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First published online April 26, 2006
British Journal of Radiology (2006) 79, 681-687
© 2006 British Institute of Radiology
doi: 10.1259/bjr/89661809
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Evaluation of the larynx for tumour recurrence by diffusion-weighted MRI after radiotherapy: initial experience in four cases

V Vandecaveye, MD 1 F de Keyzer, MSc 1 V Vander Poorten, MD, PhD 2 K Deraedt, MD 3 H Alaerts, MD 3 W Landuyt, PhD 4 S Nuyts, MD, PhD 5 and R Hermans, MD, PhD 1

Departments of 1Radiology 2Otorhinolaryngology, Head and Neck Surgery 3Pathology 5Radiation Oncology, University Hospitals Leuven, Leuven and 4Department of Experimental Radiobiology/LEO, Katholieke Universiteit Leuven, Belgium


Figure 1
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  		Figure 1. (a) Transverse CT image and (b) transverse contrast-enhanced T1 weighted MR image show an ulcerated lesion in the right false vocal cord (arrows), corresponding to (c) a hyperintense rim on the b1000 image (arrows) and (d) a hypointense rim on the apparent diffusion coefficient (ADC) map (arrows). (e) This rim corresponds histologically to hypercellular cancer tissue (T) in the lateral part of the false vocal cord; medially, a necrotic ulcer (NU) is present. (f) A more detailed view of the tumour shows multiple nests of densely packed squamous cell carcinoma (SCC) cells.

 

Figure 2
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  		Figure 2. (a) Transverse CT image and (b) transverse contrast-enhanced T1 weighted MR image show thickening and increased contrast enhancement of the left vocal cord (arrows), corresponding to a hypermetabolic spot on (c) coronal FDG-PET image (arrow). The lesion is detected on (d) the b1000 DW-MR image (arrows) as a hyperintensity rim showing low intensity on (e) the apparent diffusion coefficient (ADC) map (arrows). (f) Histological section shows corresponding tumoral infiltration (arrows).

 

Figure 3
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  		Figure 3. (a) Transverse CT image and (b) transverse contrast-enhanced T1 weighted MR image show diffuse thickening and contrast-enhancement of the false vocal cords, without focal nodular mass. Small air bubble adjacent to the right arytenoid can be appreciated (a, arrow). (c) Coronal FDG-PET image shows tracer uptake at the laryngeal level. No asymmetric hyperintensity is revealed by (d) b1000 and (e) the ADC map shows diffuse hyperintensity of the soft tissues at the same level. Histological examination reveals necrosis, inflammation and purulent infiltration, without evidence for tumour recurrence. (f) Detailed histological image shows granulation tissue and inflammatory infiltrate.

 

Figure 4
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  		Figure 4. (a) Transverse non-fat saturated T1 weighted MR image before and (b) fat-saturated image after administration of contrast agent at the level of the vocal cords showing right-sided soft tissue ulceration (b, arrowhead) and tissue swelling on the left side (b, arrows), not allowing exclusion of tumour recurrence. Both (c) b1000 image and (d) apparent diffusion coefficient (ADC) map do not show a restrictive focal lesion, supporting the diagnosis of laryngeal necrosis without tumour recurrence. (e) Five and (f) 10 times magnified histopathological sections show necrotic tissue (N), and stromal tissue with reactive changes (S); multiple neutrophils and giant cells are visible, suggesting profound inflammatory reaction. No tumoral tissue was found.

 




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