Systematic review of the diagnostic value of magnetic resonance imaging for early glottic carcinoma

Additional Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) Improves Pre-Therapeutical Detection of Early-Stage (pT1a) Glottic Cancer: A Feasibility and Interobserver Reliability Study

(1) Background: Early-stage glottic cancer is easily missed on magnetic resonance imaging (MRI). Diffusion-weighted imaging (DWI) may improve diagnostic accuracy. Therefore, our aim was to assess the value of adding diffusion-weighted imaging with background body signal suppression (DWIBS) to pre-therapeutic MRI staging. (2) Methods: Two radiologists with 8 and 13 years of experience, blinded to each other's findings, initially interpreted only standard MRI, later DWIBS alone, and afterward, standard MRI + DWIBS in 41 patients with histopathologically proven pT1a laryngeal cancer of the glottis. (3) Results: Detectability rates with standard MRI, DWIBS only, and standard MRI + DWIBS were 68-71%, 63-66%, and 73-76%, respectively. Moreover, interobserver reliability was calculated as good (κ = 0.712), very good (κ = 0.84), and good (κ = 0.69) for standard MRI, DWIBS only, and standard MRI + DWIBS, respectively. (4) Conclusions: Standard MRI, DWIBS alone, and standard MRI + DWIBS showed an encouraging detection rate, as well as distinct interobserver reliability in the diagnosis of early-stage laryngeal cancer when compared to the definitive histopathologic report.

MR Imaging of Laryngeal and Hypopharyngeal Cancer

State-of-the-art MR imaging of the larynx and hypopharynx with high-resolution surface coils, parallel imaging techniques, and DWI has several advantages over CT for assessing submucosal tumor spread, in particular neoplastic involvement of the paraglottic space, laryngeal cartilages, and extralaryngeal soft tissues. Current diagnostic MR imaging criteria based on a combination of distinct imaging features on morphologic sequences combined with DWI allow improved discrimination between tumor, peritumoral inflammation, and fibrosis and, ultimately, an increased precision for submucosal tumor delineation, which is a key prerequisite for tailored treatment options. Multiparametric MR imaging with DWI has a higher diagnostic performance than CT.

Multifunctional Hybrid Nanoprobe for Photoacoustic/PET/MR Imaging-Guided Photothermal Therapy of Laryngeal Cancer

Laryngeal cancer is highly aggressive and insensitive to conventional targeted therapies, which often result in poor therapeutic outcomes. Image-guided precision therapy is a promising strategy in oncology that has superior safety and efficacy versus conventional therapies. Here, we present a multifunctional theranostic nanoplatform based on melanin-coated gold nanorod (GNR) that exhibits excellent multimodal imaging ability and photothermal effects. These attributes make the platform applicable for multimodal photoacoustic (PA)/positron emission tomography (PET)/magnetic resonance (MR) image-guided photothermal treatment of laryngeal cancer. The melanin nanoparticles markedly suppress the cytotoxicity of the template cetyltrimethylammonium bromide bilayer and conferred the GNR with excellent PET/MR imaging performances, due to their native biocompatibilities and strong affinities to metal ions. Moreover, the introduction of GNR to the melanin nanoparticles greatly improved the near-infrared absorbances and passive targeting capabilities, leading to exceptional PA imaging and photothermal ablation of tumors. The nanoplatform exhibits high stability and dispersity under physiological conditions. After intravenous injection, the nanoplatform could be precisely tracked in vivo and enabled laryngopharyngeal superficial cancer to be located and imaged. Combined photothermal therapy effectively ablated tumors with negligible side effects. Thus, this work presents a unique and biocompatible nanoplatform that allows multimodal imaging, high anti-tumor PTT efficacy, and negligible side effects in the treatment of laryngeal cancer.

Clinical value of (dedicated) 3 Tesla and 7 Tesla MRI for cT1 glottic carcinoma: A feasibility study

OBJECTIVE

To assess the feasibility of the clinical use of 3 Tesla and 7 Tesla Magnetic Resonance Imaging for early (cT1) glottic carcinoma, including structural assessment of technical image quality and visibility of the tumor; and if feasible, to correlate MRI findings to routine diagnostics.

METHODS

Prospective feasibility study. Twenty patients with primary clinical T1 glottic carcinoma underwent both routine clinical staging and CT. In addition, a 3 T and 7 T MRI protocol, developed for small laryngeal lesions, was performed in a 4-point immobilization mask, using dedicated surface coils. Afterwards, routine endoscopic direct suspension laryngoscopy under general anaesthesia was performed.

RESULTS

Only 2 of 7 (29%) of 7 T MRI scans were rated as moderate to good technical image quality. After exclusion of three patients with only mild to moderate dysplasia at the time of MRI, 13 of 17 (76%) of 3 T MRIs were of adequate technical image quality. Tumor visualization was adequate in 8 of 13 (62%) of patients with invasive squamous cell carcinomas. With exclusion of the four MRIs with motion artefacts, the tumor and its boundaries could be adequately seen in 8 of 9 (89%) patients with squamous cell carcinoma versus only one in four (25%) of patients with carcinoma in situ lesions.

CONCLUSIONS

7 Tesla MRI was considered not feasible. 3 Tesla MRI, with adequate patient selection, namely clinical exclusion of patients with a history of claustrophobia and inclusion of only histologically proven invasive squamous cell carcinoma, can be feasible. Especially with further improvement of MR image quality.

LEVEL OF EVIDENCE

2B, prospective diagnostic study.