Pilot Study of Diffusion-Weighted MRI Technique in Head and Neck Cancer Patients with Clinically N0 Neck

Abstract

Abstract:
Introduction: At present, radiology such as CT or MRI play a major role for detection of metastasis lymph node in head and neck cancer patients. Conventional MRI provides excellent anatomical information and Diffusion weighted imaging (DWI) technique of MRI provide biophysical mechanism based on the microscopic random translational motion of water molecules in biological tissues. There is no study about efficacy of DWI MRI in detection of pathologic lymph node of head and neck cancer patients with clinically N0. Objective: To study the efficacy of DWI MRI compare conventional MRI in detection of pathologic lymph node of head and neck cancer patients with clinically N0. Methodology: Thirteen patients diagnosed with head and neck cancer with clinically N0 in Phramongkutklao Hospital having preoperative conventional MRI and DWI MRI with subsequent pathologic proved by neck dissection (20 neck dissections). Then first analysis DWI MRI and pathological result from neck dissection. After that about 4-6 week we re-analysis of previously conventional MRI and measure of correlation between DWI MRI and conventional MRI. Result: All patients are squamous cell carcinoma (SCCA). Mean age are 61.6 year, 77% (10/13) are male, 23% (3/13) are female, 46% (6/13) are oral cancer, 46% (6/13) are laryngeal cancer, and 8% (1/13) are oropharyngeal cancer. Mean duration time from MRI to surgery is 13.4 days and total number of neck dissection is 20 necks. DWI MRI revealed 80% sensitivity, 90% specificity, 85% PPV, 81.81% NPV and 85% accuracy better than conventional MRI revealed 70% sensitivity, 80% specificity, 77% PPV, 72.72% NPV and 75% accuracy. DWI MRI can detect pathologic lymph node size average 1.1 cm. MRI and DWI MRI has same efficacy for detection of pathologic lymph node (kappa coefficient 0.69, p 0.0008). Conclusion: DWI MRI provide high specificity and efficacy more than conventional MRI to define and diagnosis pathologic lymph node in clinically N0 neck of head and neck cancer patient but statistic not significant.