Detection of clinically occult primary tumours in patients with cervical metastases of unknown primary tumours: comparison of three-dimensional THRIVE MRI, two-dimensional spin-echo MRI, and contrast-enhanced CT

M. G. Yoo, J. Kim, S. Bae, S. S. Ahn, S. J. Ahn, Y. W. Koh

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Abstract

Aim: To evaluate and compare the utility of contrast-enhanced three-dimensional (3D) T1-weighted high-resolution isotropic volume examination (THRIVE), spin-echo (SE) T1-weighted magnetic resonance imaging (MRI), and computed tomography (CT) for detecting clinically occult primary tumours in patients with cervical lymph node metastases. Materials and methods: Seventy-three consecutive patients with tumours that went undetected during endoscopic or physical examinations underwent preoperative contrast-enhanced CT and MRI (SE and 3D THRIVE) after gadolinium injection. Guided biopsy results served as reference standards. The diagnostic performances of the imaging techniques were compared with McNemar's tests. Results: Primary tumours were identified in 59 (80.8%) of the 73 patients after surgery. Of these, 36 were found in the palatine tonsil, 11 in the base of the tongue, seven in the nasopharynx, and five in the pyriform sinus. The sensitivity (72.9%) and accuracy (71.2%) of 3D THRIVE for detecting primary tumours were higher than were those of SE T1-weighted MRI (49.2% and 53.4%, p≤0.002) or CT (36.4% and 46.4%, p≤0.001). The specificities of these techniques did not differ. The diagnostic performance of 3D THRIVE (area under the curve [AUC]=0.681) for detecting tumours did not differ from that of SE T1-weighted MRI or CT (AUC=0.671 and 0.608, p>0.05). Conclusion: 3D THRIVE was more sensitive at detecting primary tumours than was SE T1-weighted MRI or CT in patients with cervical metastases of unknown primary tumours. This sequence may improve biopsy and therapeutic planning in these patients.

Original languageEnglish
Pages (from-to)410.e9-410.e15
JournalClinical Radiology
Volume73
Issue number4
DOIs
Publication statusPublished - 2018 Apr

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Unknown Primary Neoplasms
Tomography
Magnetic Resonance Imaging
Neoplasm Metastasis
Neoplasms
Area Under Curve
Pyriform Sinus
Biopsy
Nasopharynx
Palatine Tonsil
Gadolinium
Diagnostic Imaging
Tongue
Physical Examination
Lymph Nodes
Injections

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

@article{df10ad0ae7454d03b6ca0928b14820b6,
title = "Detection of clinically occult primary tumours in patients with cervical metastases of unknown primary tumours: comparison of three-dimensional THRIVE MRI, two-dimensional spin-echo MRI, and contrast-enhanced CT",
abstract = "Aim: To evaluate and compare the utility of contrast-enhanced three-dimensional (3D) T1-weighted high-resolution isotropic volume examination (THRIVE), spin-echo (SE) T1-weighted magnetic resonance imaging (MRI), and computed tomography (CT) for detecting clinically occult primary tumours in patients with cervical lymph node metastases. Materials and methods: Seventy-three consecutive patients with tumours that went undetected during endoscopic or physical examinations underwent preoperative contrast-enhanced CT and MRI (SE and 3D THRIVE) after gadolinium injection. Guided biopsy results served as reference standards. The diagnostic performances of the imaging techniques were compared with McNemar's tests. Results: Primary tumours were identified in 59 (80.8{\%}) of the 73 patients after surgery. Of these, 36 were found in the palatine tonsil, 11 in the base of the tongue, seven in the nasopharynx, and five in the pyriform sinus. The sensitivity (72.9{\%}) and accuracy (71.2{\%}) of 3D THRIVE for detecting primary tumours were higher than were those of SE T1-weighted MRI (49.2{\%} and 53.4{\%}, p≤0.002) or CT (36.4{\%} and 46.4{\%}, p≤0.001). The specificities of these techniques did not differ. The diagnostic performance of 3D THRIVE (area under the curve [AUC]=0.681) for detecting tumours did not differ from that of SE T1-weighted MRI or CT (AUC=0.671 and 0.608, p>0.05). Conclusion: 3D THRIVE was more sensitive at detecting primary tumours than was SE T1-weighted MRI or CT in patients with cervical metastases of unknown primary tumours. This sequence may improve biopsy and therapeutic planning in these patients.",
author = "Yoo, {M. G.} and J. Kim and S. Bae and Ahn, {S. S.} and Ahn, {S. J.} and Koh, {Y. W.}",
year = "2018",
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doi = "10.1016/j.crad.2017.10.020",
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pages = "410.e9--410.e15",
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TY - JOUR

T1 - Detection of clinically occult primary tumours in patients with cervical metastases of unknown primary tumours

T2 - comparison of three-dimensional THRIVE MRI, two-dimensional spin-echo MRI, and contrast-enhanced CT

AU - Yoo, M. G.

AU - Kim, J.

AU - Bae, S.

AU - Ahn, S. S.

AU - Ahn, S. J.

AU - Koh, Y. W.

PY - 2018/4

Y1 - 2018/4

N2 - Aim: To evaluate and compare the utility of contrast-enhanced three-dimensional (3D) T1-weighted high-resolution isotropic volume examination (THRIVE), spin-echo (SE) T1-weighted magnetic resonance imaging (MRI), and computed tomography (CT) for detecting clinically occult primary tumours in patients with cervical lymph node metastases. Materials and methods: Seventy-three consecutive patients with tumours that went undetected during endoscopic or physical examinations underwent preoperative contrast-enhanced CT and MRI (SE and 3D THRIVE) after gadolinium injection. Guided biopsy results served as reference standards. The diagnostic performances of the imaging techniques were compared with McNemar's tests. Results: Primary tumours were identified in 59 (80.8%) of the 73 patients after surgery. Of these, 36 were found in the palatine tonsil, 11 in the base of the tongue, seven in the nasopharynx, and five in the pyriform sinus. The sensitivity (72.9%) and accuracy (71.2%) of 3D THRIVE for detecting primary tumours were higher than were those of SE T1-weighted MRI (49.2% and 53.4%, p≤0.002) or CT (36.4% and 46.4%, p≤0.001). The specificities of these techniques did not differ. The diagnostic performance of 3D THRIVE (area under the curve [AUC]=0.681) for detecting tumours did not differ from that of SE T1-weighted MRI or CT (AUC=0.671 and 0.608, p>0.05). Conclusion: 3D THRIVE was more sensitive at detecting primary tumours than was SE T1-weighted MRI or CT in patients with cervical metastases of unknown primary tumours. This sequence may improve biopsy and therapeutic planning in these patients.

AB - Aim: To evaluate and compare the utility of contrast-enhanced three-dimensional (3D) T1-weighted high-resolution isotropic volume examination (THRIVE), spin-echo (SE) T1-weighted magnetic resonance imaging (MRI), and computed tomography (CT) for detecting clinically occult primary tumours in patients with cervical lymph node metastases. Materials and methods: Seventy-three consecutive patients with tumours that went undetected during endoscopic or physical examinations underwent preoperative contrast-enhanced CT and MRI (SE and 3D THRIVE) after gadolinium injection. Guided biopsy results served as reference standards. The diagnostic performances of the imaging techniques were compared with McNemar's tests. Results: Primary tumours were identified in 59 (80.8%) of the 73 patients after surgery. Of these, 36 were found in the palatine tonsil, 11 in the base of the tongue, seven in the nasopharynx, and five in the pyriform sinus. The sensitivity (72.9%) and accuracy (71.2%) of 3D THRIVE for detecting primary tumours were higher than were those of SE T1-weighted MRI (49.2% and 53.4%, p≤0.002) or CT (36.4% and 46.4%, p≤0.001). The specificities of these techniques did not differ. The diagnostic performance of 3D THRIVE (area under the curve [AUC]=0.681) for detecting tumours did not differ from that of SE T1-weighted MRI or CT (AUC=0.671 and 0.608, p>0.05). Conclusion: 3D THRIVE was more sensitive at detecting primary tumours than was SE T1-weighted MRI or CT in patients with cervical metastases of unknown primary tumours. This sequence may improve biopsy and therapeutic planning in these patients.

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DO - 10.1016/j.crad.2017.10.020

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