Dynamic Contrast-Enhanced
MR Imaging Applications in
Head and Neck Tumors
Halil ÖZER 1, Ali Yusuf ÖNER 1, Atilla KOKURCAN 1, Merve YAZOL 1,
Utku AYDİL 2 , Yusuf KIZIL 2 , Ali Murat KOÇ 1 , Emin Turgut TALI1
1.Gazi University School of Medicine , Department of Radiology ,Ankara-Turkey
2.Gazi University School of Medicine , Department of Otorhinolaryngology ,Ankara-Turkey
Purpose
• Dynamic contrast-enhanced magnetic resonance
imaging (DCE-MRI) has been used for the diagnosis
and for monitoring therapeutic response in tumors.
• More recently, pharmacokinetic models have been used
to extract parameters related to tumor microcirculation
by using DCE-MR imaging in head and neck tumors.
• The purpose of this exhibit is to describe and illustrate
feasibility and quantitative permeability values derived
from DCE-MRI in different head and neck tumors.
Methods
• Supra- infrahyoid head and neck tumors including
nasopharynx, hypopharynx, larynx, salivary glands,
oral cavity, paranasal sinuses were included.
• DCE-MRI following intravenous administration of
0,01 mmol/kg of gadodiamide was performed for
each patient with a 3T scanner.
• All data sets were transferred to a workstation for
image evaluation.
Methods-II
• For quantitative DCE-MRI evaluation, after an image coregistration, a pooled arterial input function obtained
from the vertebral artery, in regard of the gadolinium
concentration, was used for the modeling procedure.
Methods-III
• For all data sets region of interests were defined within
the tumor, muscle and vertebral artery with the help of
conventional images.
• Additional ROI were defined for lymph nodes at
differents stations bilaterally.
• Ktrans, Kep, Ve were then calculated from DCE-MRI
respectively. DCE-MRI findings and quantitative
permeability data were evaluated.
Findings-I
Upper Alveolar Ridge&Hard
Palate Adenocarcinoma
(a)
(b)
(c)
• Left upper alveolar ridge and hard palate adenocarcinoma with
bilateral metastatic servical lymph nodes.
• Fat-saturated T2-weighted (a), fat-saturated T1-weighted prepostcontrast (b,c) axial images show a heterogeneously
enhancing mass in the left hard palate extending posteriorly to the
upper alveolar ridge.
(d)
(e)
(f)
• Fat-saturated T2-weighted (d), fat-saturated T1-weighted prepostcontrast (e.f) axial images show bilateral servical lymph nodes.
(g)
(h)
• Diffusion-weighted image (g) and corresponding apparent diffusion
coefficient (h) map show diffusion restriction within lymph nodes,
indicating high cellularity.
• DCE-MR images in patient with pathologically confirmed hard palate
adenocarcinoma and metastatic lymph nodes.
• Four time-intensity curves of tumor ROI , vertebral artery ROI , muscle
ROI and lymph node ROI .
• Tumor time- intensity curve showing rapid early enhancement followed by
sustained delayed enhancement. Metastatic lymph nodes time- intensity
curve showing rapid early enhancement followed by plateau phase.
Mean Tumor Artery Muscle L.Node
Ktrans
0,194
0,342
0,038
0,167
Kep
Ve
0,272
0,709
0,832
0,399
0,694
0,054
0,578
0,294
Kinetic paraemeters derived from
dynamic contrast enhanced series of the
tumor and lymph node are higher than
the referance muscle measurements,
reflecting inceased tissue neovascularity.
• Ktrans Map
Findings-II
Maxillary Sinus Squamous Cell
Carcinoma
(a)
(b)
(c)
• Maxillary sinus squamous cell carcinoma.
• Fat-saturated T2-weighted (a), fat-saturated T1-weighted prepostcontrast (b,c) axial images demonstrate masses within left maxillary
sinus .
• DCE-MR images in patient with pathologically confirmed squamous
cell carcinoma .
• Three time-intensity curves of tumor ROI , vertebral artery ROI and
muscle ROI. Tumor time- intensity curve showing rapid early
enhancement followed followed by plateau phase.
Mean Tumor
Artery
Muscle
Ktrans 0,320
0,506
0,029
1,289
0,399
0,120
0,313
Kep
Ve
0,562
0,583
Mean K trans , Kep and Ve of
tumor values higher than muscle
values.
• Ktrans Map
Findings-III
Non-Hodgkin's lymphoma of
maxillary sinus
(a)
(b)
(c)
• Non-Hodgkin's lymphoma of maxillary sinus : Fat-saturated T2weighted (a), fat-saturated T1-weighted pre-postcontrast (b,c) axial
images demonstrate masses within the right maxillary sinus .
• DCE-MR images in patient with pathologically confirmed non-Hodgkin’s
lymphoma of maxillary sinus.
• Three time-intensity curves of tumor ROI , vertebral artery ROI and
muscle ROI. Tumor time- intensity curve showing rapid early
enhancement followed followed by washout.
Mean Tumor
Artery
Muscle
Ktrans 0,317
0,547
0,079
1,797
0,299
0,306
0,264
Kep
Ve
0,711
0,445
Mean K trans , Kep and Ve of
tumor values higher than muscle
values.
• Ktrans Map
Findings-IV
Nasopharnygeal Carcinoma
(a)
(b)
(c)
• Nasopharyngeal carcinoma with bilateral metastatic servical lymph nodes.
• Fat-saturated T2-weighted (a), fat-saturated T1-weighted pre-postcontrast
(b,c) axial images show left asymmetric nasopharyngeal mass
(d)
(e)
(f)
• Fat-saturated T2-weighted (d), fat-saturated T1-weighted prepostcontrast (e,f) axial images show bilateral servical lymph nodes.
• Diffusion-weighted image (DWI) and corresponding apparent diffusion
coefficient (ADC) map show diffusion restriction within lymph nodes,
indicating high cellularity.
• DCE-MR images in patient with pathologically confirmed
nasopharyngeal carcinoma and metastatic lymph nodes.
• Four time-intensity curves of tumor ROI , vertebral artery ROI , muscle
ROI and lymph node ROI.
• Tumor time-intensity curve showing rapid early enhancement followed
by sustained delayed enhancement. Metastatic lymph nodes timeintensity curve shows rapid early enhancement followed by plateau
phase.
Mean Tumor Artery Muscle L.Node
•
Ktrans Map
Ktrans
0,184
0,394
0,044
0,122
Kep
Ve
0,195
0,942
0,824
0,502
0,239
0,215
0,345
0,355
Kinetic paraemeters derived from
dynamic contrast enhanced series of the
tumor and lymph node are higher than
the referance muscle measurements,
reflecting increased tissue
neovascularity.
Findings-V
Supraglottic Squamous Cell
Carcinoma
(a)
(b)
(c)
• Supraglottic squamous cell carcinoma. Fat-sat T2-weighted (a), fat-sat
T1-weighted pre-postcontrast (b,c) axial images show a heterogeneously
enhancing right supraglottic mass.
• DCE-MR images in patient with pathologically confirmed squamous
cell carcinoma.
• Three time-intensity curves of tumor ROI , vertebral artery ROI and
muscle ROI. Tumor time- intensity curve shows rapid early
enhancement followed followed by plateau phase.
Mean Tumor
Artery
Muscle
Ktrans 0,057
0,143
0,015
0,634
0,226
0,069
0,304
Kep
Ve
0,314
0,191
Kinetic paraemeters derived from
dynamic contrast enhanced series
of the tumor and lymph node are
higher than the referance muscle
measurements, reflecting inceased
tissue neovascularity.
• Ktrans Map
Findings-VI
Glottic Squamous Cell Carcinoma
(a)
(a)
(b)
(b)
(c)
(c)
• Right glottic scc and metastatic lymph nodes. The glottic level is
demonstrated by different sequences: Fat-sat TSE T2-weighted (a),
fat-sat SE T1-weighted precontrast (b), fat-sat SE T1-weighted
postcontrast (c). TSE, turbo spin echo.
(d)
(a)
(e)
(b)
• On diffusion-weighted imaging (DWI), bilateral metastatic lymph
nodes show diffusion restriction, high signal on b800 (d) and a
very low signal on apparent diffusion coefficient (ADC) map (e).
• DCE-MR images in patient with pathologically confirmed squamous cell
carcinoma and metastatic lymph nodes
• Four time-intensity curves of tumor ROI , vertebral artery ROI , muscle
ROI and lymph node ROI.
• Tumor time- intensity curve showing rapid early enhancement followed by
plateau phase. Metastatic lymph nodes time- intensity curve shows rapid
early enhancement followed by washout.
Mean Tumor Artery Muscle L.Node
Ktrans
0,170
0,222
0,018
0,211
Kep
Ve
0,377
0,432
0,966
0,253
0,139
0,134
0,800
0,264
Mean K trans , Kep and Ve of tumor
and lymph node values are higher
than muscle values.
• Ktrans Map
Findings-VII
Pleomorphic Adenoma of Parotid
Gland
(a)
(b)
(c)
• Pleomorphic adenoma in right parotid gland .
• Fat-saturated T2-weighted (a), fat-saturated T1-weighted (b) axial
images demonstrate a well-circumscribed and lobulated mass in right
parotid gland which enhances homogeneously on T1 post-contrast
image (c).
• DCE-MR images in patient with pathologically confirmed pleomorphic
adenoma.
• Three time-intensity curves of tumor ROI , vertebral artery ROI and
muscle ROI. Tumor time- intensity curve shows rapid early
enhancement followed by plateau phase.
Mean Tumor
Artery
Muscle
Ktrans 0,238
0,115
0,032
0,472
0,227
0,432
0,099
Kep
Ve
0,353
0,680
• Mean K trans , Kep and Ve of
tumor values higher than
muscle values.
• Ktrans Map
Discussion-I
• Architectural and functional abnormalities of blood
vessels are a common feature in tumors.
• DCE-MRI enables the quantative assessment of tumor
microcirculation properties,including vessel size and
distribution,hyperpermeability, flow heterogenity and its
spatial distribution.
Discussion-II
• DCE-MRI findings and permeability measurements of
different head and neck tumors shows favorable
correlation in tumor depiction.
• Mean Ktrans, Kep, Ve of the lesion values in patients
with head and neck tumors are significantly higher than
muscle values.
• Same correlation is also present for metastatic lymph
nodes compared to reactive ones and plays an important
role in tumor staging.
Conclusion
• DCE MRI is a straight forward technique that can easily
be implemented in to the routine MRI evaluation of H&N
tumors.
• Although robust in nature, DCE and derived kinetic
parameters are extremely useful for characterising H&N
tumors, and may be helpful as an adjunctive method in
the evaluation of tumor vascularity and staging.
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