 (13%) 1 (10%) Adenocarcinoma 1 (3%) 1 (10%) Sarcoma 1 (3%) Melanoma metastasis 1 (3%) Tumor stage pT1 4 (13%) 4 (40%) pT2 6 (20%) 6 (60%) pT3 1 (3%) pT4 16 (53%) Lymph node stage pN0 12 (38%) pN1 5 (17%) pN2a 1 (3%) pN2b 6 (20%) pN2c 1 (3%) pN3 0 Initial tumor location Base of tongue 1 (3%) Tongue 6 (20%) 2 (20%) Floor of mouth 4 (13%) 3 (30%) Vestibule or lip 2 (7%) Maxillary 2 (7%) Palate 3 (10%) Mandibular 8 (27%) Amygdala 1 (3%) 3 (30%) Salivary glands 3 (10%) 2 (20%) Staging Initial diagnosis 23 (77%) 6 (60%) Recurrence 7 (23%) 4 (40%) First Raters Group Second Raters Group Contrast-Free Session Postgadolinium Session Contrast-Free Session Postgadolinium Session Region extension Se Sp Se Sp Se Sp Se Sp Median line involvement 0.67 0.96 0.67 0.95 0.83 0.95 0.83 0.95 Vascular extension 0 1 0 1 1 0.93 1 0.93 Mandibular cortical bone 0.9 0.95 0.9 0.95 0.9 0.95 0.9 0.95 Mandibular medullary bone 0.88 0.9 0.88 0.9 0.88 0.9 0.88 0.9 Intermaxillary commissure 1 0.91 1 0.86 1 0.95 1 0.89 Vestibule 0.92 1 0.92 1 0.92 1 0.92 1 Skin 0.67 1 1 1 0.67 0.92 0.67 1 Mobile tongue 0.8 1 0.8 1 0.67 1 0.67 1 Palatoglossal arch 0.67 1 0.33 1 1 0.96 0.67 1 Palatine tonsil 1 0.92 1 0.92 1 1 0.5 1 Floor of mouth 0.78 0.94 0.78 0.94 0.89 1 0.89 1 Submandibular glands 1 0.9 1 0.9 1 1 1 1 Soft palate 0.67 0.96 0.67 1 1 0.81 1 0.81 Hard palate 1 1 1 1 1 0.96 1 0.96 Maxillary bone 1 0.96 1 0.96 1 0.92 1 0.92 Maxillary sinus 1 0.96 1 0.96 1 0.96 1 0.96 Masseter muscle 1 0.96 1 0.96 1 0.96 1 1 Pterygoid muscles 1 0.89 1 0.92 1 0.88 1 0.88 Nasal fossa 1 1 1 1 0.5 0.96 1 0.96 Subarachnoid spaces 1 1 1 1 1 1 1 1 Parotid glands 0 1 1 1 1 1 0 1 Perineural extension (V) 1 1 1 1 1 0.96 1 0.96 Perineural extension (VII) 0 1 0.5 1 1 1 1 1 All locations 0.83 0.98 0.85 0.98 0.88 0.98 0.9 0.98 All locations T1-T2 0.79 0.99 0.79 0.99 0.79 0.98 0.89 0.98 Note:—Se indicates sensitivity; Sp, specificity.
