Skip to main content

Advertisement

SpringerLink
Log in

Improved detection rates and treatment planning of head and neck cancer using dual-layer spectral CT

  • Head and Neck
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to evaluate the advantages of dual-layer spectral CT (DLSCT) in detection and staging of head and neck cancer (HNC) as well as the imaging of tumour margins and infiltration depth compared to conventional contrast enhanced CT (CECT).

Materials and methods

Thirty-nine patients with a proven diagnosis of HNC were examined with a DLSCT scanner and retrospectively analysed. An age-matched healthy control group of the same size was used. Images were acquired in the venous phase. Virtual monoenergetic 40keV-equivalent (MonoE40) images were compared to CECT-images. Diagnostic confidence for tumour identification and margin detection was rated independently by four experienced observers. The steepness of the Hounsfield unit (HU)-increase at the tumour margin was analysed. External carotid artery branch image reconstructions were performed and their contrast compared to conventional arterial phase imaging. Means were compared using a Student’s t-test. ANOVA was used for multiple comparisons.

Results

MonoE40 images were superior to CECT-images in tumour detection and margin delineation. MonoE40 showed significantly higher attenuation differences between tumour and healthy tissue compared to CECT-images (p < 0.001). The HU-increase at the boundary of the tumour was significantly steeper in MonoE40 images compared to CECT-images (p < 0.001). Iodine uptake in the tumour was significantly higher compared to healthy tissue (p < 0.001). MonoE40 compared to conventional images allowed visualisation of external carotid artery branches from the venous phase in a higher number of cases (87% vs. 67%).

Conclusion

DLSCT enables improved detection of primary and recurrent head and neck cancer and quantification of tumour iodine uptake. Improved contrast of MonoE40 compared to conventional reconstructions enables higher diagnostic confidence concerning tumour margin detection and vessel identification.

Key Points

• Sensitivity concerning tumour detection are higher using dual-layer spectral-CT than conventional CT.

• Lesion to background contrast in DLSCT is significantly higher than in CECT.

• DLSCT provides sufficient contrast for evaluation of external carotid artery branches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CECT:

Contrast-enhanced CT

CNR:

Contrast-to-noise ratio

CT:

Computer tomography

DLSCT:

Dual-layer spectral CT

HNC:

Head and neck cancer

HU:

Hounsfield unit

MonoE40:

Monoenergetic 40 keV-equivalent

MRI:

Magnetic resonance imaging

ROI:

Region of interest

SNR:

Signal-to-noise ratio

STIR:

Short tau inversion recovery

References

  1. Siegel RL, Miller KD, Jemal A (2017) Cancer Statistics, 2017. CA Cancer J Clin 67:7–30

    Article  Google Scholar 

  2. Hoorweg JJ, Kruijt RH, Heijboer RJ, Eijkemans MJ, Kerrebijn JD (2006) Reliability of interpretation of CT examination of the larynx in patients with glottic laryngeal carcinoma. Otolaryngol Head Neck Surg 135:129–134

    Article  CAS  Google Scholar 

  3. Argiris A, Karamouzis MV, Raben D, Ferris RL (2008) Head and neck cancer. Lancet 371:1695–1709

    Article  CAS  Google Scholar 

  4. Snow GB, Patel P, Leemans CR, Tiwari R (1992) Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 249:187–194

    Article  CAS  Google Scholar 

  5. Trotta BM, Pease CS, Rasamny JJ, Raghavan P, Mukherjee S (2011) Oral cavity and oropharyngeal squamous cell cancer: key imaging findings for staging and treatment planning. Radiographics 31:339–354

    Article  Google Scholar 

  6. Kitajima K, Suenaga Y, Sugimura K (2015) Present and future role of FDG-PET/CT imaging in the management of head and neck carcinoma. Jpn J Radiol 33:776–789

    Article  Google Scholar 

  7. Cooper JS, Mukherji SK, Toledano AY et al (2007) An evaluation of the variability of tumour-shape definition derived by experienced observers from CT images of supraglottic carcinomas (ACRIN protocol 6658). Int J Radiat Oncol Biol Phys 67:972–975

    Article  Google Scholar 

  8. Rasch C, Steenbakkers R, van Herk M (2005) Target definition in prostate, head, and neck. Semin Radiat Oncol 15:136–145

    Article  Google Scholar 

  9. Burkill GJ, Evans RM, Raman VV, Connor SE (2016) Modern Radiology in the Management of Head and Neck Cancer. Clin Oncol (R Coll Radiol) 28:440–450

    Article  CAS  Google Scholar 

  10. Chan AT, Gregoire V, Lefebvre JL et al (2012) Nasopharyngeal cancer: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii83–vii85

    Article  Google Scholar 

  11. Gregoire V, Lefebvre JL, Licitra L, Felip E, Group E-E-EGW (2010) Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v184–v186

    Article  Google Scholar 

  12. Kanda T, Kitajima K, Suenaga Y et al (2013) Value of retrospective image fusion of (1)(8)F-FDG PET and MRI for preoperative staging of head and neck cancer: comparison with PET/CT and contrast-enhanced neck MRI. Eur J Radiol 82:2005–2010

    Article  Google Scholar 

  13. Kato H, Kanematsu M, Makita H et al (2014) CT and MR imaging findings of palatal tumour. Eur J Radiol 83:e137–e146

    Article  Google Scholar 

  14. Prestwich RJ, Sykes J, Carey B, Sen M, Dyker KE, Scarsbrook AF (2012) Improving target definition for head and neck radiotherapy: a place for magnetic resonance imaging and 18-fluoride fluorodeoxyglucose positron emission tomography? Clin Oncol (R Coll Radiol) 24:577–589

    Article  CAS  Google Scholar 

  15. Bhatnagar P, Subesinghe M, Patel C, Prestwich R, Scarsbrook AF (2013) Functional imaging for radiation treatment planning, response assessment, and adaptive therapy in head and neck cancer. Radiographics 33:1909–1929

    Article  Google Scholar 

  16. Bird D, Scarsbrook AF, Sykes J et al (2015) Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma. BMC Cancer 15:844

    Article  Google Scholar 

  17. Johnson TRC (2011) Dual energy CT in clinical practice. Springer, Heidelberg

    Book  Google Scholar 

  18. McCollough CH, Leng S, Yu L, Fletcher JG (2015) Dual- and Multi-Energy CT: Principles, Technical Approaches, and Clinical Applications. Radiology 276:637–653

    Article  Google Scholar 

  19. Forghani R, Mukherji SK (2018) Advanced dual-energy CT applications for the evaluation of the soft tissues of the neck. Clin Radiol 73:70–80

    Article  CAS  Google Scholar 

  20. Crewson PE (2005) Reader agreement studies. AJR Am J Roentgenol 184:1391–1397

    Article  Google Scholar 

  21. Perez-Lara A, Levental M, Rosenbloom L, Wing G, Forghani R (2017) Routine Dual-Energy Computed Tomography Scanning of the Neck in Clinical Practice: A Single-Institution Experience. Neuroimaging Clin N Am 27:523–531

    Article  Google Scholar 

  22. Leslie A, Fyfe E, Guest P, Goddard P, Kabala JE (1999) Staging of squamous cell carcinoma of the oral cavity and oropharynx: a comparison of MRI and CT in T- and N-staging. J Comput Assist Tomogr 23:43–49

    Article  CAS  Google Scholar 

  23. Forghani R, Kelly H, Yu E et al (2017) Low-Energy Virtual Monochromatic Dual-Energy Computed Tomography Images for the Evaluation of Head and Neck Squamous Cell Carcinoma: A Study of Tumour Visibility Compared With Single-Energy Computed Tomography and User Acceptance. J Comput Assist Tomogr 41:565–571

    Article  Google Scholar 

  24. Lam S, Gupta R, Levental M, Yu E, Curtin HD, Forghani R (2015) Optimal Virtual Monochromatic Images for Evaluation of Normal Tissues and Head and Neck Cancer Using Dual-Energy CT. AJNR Am J Neuroradiol 36:1518–1524

    Article  CAS  Google Scholar 

  25. Wichmann JL, Noske EM, Kraft J et al (2014) Virtual monoenergetic dual-energy computed tomography: optimization of kiloelectron volt settings in head and neck cancer. Invest Radiol 49:735–741

    Article  Google Scholar 

  26. Albrecht MH, Scholtz JE, Kraft J et al (2015) Assessment of an Advanced Monoenergetic Reconstruction Technique in Dual-Energy Computed Tomography of Head and Neck Cancer. Eur Radiol 25:2493–2501

    Article  Google Scholar 

  27. Nair JR, DeBlois F, Ong T et al (2017) Dual-Energy CT: Balance Between Iodine Attenuation and Artifact Reduction for the Evaluation of Head and Neck Cancer. J Comput Assist Tomogr 41:931–936

    Article  Google Scholar 

  28. Roele ED, Timmer V, Vaassen LAA, van Kroonenburgh A, Postma AA (2017) Dual-Energy CT in Head and Neck Imaging. Curr Radiol Rep 5:19

    Article  Google Scholar 

  29. Ehn S, Sellerer T, Muenzel D et al (2018) Assessment of quantification accuracy and image quality of a full-body dual-layer spectral CT system. J Appl Clin Med Phys 19:204–217

    Article  Google Scholar 

  30. Kuno H, Onaya H, Iwata R et al (2012) Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT. Radiology 265:488–496

    Article  Google Scholar 

  31. Evans GR, Schusterman MA, Kroll SS et al (1994) The radial forearm free flap for head and neck reconstruction: a review. Am J Surg 168:446–450

    Article  CAS  Google Scholar 

  32. Gu DH, Yoon DY, Park CH et al (2010) CT, MR, (18)F-FDG PET/CT, and their combined use for the assessment of mandibular invasion by squamous cell carcinomas of the oral cavity. Acta Radiol 51:1111–1119

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Fabian K. Lohöfer and Georgios A. Kaissis contributed equally to this work.

Authors and Affiliations

  1. Institute for diagnostic and interventional Radiology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675, München, Germany

    Fabian K. Lohöfer, Georgios A. Kaissis, Frances L. Köster, Sebastian Ziegelmayer, Ingo Einspieler, Carlos Gerngross, Michael Rasper, Peter B. Noel, Ernst J. Rummeny & Rickmer F. Braren

  2. Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675, München, Germany

    Steffen Koerdt & Andreas Fichter

  3. Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany

    Steffen Koerdt

Authors
  1. Fabian K. Lohöfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georgios A. Kaissis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frances L. Köster
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastian Ziegelmayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ingo Einspieler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlos Gerngross
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Rasper
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter B. Noel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Steffen Koerdt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Andreas Fichter
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ernst J. Rummeny
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rickmer F. Braren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rickmer F. Braren.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Rickmer Braren.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because only an anonymous retrospective analysis of images was performed.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

Electronic supplementary material

ESM 1

(DOCX 19294 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lohöfer, F.K., Kaissis, G.A., Köster, F.L. et al. Improved detection rates and treatment planning of head and neck cancer using dual-layer spectral CT. Eur Radiol 28, 4925–4931 (2018). https://doi.org/10.1007/s00330-018-5511-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5511-2

Keywords

Search

Navigation