American Journal of Neuroradiology 28:1540-1546, September 2007
DOI 10.3174/ajnr.A0599
© 2007 American Society of Neuroradiology
HEAD & NECK
Has the Degree of Contrast Enhancement with MR Imaging in Laryngeal Carcinoma Added Value to Anatomic Parameters Regarding Prediction of Response to Radiation Therapy?
a Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands
b Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands
c Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
d Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
e Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
f Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
Please address correspondence to R. Ljumanovic, MD, Department of Radiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands; e-mail: Redina.Ljumanovic{at}vumc.nl
BACKGROUND AND PURPOSE: Our aim was to retrospectively investigate the prognostic significance of the degree of contrast enhancement in tumors and its additional value in previously considered MR imaging parameters with regard to local control of laryngeal cancer treated with radiation therapy (RT) alone.
MATERIALS AND METHODS: Pretreatment MR images of 64 consecutive patients (54 men and 10 women, 43–80 years of age) with supraglottic and glottic cancer were retrospectively reviewed on clinical and previously considered MR imaging parameters such as tumor involvement of specific laryngeal anatomic subsites, including laryngeal cartilages, tumor volume, extralaryngeal tumor spread, and, in addition, the degree of contrast enhancement. Clinical and MR imaging parameters were associated with regard to local control at 2 years by using the Cox regression model. "Local control" was defined as absence of primary tumor recurrence.
RESULTS: When using a threshold of the mean average contrast enhancement of 77%, the 2-year local control rate in the groups of patients with a degree of enhancement below and above this threshold was 57% and 70%, respectively (P=.3). Enhancement of tumor tissue in pre-epiglottic space (PES) was low, most probably due to its adipose tissue and poor vascular content, whereas tumor tissue involving paraglottic space (PGS) did enhance. Results of multivariate analysis indicated that the degree of contrast enhancement yielded the prognostic information (P=.07) with 2 independent prognostic factors: primary tumor volume (P=.007) and subglottic extension (P=.002) with regard to local control. Using these previously mentioned 3 MR imaging parameters as potential risk factors, we defined 4 categories, resulting in the following local control rates respectively: 90% for the group without risk factors, 73% for the group with 1, 60% for the group with 2, and finally 0% for the group with 3 risk factors, which was significantly lower than the rates in previous risk groups (P < .001).
CONCLUSION: PES has a lower degree of contrast enhancement than the PGS and may correlate with the worse outcome. Including a low degree of contrast enhancement as a parameter to primary tumor volume and subglottic extension may increase the predictive value of MR imaging for local outcome and may be helpful to identify a subset of patients whose tumors all recurred locally within 2 years after primary RT.