Differentiating recurrent tumours from post-treatment changes in head and neck cancers: does diffusion-weighted MRI solve the eternal dilemma?

Clin Radiol. 2017 Jan;72(1):74-83. doi: 10.1016/j.crad.2016.09.019. Epub 2016 Oct 24.


Aim: To evaluate the utility of diffusion-weighted imaging (DWI) in differentiating post-treatment changes from tumour recurrence in head and neck cancers and to establish a threshold apparent diffusion coefficient (ADC) value to differentiate the two conditions.

Materials and methods: This was a prospective study of 80 treated head and neck cancer patients. The patient cohort consisted of a wide spectrum of head and neck sites, including the oral cavity, oropharynx, larynx, hypopharynx, paranasal sinuses, orbits, salivary glands, and infra-temporal fossa. Qualitative analysis of the diffusion images and quantitative analysis of the corresponding ADC maps was performed and the data were correlated with histopathological findings and clinical examinations.

Results: The mean ADC value of recurrent tumours in the present cohort was 0. 932±0.19×10-3 mm2/s and the mean ADC value of lesions representing post-treatment changes was 1.394±0.32×10-3 mm2/s. A threshold ADC value of 1.2×10-3mm2/s used to differentiate post-treatment changes from recurrent head and neck cancers showed the highest combined sensitivity of 90.13%, specificity of 82.5%, accuracy of 86.4%, positive predictive value of 84.4%, negative predictive value of 88.9%, and mean kappa measurement of agreement of 72.8.

Conclusion: Combined qualitative and quantitative analysis of DWI is a useful non-invasive technique to differentiate recurrent head and neck malignancies from post-treatment changes using a threshold ADC value.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Diagnosis, Differential
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Image Interpretation, Computer-Assisted / methods
  • India
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / prevention & control*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Treatment Outcome
  • Young Adult