Performance of NI-RADS on CECT Alone to Predict Recurrent Head and Neck Squamous Cell Carcinoma after Chemoradiotherapy: Added Value of RECIST 1.1

Abstract

Background The Head and Neck Imaging Reporting and Data System (NI-RADS) is a standardized reporting format for the categorization of the degree of suspicion for recurrent head and neck malignancies on positron emission tomography/computed tomography. Purpose The purpose of our study was to analyze the efficacy of the NI-RADS rating scale and criteria for contrast-enhanced computed tomography (CECT) alone in predicting the local and regional recurrence of malignancies after chemoradiotherapy. Material and Methods CECT of the patients with head and neck cancers receiving radiotherapy and concurrent chemotherapy as a primary treatment was obtained 3 months after the completion of radiotherapy and NI-RADS scoring was done using components of Response Evaluation Criteria in Solid Tumors (RECIST 1.1) criteria. Their management was guided according to the recommendations based on their NI-RADS score. Results Thirty patients with squamous cell carcinoma of the neck were included in this study. The positive or negative status of the recurrent disease was based on biopsy results or follow-up protocol as recommended in NI-RADS rating scale. Fifteen patients had path proven recurrence at the primary tumor site. For primary tumor site, disease persistence rates of 4% for NI-RADS 1, 24% for NI-RADS 2, and 80% for NI-RADS 3 scores were seen. Five patients had recurrent lymph nodal disease. For lymph nodal assessment, NI-RADS categories 1, 2, and 3 revealed nodal disease recurrence rates of 5.3, 25, and 66.7%, respectively. Conclusion CECT alone may be used to assign the NI-RADS rating scale using RECIST 1.1 criteria to predict the presence or absence of recurrent tumor in patients with neck malignancies.

Keywords: CT; adults; head/neck; larynx; neoplasms-primary.

Fig. 1

Expected postradiation changes. Axial sections of follow-up computed tomographic scan of patients at 3 months after completion of radiotherapy showing ( A ) thickening of skin and platysma, ( B ) reticulation of subcutaneous fat ( arrow ), ( C ) thickening ( calipers ) of pharyngeal wall, and ( D ) increased preepiglottic fat ( arrow ).

Fig. 2

Flowchart summarizing the inclusion of the patients and their Neck Imaging-Reporting and Data System (NI-RADS) categorization.

Fig. 3

Follow-up computed tomographic scans of postradiotherapy carcinoma of base of tongue. ( A ) Neck Imaging-Reporting and Data System (NI-RADS) 1. ( B ) NI-RADS 2a—Asymmetrical mucosal enhancement on left side ( white arrow ). ( C ) NI-RADS 2b—nonenhancing soft tissue lesion on left side ( black arrow ). ( D ) NI-RADS 3—moderately enhancing mass lesion on right side ( curved white arrow ).

Fig. 4

Follow-up computed tomographic scans of postradiotherapy carcinoma of pyriform sinus. ( A ) Neck Imaging-Reporting and Data System (NI-RADS 1). ( B ). NI-RADS 2a—asymmetrical mucosal enhancement on right side ( white double arrow ). ( C ) NI-RADS 2b—minimally enhancing soft tissue lesion on left side ( white arrow ), subsequently positive for recurrent disease. ( D ) NI-RADS 3—frankly enhancing soft tissue lesion on left side ( black arrow ).

Fig. 5

Follow-up computed tomographic scans of postradiotherapy supraglottic carcinoma. ( A ) Neck Imaging-Reporting and Data System (NI-RADS) 2a—anterior focal mucosal enhancement ( short arrow ), negative for recurrent disease. ( B ) NI-RADS 2b—nonenhancing increased soft tissue bulk ( white arrow ). ( C ) NI-RADS 3—irregularly thickened epiglottis and supraglottic mucosa on the left side ( double black arrow ).

Fig. 6

Follow-up computed tomographic scans of postradiotherapy glottic carcinoma. ( A ) Neck Imaging-Reporting and Data System (NI-RADS 1). ( B ) NI-RADS 2a—asymmetrical mucosal enhancement on right side anteriorly ( white arrow ). ( C ) NI-RADS 2b—nonenhancing left-sided soft tissue ( black arrow ). ( D ) NI-RADS 3—enhancing lesion on left side posteriorly ( curved black arrow ).

Fig. 7

Neck Imaging-Reporting and Data System (NI-RADS). Follow-up computed tomographic scans of patients at 3 months after completion of radiotherapy showing ( A ) small less than 1 cm lymph node (NI-RADS 1) ( arrow ), negative for nodal recurrent disease; ( B ) marginally enlarging lymph node ( arrow ) without significant postcontrast enhancement (NI-RADS 2), negative for nodal recurrent disease; and ( C ) significantly enlarging lymph node ( arrow ) with central necrosis (NI-RADS 3), positive for nodal recurrent disease.