PT  - JOURNAL ARTICLE
AU  - Verhappen, M.H.
AU  - Pouwels, P.J.W.
AU  - Ljumanovic, R.
AU  - van der Putten, L.
AU  - Knol, D.L.
AU  - De Bree, R.
AU  - Castelijns, J.A.
TI  - Diffusion-Weighted MR Imaging in Head and Neck Cancer: Comparison between Half-Fourier Acquired Single-Shot Turbo Spin-Echo and EPI Techniques
AID  - 10.3174/ajnr.A2949
DP  - 2012 Feb 09
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2012/02/09/ajnr.A2949.short
4100  - http://www.ajnr.org/content/early/2012/02/09/ajnr.A2949.full
AB  - BACKGROUND AND PURPOSE: Several studies have reported on the clinical utility of DWI in head and neck cancer, but none of these studies compared HASTE with EPI-DWI in patients with head and neck cancer. The aim of our study was to compare detection and delineation of primary tumors and lymph nodes by using HASTE and EPI-DWI techniques in patients with HNSCC. MATERIALS AND METHODS: Twelve patients with HNSCC and a total of 12 primary tumors and 77 visualized lymph nodes on MR imaging underwent DWI by using both EPI-based and HASTE techniques. Interobserver agreement for detection, delineation, and ADC values of primary tumors and lymph nodes was assessed by 2 radiologists, and artifacts for both DWI techniques were described. RESULTS: The number of lesions (primary tumors and lymph nodes) identified on pretreatment EPI-DWI was higher compared with pretreatment HASTE-DWI, with means of total lesions of 88.5 and 69.0, respectively. Delineation of lesions was also better on pretreatment EPI-DWI compared with pretreatment HASTE-DWI, with means of well-delineated lesions of 80.5 and 27.5, respectively. Both EPI- and HASTE-DWI showed good interobserver agreement between radiologists of ADC values in lesions with ICC values of 0.79 and 0.92, respectively. Intraobserver agreement for ADC values in lesions assessed with EPI- versus HASTE-DWI techniques was low, with ICC values of 0.31 and 0.42, respectively. Significant interobserver disagreement concerning detection was only seen with HASTE-DWI, and none of the DWI techniques showed significant interobserver disagreements regarding delineation. EPI-DWI was more prone to susceptibility artifacts than HASTE-DWI: Ninety-one percent of primary tumors and 16% of lymph nodes were affected by susceptibility artifacts on pretreatment EPI-DWI, whereas these artifacts were not seen on HASTE-DWI. CONCLUSIONS: Primary tumors and lymph nodes are more easily visualized on EPI-DWI compared with HASTE-DWI. EPI-DWI has geometric distortion, however, which has a negative effect on interobserver agreement of ADC values. Abbreviations CIconfidence intervalHASTEhalf-Fourier acquired single-shot turbo spin-echoHNSCChead and neck squamous cell carcinomaICCintraclass correlation coefficientSTIRshort τ inversion recovery