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Recurrent head and neck cancer

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

Patient history

This patient has a prior history of floor of mouth cancer on the right side and multiple recurrences for which multiple surgical interventions and chemoradiation have been performed. There is clinical suspicion of small ulceration on the right lateral tongue. MRI is requested for pre-operative staging.

MR examination

Ingenia 3.0T with dSHeadNeckSpine coil solution is used to scan the entire head and neck from skull base to thoracic inlet.
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;
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 if needed, depending on lesion location and clinical need).

ExamCard used:

Images

 T2W DWI b1000
T2W
DWI b1000
 4D-THRIVE Initial slope map
4D-THRIVE
Initial slope map

These images show the area of the clinically suspected small ulceration. On the T2-weighted images it is visible as a thin slightly hyperintense line (arrow). No clear abnormalities are seen on b1000 DWI. 4D-THRIVE shows strong arterial enhancement, confirmed as a red area on the initial slope map. This area was proven to be in-situ squamous cell carcinoma. No clear abnormalities are seen on b1000 DWI.


 T1W DWI b1000
T1W
DWI b1000
 4D-THRIVE Initial slope map
4D-THRIVE
Initial slope map

The T1-weighted image shows no focal abnormality at the level of the base of the left tonsil. The b1000 DWI shows a hyperintense lesion in the left base of the tonsil. This is confirmed by the visualization of a hyperenhancing lesion on 4D-THRIVE and by the initial slope map. Histopathology proved this is synchronous tumor recurrence.

Diagnosis

Superficial tumoral ulceration on the right lateral tongue. Second area of synchronous tumor recurrence at the base of the left tonsil. After these findings surgery was not performed.

Clinical impact of Ingenia 3.0T MR imaging

This case highlights the advantages of adding DWI to help visualize potential tumor recurrence. DWI and 4D-THRIVE provide lesion conspicuity to help in nodal characterization and differentiation of post-radiotherapy necrosis and inflammation from tumor recurrence.


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Nov 5, 2013

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

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