CT Perfusion in Evaluation of Cervical Lymph Node Metastasis in Head and Neck Malignancies: A Cross-sectional Study
Introduction: Though, many cross-sectional modalities are available for evaluation of cervical lymph node metastasis but their results are highly variable. There is paucity of the literature in India, regarding lymph nodal assessment using Computed Tomography (CT) perfusion in head and neck mali...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2022-10-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/17075/56097_CE(AD)_F(SS)_PF1(SC_SS)_PFA(SS)_PB(SC_SS)_PN(SS).pdf |
| Summary: | Introduction: Though, many cross-sectional modalities are
available for evaluation of cervical lymph node metastasis but
their results are highly variable. There is paucity of the literature
in India, regarding lymph nodal assessment using Computed
Tomography (CT) perfusion in head and neck malignancies even
though, there is high incidence of oral cancer in India.
Aim: To assess the role of Computed Tomography Perfusion
(CTP) in evaluation of cervical lymph nodes in head and neck
malignancies, by using CT perfusion parameters as compared
to histopathology.
Materials and Methods: This cross-sectional study was
conducted in the Department of Radiodiagnosis in collaboration
with the Department of Surgery and Pathology at Vardhman
Mahavir Medical College and Safdarjung Hospital, Delhi, India,
from October 2017 to April 2019. The study included 30 newly
diagnosed head and neck cancer patients, with 46 nodes
planned for surgical neck dissection. Computed tomography
scan of neck was acquired using Siemens Somatom Definition
Flash 256CT scanner. Reconstruction and post processing
was performed on workstation and perfusion parameters were
obtained to generate the CT perfusion maps. Differentiation
between benign and malignant lymph nodes was done, on the
basis of CT perfusion parameters such as Blood Flow (BF),
Blood Volume (BV), Mean Transit Time (MTT) and Permeability
Surface (PS), which were compared with histopathological
findings of resected lymph nodes. McNemar’s test was applied for comparison and statistical analysis. Receiver Operating
Characteristic (ROC) curve of quantitative parameters were
obtained, for the detection of sensitivity, specificity, Positive
Predictive Value (PPV), Negative Predictive Value (NPP) and
diagnostic accuracy.
Results: Out of 46 nodes, 23 were metastatic and 23 were non
metastatic. The average value of BF in metastatic nodes was
174.61±71.76 mL/100g/min, BV was 16.32±11.9 mL/100g,
MTT was 4.83±2.54 seconds and PS was 49.3±28.59
mL/100g/min. The average values for non metastatic nodes
were: BF 88.06±34.4 mL/100g/min, BV: 9.89±7.63 mL/100g,
MTT: 13.11±18.58 seconds and PS: 37.07±29.26 mL/100g/
min. The differences between the parameters like blood flow
(p-value <0.0001), blood volume (p-value=0.005) and MTT
(p-value=0.002) in malignant and benign nodes were significant.
In case of blood flow, sensitivity was 82.61% and diagnostic
accuracy was 84.78%. In case of blood volume, sensitivity was
91.30% and diagnostic accuracy was 73.91%. In case of mean
transit time, sensitivity was 56.52% and diagnostic accuracy
was 73.91%. In case of permeability surface, sensitivity was
91.30% and diagnostic accuracy was 67.39%.
Conclusion: Blood flow and blood volume values were
significantly increased in metastatic cervical lymph nodes
as compared to non metastatic nodes, whereas MTT was
significantly low. Permeability surface showed equivocal
results. |
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| ISSN: | 2249-782X 0973-709X |