Elsevier

Oral Oncology

Volume 40, Issue 6, July 2004, Pages 579-584
Oral Oncology

Application of dynamic contrast-enhanced MRI to differentiate malignant lymphoma from squamous cell carcinoma in the head and neck

https://doi.org/10.1016/j.oraloncology.2003.12.002Get rights and content

Abstract

Because malignant lymphoma, the second most common malignant tumor of the head and neck, and squamous cell carcinoma (SCC), the most common malignant tumor of the head and neck, require different treatments, it is important to be able to differentiate them. In the present study, we attempted to differentiate malignant lymphomas from SCCs using dynamic contrast-enhanced MRI (DCE-MRI). Seventeen lesions (in 8 cases) of malignant lymphoma and 30 cases of SCC were compared by DCE-MRI.

Thirteen of 17 malignant lymphomas (76.5%) showed the maximum contrast index (CI) at 90–180 s, while 26 of 30 SCCs (86.7%) showed the maximum CI at a much faster 60–105 s. There was a statistically significant difference between SCC and malignant lymphoma in the time needed reach the maximum CI (p=0.0177). There was also significant difference between SCC and malignant lymphoma in their maximum CIs (p<0.001), with the maximum CIs of 29/30 SCCs (96.7%) above 2.0, while 12/17 malignant lymphomas (70.6%) showed CIs of less than 2.0. We consider these findings to be useful for distinguishing lymphomas from SCCs.

Introduction

Malignant lymphoma is the sond most common malignant tumor of the head and neck, and is treated by chemotherapy, radiotherapy, or a combination of these. For squamous cell carcinoma (SCC), the most common malignant tumor of the head and neck, surgery is usually the performed treatment. Because malignant lymphomas and SCCs require different treatments, it is important to be able to differentiate them. MRI is effective for diagnosing tumors and has some advantages over traditional techniques, especially in detecting soft tissue lesions.[1], [2] However, MRI examination has not yet come into use for the differential diagnosis of tumors. Therefore, plain MR signals often cannot contribute to a differential diagnosis or to be used to determine whether a tumor is benign or malignant. It has been reported that dynamic contrast-enhanced MRI (DCE-MRI) is useful for the differential diagnosis of some tumors, and many investigators have attempted to use it to identify differences between benign and malignant tumors, as well as to assess the malignancy of tumors.[3], [4], [5], [6] We have also reported the usefulness of DCE-MRI for tumor diagnosis.[7], [8], [9] Nevertheless, there have been few reports to date of DCE-MRI used in malignant lymphoma and/or SCC of the head and neck for diagnostic or predictive purposes.

In the present study, we attempted to differentiate malignant lymphomas from SCCs in the head and neck using DCE-MRI.

Section snippets

Materials

Thirty patients with primary head and neck SCC (Table 1) and 8 patients (17 lesions) with malignant lymphoma (Table 2) underwent DCE-MRI at our hospital, the SCC patients between 1997 and 1999, and the lymphoma patients between 1999 and 2002. All subjects gave their informed consent. The SCC patient population consisted of 14 females and 16 males regarding in age from 47 to 93 years old (mean, 69.3 years old). The lymphoma patients were 1 female and 7 males who were between 50 and 82 years old

Results

The CI curves of malignant lymphoma and SCC, calculated from a dynamic series, are shown in Fig. 1, Fig. 2, respectively. Of 17 curves of malignant lymphoma, 14 (82.4%) increased rapidly, followed by a relatively rapid initial decrease and a gradual decrease thereafter. The remaining 3 cases (17.6%) had no apparent peak, reaching a maximum CI and sustaining a temporary plateau, followed by a gradual decrease thereafter. Thirteen curves of malignant lymphoma (76.5%) reached their maximum CI at

Discussion

Dynamic features show the characteristic features of tumors and may be useful for making a differential diagnosis. DCE-MRI may therefore be useful in diagnosing some tumors and in predicting their biological behavior. However, there have been few reports to date of DCE-MRI used diagnostic or predictive purposes in cases of tumors of head and neck. Although there have been a few reports on the basis of DCE-MRI in malignant lymphoma and SCC patients,[10], [11] there has been no report to date on

Acknowledgements

This work was supported by a Grant-in-Aid for Scientific Research on Priority Areas of Okayama University and Grant-in-Aid (14370603, 14771037, 14771038) for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan.

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    Citation Excerpt :

    Lee and colleagues6 used DCE MR imaging–derived parameters to differentiate SCC, undifferentiated carcinoma (UD), and lymphoma; they showed that Ktrans, AUC60, and AUC90 were significantly different between UD and SCC and UD and lymphoma but not between SCC and lymphoma. Similarly, Asaumi and colleagues42 attempted to differentiate malignant lymphomas from SCCs using DCE MR imaging with 17 lesions of malignant lymphoma and 30 cases of SCC. The results showed that there was a significant difference between SCC and malignant lymphoma in the time to reach the maximum CI.

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