The Diagnostic Value of CEUS in Assessing Non-Ossified Thyroid Cartilage Invasion in Patients with Laryngeal Squamous Cell Carcinoma

Abstract

Background: Accurate assessment of thyroid cartilage invasion in squamous cell carcinoma (SCC) of the larynx remains a challenge in clinical practice. The aim of this study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS), contrast-enhanced computed tomography (CECT), and magnetic resonance imaging (MRI) in the detection of non-ossified thyroid cartilage invasion in patients with SCC. Methods: CEUS, CECT, and MRI scans of 27 male patients with histologically proven SCC were evaluated and compared. A total of 31 cases were assessed via CEUS and CECT. The MR images of five patients and six cases were excluded (one patient had two suspected sites), leaving twenty-five cases for analysis via MRI. Results: CEUS showed the highest accuracy and specificity compared with CECT and MRI (87.1% vs. 64.5% and 76.0% as well as 84.0% vs. 64.0% and 72.7%, respectively). The sensitivity and negative predictive value of CEUS and MRI were the same (100%). CEUS yielded four false-positive findings. However, there were no statistically significant differences among the imaging modalities (p > 0.05). Conclusions: CEUS showed better diagnostic performance than CECT and MRI. Therefore, CEUS has the potential to accurately assess non-ossified thyroid cartilage invasion and guide appropriate treatment decisions, hopefully leading to improved patient outcomes.

Keywords: CECT; CEUS; MRI; laryngeal cancer; non-ossified thyroid cartilage.

Figure 1

True-positive findings through axial CECT and CEUS. (a) In this CECT image, a partial bilateral ossification of the thyroid cartilage with a similar tissue density between the tumor (T) and the non-ossified thyroid cartilage (red arrow) can be seen; (b) CEUS image taken after intravenous contrast material administration showing the enhancement of the tumor (T) with invasion of the right anterior part of the non-ossified thyroid cartilage (asterisks); the adjacent hypoechogenic cartilage is non-invaded (white arrows).

Figure 2

Bilateral glottic cancer adjacent to the non-ossified thyroid cartilage lamina. (a) Axial CECT findings on the left side were false-positive for tumor invasion (red arrow). (b) CEUS image of the left side at the same level as (a) in the transverse plane shows true-negative findings, i.e., non-enhanced non-ossified cartilage (white arrows).

Figure 3

Supraglottic squamous cell carcinoma on the left side. (a) Axial CECT represents two sites, namely, sites that were false-positive anteriorly (yellow arrow) and true-positive posteriorly (red arrow), whereas MRI (b) contrast-enhanced high-resolution T1-weighted turbo spin echo Dixon and CEUS (c) findings were true-negative anteriorly (white arrow) and true-positive posteriorly (red arrows), respectively.

Figure 3

Supraglottic squamous cell carcinoma on the left side. (a) Axial CECT represents two sites, namely, sites that were false-positive anteriorly (yellow arrow) and true-positive posteriorly (red arrow), whereas MRI (b) contrast-enhanced high-resolution T1-weighted turbo spin echo Dixon and CEUS (c) findings were true-negative anteriorly (white arrow) and true-positive posteriorly (red arrows), respectively.

Figure 4

Supraglottic squamous cell carcinoma on the right side anteriorly adjacent to non-ossified cartilage inner lamina. (a) Axial CECT and (c) CEUS findings were false positive (red arrow) for tumor invasion of the thyroid cartilage, whereas MRI findings, as shown in (b), in axial contrast-enhanced high-resolution T1-weighted turbo spin echo Dixon images were true negative (white arrow).