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Head-neck primary tumor visualization and staging

Case Study
Vandecaveye, Vincent, M.D., Ph.D. University Hospitals Leuven • Belgium
De Keyzer, Frederik, M.Sc. University hospitals Leuven • Belgium

Patient history

A patient with right-sided glottis cancer showed cystic metastatic adenopathy in right neck (level II). As this is an unusual presentation for glottic cancer, the patient was referred for MRI with DWI to asses a possible second suspicious lesion.  The exam was done at University Hospitals Leuven.

MR examination

Ingenia 3.0T was used with the dSHeadNeck coil solution.

Our routine head-neck tumor protocol was used covering the entire head and neck from skull base to thoracic inlet. It includes:

Pre-contrast T2- and T1-weighted in transverse orientation;
STIR-DWI b1000 for primary tumor visualization;
SPAIR-DWI with 6 b-values ranging from b0 to b1000 for nodal staging using ADC;
Post-contrast 4D-THRIVE and transverse T1-weighted TSE (coronal and/or sagittal depending on lesion location and clinical need).

ExamCard used:

Images

 T2W T2W
T2W
T2W
 4D-THRIVE T1W TSE DWI b1000
4D-THRIVE
T1W TSE
DWI b1000


The first T2-weighted image shows the right glottis cancer.
The second T2-weighted image shows the cystic adenopathy in the right neck (level II).

No apparent abnormalities are seen in the right tonsil on post-contrast 4D-THRIVE and T1W TSE, but DWI shows a hyperintense lesion in the right tonsil. This lesion was not visible on CT and PET/CT.
Histopathology proved this to be a second primary tumor.

Diagnosis

The patient has right-sided glottis cancer, incidental finding of cystic metastatic adenopathy in the right neck, level II. There is a second primary tumor in the right tonsil.

Clinical impact of Ingenia 3.0T imaging

Ingenia 3.0T has excellent field homogeneity and high SNR that benefit DWI. It also provides the ability to scan the entire head and neck with large coverage in acceptable scanning time.  
Compared to our 1.5T it offers larger coverage in significantly less time.
 
In this MR exam a lesion was visualized that histopathology confirmed to be a second primary tumor. This lesion was was not visible on CT or PET/CT or conventional MRI.

The finding had a major impact on treatment. The radiation treatment was adapted towards the two primary tumors.


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Case Study
Ingenia 3.0T
Release 4
dSHeadNeckSpine coil, dStream, DWI, Neck, Neuro, Oncology, THRIVE
 

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