Are Gadolinium-Enhanced MR Sequences Needed in Simultaneous 18F-FDG-PET/MRI for Tumor Delineation in Head and Neck Cancer?

Editor’s Choice

Consecutive patients who underwent simultaneous head and neck 18F-FDG-PET/MR imaging staging or restaging followed by surgery were retrospectively included in this study. Local tumor invasion and lymph node extension were assessed by 2 rater groups in 45 head and neck anatomic regions using 18F-FDG-PET/MR imaging. Two reading sessions were performed, one without contrast-enhanced sequences (using only T1WI, T2WI, and PET images) and a second with additional T1-weighted postcontrast sequences. The k concordance coefficient between the reading sessions and sensitivity and specificity for each region were calculated. There was excellent agreement between the contrast-free and postgadolinium reading sessions in delineating precise tumor extension in the 45 anatomic regions studied. The diagnostic accuracy did not differ between contrast-free and postgadolinium reading sessions, being 0.97 for both groups and both reading sessions. The authors conclude that gadolinium-based contrast administration showed no added value for accurate characterization of head and neck primary tumor extension and could possibly be avoided in the PET/MR imaging head and neck workflow.

Abstract

BACKGROUND AND PURPOSE

Figure 1 from Pyatigorskaya et al
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).

PET/MRI with 18F-FDG has demonstrated the advantages of simultaneous PET and MR imaging in head and neck cancer imaging, MRI allowing excellent soft-tissue contrast, while PET provides metabolic information. The aim of this study was to evaluate the added value of gadolinium contrast–enhanced sequences in the tumor delineation of head and neck cancers on 18F-FDG-PET/MR imaging.

MATERIALS AND METHODS

Consecutive patients who underwent simultaneous head and neck 18F-FDG-PET/MR imaging staging or restaging followed by surgery were retrospectively included. Local tumor invasion and lymph node extension were assessed in 45 head and neck anatomic regions using 18F-FDG-PET/MR imaging by 2 rater groups (each one including a radiologist and a nuclear medicine physician). Two reading sessions were performed, one without contrast-enhanced sequences (using only T1WI, T2WI, and PET images) and a second with additional T1WI postcontrast sequences. The results were compared with the detailed histopathologic analysis, used as reference standard. The κ concordance coefficient between the reading sessions and sensitivity and specificity for each region were calculated.

RESULTS

Thirty patients were included. There was excellent agreement between the contrast-free and postgadolinium reading sessions in delineating precise tumor extension in the 45 anatomic regions studied (Cohen κ = 0.96, 95% CI = [0.94–0.97], P < .001). The diagnostic accuracy did not differ between contrast-free and postgadolinium reading sessions, being 0.97 for both groups and both reading sessions. For the 2 rater groups, there was good sensitivity for both contrast-free (0.83 and 0.85) and postgadolinium reading sessions (0.88 and 0.90, respectively). Moreover, there was excellent specificity (0.98) for both groups and reading sessions.

CONCLUSIONS

Gadolinium chelate contrast administration showed no added value for accurate characterization of head and neck primary tumor extension and could possibly be avoided in the PET/MR imaging head and neck workflow.

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Are Gadolinium-Enhanced MR Sequences Needed in Simultaneous 18F-FDG-PET/MRI for Tumor Delineation in Head and Neck Cancer?
Jeffrey Ross
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