J Korean Soc Radiol.  2013 Jul;69(1):11-22. 10.3348/jksr.2013.69.1.11.

The Role and Utility of Diffusion-Weighted Imaging in Assessment of Head and Neck Tumors: A Review Article

• Sol YL
• Kim HJ
• Lee BJ

• KMID: 2002885
• DOI: http://doi.org/10.3348/jksr.2013.69.1.11

Abstract

Conventional MRI and CT are the chosen imaging modalities when evaluating head and neck cancers; however, sometimes both diagnostic tools yield low sensitivity and accuracy in making the diagnosis, staging, and assessing the post-treatment response. This article reviews the role and utility of diffusion-weighted imaging (DWI) in assessing head and neck cancer. DWI is a technique which analyzes the structures of biologic tissues at a microscopic level. Apparent diffusion coefficient value, determined from DWI, can help detect the differences in the microstructures of tumor tissues and non-tumor tissues. Therefore, DWI is a useful technique in a clinical practice, which provides information of histopathological characterization, differential diagnosis, and stage of head and neck cancer and assessment of treatment response.

MeSH Terms

Diagnosis, Differential
Diffusion
Head
Head and Neck Neoplasms
Neck

Figure

• 

  Fig. 1 A 47-year-old woman with SCC in the tongue. Axial T2- (A) and contrast enhanced T1-weighted images (B) show a mass in the right lateral tongue (arrow). DWI with b value of 1000 (C) reveals high signal intensity of the mass. The mean ADC value within the lesion measured 0.914 × 10-3 mm2/s on the ADC map image (D, open arrow). Note.-ADC = apparent diffusion coefficient, DWI = diffusion-weighted imaging, SCC = squamous cell carcinoma

• 

  Fig. 2 A 5-year-old male with lymphangioma in the left cheek. Axial T2- (A), T1-weighted images (B) reveal a mass with heterogenous signal intensity (arrows). The mass is enhanced in the central portion on contrast enhanced T1-weighted image (C). The mean ADC value of the mass measured 1.936 × 10-3 mm2/s on the ADC map image (D, open arrow). Note.-ADC = apparent diffusion coefficient

• 

  Fig. 3 A 47-year-old female with Warthin's tumor in the left parotid gland. Axial T2-weighted image (A) shows a round bright signal intensity mass (arrow). On T1-weighted image (B) the mass reveals low signal intensity. The mass represents high signal intensity on the DWI (C, arrow) and the ADC map image (D, open arrow). The ADC value of the lesion measured 0.731 × 10-3 mm2/s. Note.-ADC = apparent diffusion coefficient, DWI = diffusion-weighted imaging

• 

  Fig. 4 MR images of diffuse large B-cell lymphoma (A-C) in a 71-year-old woman and SCC (D-F) in a 58-year-old woman. In both patients, masses are located in the left nasopharynx (arrow), revealing hypointensity on T2-weighted image (A, D) and hyperintensity on DWI (B, E). The ADC value measured 0.526 × 10-3 mm2/s in lymphoma (C, open arrow), which was lower than that of patient with SCC (F, 0.877 × 10-3 mm2/s, open arrow). Note.-ADC = apparent diffusion coefficient, DWI = diffusion-weighted imaging, SCC = squamous cell carcinoma

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  Fig. 5 A 64-year-old man with lymph nodal metastasis. Axial T2-weighted (A) and contrast enhanced T1-weighted images (B) reveal a 1-cm sized lymph node at the left level II, which is difficult to differentiate benign and malignant node. However, the node shows hyperintensity on DWI (C, arrow) and decreased ADC value (0.654 × 10-3 mm2/s) on the ADC map image (D, open arrow). Note.-ADC = apparent diffusion coefficient, DWI = diffusion-weighted imaging

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  Fig. 6 A 49-year-old man with squamous cell cancer in the left tongue. Axial T2-weighted (A) and contrast enhanced T1-weighted images (B) show a malignant mass in the left tongue base (arrow), biopsy-proven SCC. A large metastatic lymphadenopathy is also seen in the left level II. The node shows hyperintensity with central hypointensity on DWI (C). The ADC map (D) reveals low signal intensity of the enhanced peripheral part of the tumor with low ADC value (0.987 × 10-3 mm2/s, open arrow) representing a viable portion of the tumor. The non-enhancing central part of the tumor shows high signal intensity with high ADC value (1.597 × 10-3 mm2/s, asterisk) representing a necrotic portion of the tumor. Note.-ADC = apparent diffusion coefficient, SCC = squamous cell carcinoma

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  Fig. 7 A 71-year-old man with recurrent squamous cell cancer in the left maxillary sinus. Axial T1-weighted image (A) shows a mass at the lateral margin of previous resection site in the left maxillary sinus (arrows). On axial contrast T1-weighted image (B), the lesion is well-enhanced. The ADC map image (C) shows low signal intensity with a mean value of 0.581 × 10-3mm2/s, representing recurrence. Increased FDG uptake is noted in the lesion on PET/CT scan (D). Note.-ADC = apparent diffusion coefficient, FDG = fluorodeoxyglucose, PET/CT = positron emission tomography/CT

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  Fig. 8 A 54-year-old man with adenoid cystic carcinoma in the left hard palate. Initial contrast enhanced T1-weighted image (A) reveals an enhancing solid mass in the left palatal bone (arrows). Follow-up T1-weighted image (B) after post-radiation 1 1/2 year (B) shows markedly interval improving state. However, on the ADC map image at the same day (C), a focal area reveals diffusion restriction with a mean value of 0.74 × 10-3 mm2/s (open arrow), representing a remnant mass. The lesion is aggravated diffusely on the 5-month follow-up contrast enhanced T1-weighted image (D, arrows). Note.-ADC = apparent diffusion coefficient

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