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. 2023 Dec 22;85(Suppl 2):e97-e109.
doi: 10.1055/s-0043-1777793. eCollection 2024 Oct.

Diagnostic Accuracy of Contrast-Enhanced MRI for Detection of Perineural Spread in Head and Neck Cancer: A Systematic Review and Meta-Analysis

Pranav Sharma  1 , Aiyapa Ajjikuttira  1 , Eva Malacova  2 , Jennifer Gillespie  1
Affiliations

Diagnostic Accuracy of Contrast-Enhanced MRI for Detection of Perineural Spread in Head and Neck Cancer: A Systematic Review and Meta-Analysis

Pranav Sharma et al. J Neurol Surg B Skull Base. .

Abstract

Objectives The aim of this study was to determine the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (CE-MRI) for the detection of perineural spread (PNS) in head and neck cancer patients. Methods A systematic review of PubMed, Embase, Scopus, Web of Science and Cochrane Library databases was performed up to May 20, 2022. We included diagnostic accuracy studies that used CE-MRI for the diagnosis of PNS in patients with head and neck cancer, using histopathology from surgical specimens as the reference standard. Potential bias and applicability of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADUS-2) tool. Pooled joint effect sizes of sensitivity and specificity were calculated by applying bivariate random-effects meta-analysis model. Results Nine studies with 259 patients were included. The pooled sensitivity and specificity of CE-MRI for detecting PNS were 89% (95% confidence interval [CI]: 73-96) and 83% (95% CI: 73-90), respectively. Stratifying by MRI strength, 1.5 T had a higher sensitivity of 97% (95% CI: 47-100) compared with 3 T, which had a sensitivity of 83% (95% CI: 72-90). Both 1.5- and 3-T MRI had a similar specificity in detecting PNS of 85% (95% CI: 63-95) and 84% (95% CI: 75-91), respectively. Conclusions CE-MRI provides good diagnostic test accuracy for the detection of PNS in head and neck cancer. Current evidence suggests 1.5-T MRI provides greater sensitivity compared with 3-T MRI.

Keywords: contrast-enhanced MRI; head and neck cancer; magnetic resonance imaging; meta-analysis; perineural spread; systematic review.

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Conflict of interest statement

Conflict of Interest Dr. Jennifer Gillespie is the recipient of an AU$23,560.00 Diamond Care Grant as part of a study investigating the utility of 7-T MRI in imaging PNS in head and neck cancer. The remaining authors have no disclosures to declare.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study selection process illustrating search results, studies reviewed and study inclusions and exclusions.
Fig. 2
Fig. 2
Forest plot of sensitivity and specificity, stratified by magnetic resonance imaging (MRI) strength. CI, confidence interval; DFN, descending facial nerve; SF, stylomastoid foramen.
Fig. 3
Fig. 3
Hierarchical summary receiver operating characteristics (HSROC) curve of diagnostic performance of contrast-enhanced magnetic resonance imaging (CE-MRI).
Fig. 4
Fig. 4
Deek's funnel plot asymmetry test for publication bias. ESS
Fig. 5
Fig. 5
Hierarchical summary receiver operating characteristics (HSROC) curve of diagnostic performance of 1.5- and 3-T magnetic resonance imaging (MRI).
See this image and copyright information in PMC

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