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Research ArticleHead and Neck Imaging
Open Access

MR Imaging Criteria for the Detection of Nasopharyngeal Carcinoma: Discrimination of Early-Stage Primary Tumors from Benign Hyperplasia

A.D. King, L.Y.S. Wong, B.K.H. Law, K.S. Bhatia, J.K.S. Woo, Q.-Y. Ai, T.Y. Tan, J. Goh, K.L. Chuah, F.K.F. Mo, K.C.A. Chan, A.T.C. Chan and A.C. Vlantis
American Journal of Neuroradiology March 2018, 39 (3) 515-523; DOI: https://doi.org/10.3174/ajnr.A5493
A.D. King
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
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L.Y.S. Wong
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
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B.K.H. Law
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
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K.S. Bhatia
eImaging Department (K.S.B.), St Mary's Hospital, Imperial College Healthcare, National Health Service Trust, London, UK
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J.K.S. Woo
cOtorhinolaryngology, Head and Neck Surgery (J.K.S.W., A.C.V.)
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Q.-Y. Ai
aFrom the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
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T.Y. Tan
fDepartment of Radiology (T.Y.T.), Changi General Hospital, Singapore
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J. Goh
gDepartments of Diagnostic Radiology (J.G.)
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K.L. Chuah
hPathology (K.L.C.), Tan Tock Seng Hospital, Singapore.
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F.K.F. Mo
bClinical Oncology (F.K.F.M., A.T.C.C.)
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K.C.A. Chan
dDepartment of Chemical Pathology (K.C.A.C.), State Key Laboratory in Oncology in South China, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, S.A.R., China
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A.T.C. Chan
bClinical Oncology (F.K.F.M., A.T.C.C.)
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A.C. Vlantis
cOtorhinolaryngology, Head and Neck Surgery (J.K.S.W., A.C.V.)
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Abstract

BACKGROUND AND PURPOSE: MR imaging can detect nasopharyngeal carcinoma that is hidden from endoscopic view, but for accurate detection carcinoma confined within the nasopharynx (stage T1) must be distinguished from benign hyperplasia of the nasopharynx. This study aimed to document the MR imaging features of stage T1 nasopharyngeal carcinoma and to attempt to identify features distinguishing it from benign hyperplasia.

MATERIALS AND METHODS: MR images of 189 patients with nasopharyngeal carcinoma confined to the nasopharynx and those of 144 patients with benign hyperplasia were reviewed and compared in this retrospective study. The center, volume, size asymmetry (maximum percentage difference in area between the right and left nasopharyngeal halves), signal intensity asymmetry, deep mucosal white line (greater contrast enhancement along the deep tumor margin), and absence/distortion of the adenoidal septa were evaluated. Differences were assessed with logistic regression and the χ2 test.

RESULTS: The nasopharyngeal carcinoma center was lateral, central, or diffuse in 134/189 (70.9%), 25/189 (13.2%), and 30/189 (15.9%) cases, respectively. Nasopharyngeal carcinomas involving the walls showed that a deep mucosal white line was present in 180/183 (98.4%), with a focal loss of this line in 153/180 (85%) cases. Adenoidal septa were absent or distorted in 111/111 (100%) nasopharyngeal carcinomas involving the adenoid. Compared with benign hyperplasia, nasopharyngeal carcinoma had a significantly greater volume, size asymmetry, signal asymmetry, focal loss of the deep mucosal white line, and absence/distortion of the adenoidal septa (P < .001). Although size asymmetry was the most accurate criterion (89.5%) for nasopharyngeal carcinoma detection, use of this parameter alone would have missed 11.9% of early-stage T1 nasopharyngeal carcinomas.

CONCLUSIONS: MR imaging features can help distinguish stage T1 nasopharyngeal carcinoma from benign hyperplasia in most cases.

ABBREVIATIONS:

BH
benign hyperplasia
BH1
BH type 1
BH2
BH type 2
%ΔA
maximum percentage difference in area
NPC
nasopharyngeal carcinoma
  • © 2018 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 39 (3)
American Journal of Neuroradiology
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A.D. King, L.Y.S. Wong, B.K.H. Law, K.S. Bhatia, J.K.S. Woo, Q.-Y. Ai, T.Y. Tan, J. Goh, K.L. Chuah, F.K.F. Mo, K.C.A. Chan, A.T.C. Chan, A.C. Vlantis
MR Imaging Criteria for the Detection of Nasopharyngeal Carcinoma: Discrimination of Early-Stage Primary Tumors from Benign Hyperplasia
American Journal of Neuroradiology Mar 2018, 39 (3) 515-523; DOI: 10.3174/ajnr.A5493

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MR Imaging Criteria for the Detection of Nasopharyngeal Carcinoma: Discrimination of Early-Stage Primary Tumors from Benign Hyperplasia
A.D. King, L.Y.S. Wong, B.K.H. Law, K.S. Bhatia, J.K.S. Woo, Q.-Y. Ai, T.Y. Tan, J. Goh, K.L. Chuah, F.K.F. Mo, K.C.A. Chan, A.T.C. Chan, A.C. Vlantis
American Journal of Neuroradiology Mar 2018, 39 (3) 515-523; DOI: 10.3174/ajnr.A5493
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