Original articleDynamic contrast-enhanced MRI in the differentiation of posttreatment fibrosis from recurrent carcinoma of the head and neck
Introduction
Magnetic resonance imaging (MRI) is a valuable modality in the diagnosis and follow-up of patients with head and neck carcinoma. The role of MRI for differentiating recurrent tumor from fibrosis after treatment of head and neck carcinoma was previously investigated [1], [2], [3], [4], [5]. Recurrent tumors were found to demonstrate higher signal intensity (SI) on T2-weighted images than fibrotic benign changes do. However, further studies have shown that nonneoplastic inflammation or edema may also be responsible for T2 hyperintersity and that this finding is nonspecific [3]. In some cases, the identification of a suspicious lesion is still a challenge.
Dynamic contrast-enhanced MRI is valuable for the differentiation of tumor recurrence and posttreatment fibrosis in regions such as the breast, pelvis, gastrointestinal and musculoskeletal system [6], [7], [8], [9], [10], [11]. To the best of our knowledge, there is no dynamic contrast-enhanced MRI study regarding such differentiation in the head and neck region. In this study, we aimed to compare the dynamic enhancement characteristics of benign fibrotic and recurrent tumoral lesions and, therefore, to investigate the value of dynamic contrast-enhanced MRI in the differentiation of posttreatment fibrotic changes from recurrent carcinoma of the head and neck.
Section snippets
Materials and methods
Twenty-six patients aged 23–72 years (mean: 55 years), with a history of head and neck carcinoma and a radiologically detectable lesion at the site of treatment, were included in the study. All patients had received a curative treatment as radiotherapy and/or surgery. The numbers of patients are shown in Table 1 according to the type of treatment received and location of primary tumor. Patients who have received any type of treatment during the last 6 months were not included in the study, to
Results
The analysis of the images revealed mass lesion in 9 and asymmetrical soft tissue thickening in 17 primary lesion sites. All patients with a mass and four patients with progression in the size of the radiologic lesion underwent biopsy. Biopsy results were consistent with tumor in 11 and fibrosis in 2 of these 13 lesions, and these patients were included in the tumor-positive and -negative groups, respectively. The remaining 13 patients that had no mass and showed no change in asymmetry at the
Discussion
The early detection of tumor recurrence in cancer patients is crucial for better prognosis. After a successful radiation therapy, tumor tissue shows regression and fibrotic tissue takes the place of the tumor [2]. In addition, after surgery, the early development of granulation tissue at the surgical site turns out to be a fibrotic scar [12]. Such benign reactions to treatment may mimic tumor both in physical and radiological examinations; therefore, the differentiation of tumor from fibrotic
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