Assessment of tumor depth in oral tongue squamous cell carcinoma with multiparametric MRI: correlation with pathology

Abstract

Objectives: To compare the correlation of depth of invasion (DOI) measured on multiple magnetic resonance imaging (MRI) sequences and pathological DOI, in order to determine the optimal MRI sequence for measurement.

Methods: A total of 122 oral tongue squamous cell carcinoma (OTSCC) patients were retrospectively analyzed, who had received preoperative MRI and surgical resection. DOIs measured on fat-suppressed T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), dynamic enhanced-T1 high-resolution insotropic volume examination (e-THRIVE), and contrast-enhanced fat-suppressed T1WI (CE-T1WI) were respectively compared to those measured in pathologic specimens. The cutoff value of the best correlated MRI sequence was determined, and the T staging accuracy of MRI-derived DOI was evaluated.

Results: DOI derived from e-THRIVE showed the best correlation (r = 0.936, p < 0.001) with pathological DOI. The area under the curve values of MRI-derived DOI distinguishing T1 stage from T2 stage and distinguishing T2 stage from T3 stage were 0.969 and 0.974, respectively. The T staging criteria of MRI-derived DOI were 6.2 mm and 11.4 mm, with a staging accuracy of 86.9% compared to pathological DOI criteria of 5 mm and 10 mm.

Conclusion: E-THRIVE was the optimal MR sequence to measure the MR-derived DOI, and DOI derived from e-THRIVE could serve as a potential cut-off value as a clinical T staging indicator of OTSCC.

Key points: • Multiparametric MRI helps radiologists to assess the neoplasm invasion in patients with oral tongue squamous cell carcinoma. • Retrospective study indicated that measurement was most accurate on enhanced-T1 high-resolution insotropic volume examination dynamic contrast enhancement images. • T staging of oral tongue squamous cell carcinoma was accurate according to the dynamic contrast enhancement MRI-derived depth of invasion.

Keywords: Multiparametric MRI; Neoplasm Invasion; Oral tongue squamous cell carcinoma.

Fig. 1

A 55-year-old male with OTSCC in the right border of tongue. The pathological DOI was 7.0 mm. The DOIs measured on T2WI, DWI, e-THRIVE, and CE T1WI were 15.0 mm, 8.1 mm, 8.6 mm, and 15.6 mm, respectively. a The schematic diagram of DOI measurement on T2WI. b On ADC map, the tumor showed hypointensity (white star) and edema showed hyperintensity (black star). c The tumor showed significant enhancement on the e-THRIVE. The margin of tumor was well-defined (black arrow). d Both tumor and perilesional edema showed hyperintensity on contrast-enhanced T1WI

Fig. 2

Correlation between each MRI sequence based DOI and pathological DOI. a T2WI. b DWI. c E-THRIVE. d CE T1WI

Fig. 3

ROCs for the differentiating performance of e-THRIVE-derived DOI among the defined groups of OTSCC based on the eighth edition of the AJCC staging. a T1 stage vs. T2 stage. b T2 stage vs. T3 stage