ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title MRI Has Greater Diagnostic Value for the Detection of Head and Neck Cancers Than Other Imaging Modalities Such as CT or CBCT
Clinical Question In patients with head and neck cancer, is MRI a better imaging modality than CT in diagnosing and grading tumors?
Clinical Bottom Line For patients with head and neck cancer, CT is much less effective than MRI in detecting the presence of cancer. This is based on two meta-analyses of several large randomized controlled trials and a literature review showing that MRI has a higher sensitivity with respect to the assessment of soft tissues; can effectively detect both local lymph node metastases and distant metastases of oral cancers; can differentiate between metastases; and can assess the size of lymph node clusters.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 28542622Moreira/201724 primary studies; 1,403 oral cancer lesionsMeta-analysis
Key resultsThe three types of MRI exhibited satisfactory accuracy compared to biopsy. In this study dynamic contrast-enhanced (DCE) MRI had the highest sensitivity: global sensitivity 84.0% (95% CI: 76.2%–90.1%) and global specificity 89.5% (95% CI: 84.7%–93.2%). Diffusion-weighted (DW) MRI had the highest specificity: global sensitivity 76.4% (95% CI: 67.3%–83.9%) and global specificity 91.3% (95% CI: 87.3%–94.4%). Traditional MRI exhibited the lowest values for all parameters: global sensitivity 72.5% (95% CI: 66.4%–78.0%) and global specificity 86.6% (95% CI: 84.0%–88.9%).
#2) 25397614Li/201416 studies; 490 participantsMeta-analysis
Key resultsThis study showed that MRI has an acceptable diagnostic value in detecting mandibular involvement caused by head and neck cancers; it has higher sensitivity but lower specificity than CT in diagnosing patients with mandibular invasion. In diagnosis of mandibular involvement by oral cancers, MRI had a pooled sensitivity of 78% (95% CI: 72%-83%)and a pooled specificity of 83% (95% CI: 77%–87%). In detection of mandibular bone marrow invasion MRI had a sensitivity of around 95% to 100% and specificity of around 57.1% to 70.6%.
#3) 28439324Palasz/2017N/ALiterature review
Key resultsIn order to determine the site and size of the tumor, CT and MRI should be performed as initial studies, since they can help to determine the involvement of soft tissues and bones. For the evaluation of the regional lymph nodes, MRI is more helpful as it can effectively detect local lymph node metastases (and assess their size) as well as distant metastases of oral cancers, and it can differentiate between them. However, for bone evaluation CT is more helpful.
Evidence Search Search ((((MRI) OR Magnetic resonance imaging)) AND (((head and neck cancer)) OR oral cancer)) AND ((diagnosis) OR grading) Filters: Review; Free full text; Publication date from 2015/01/01 to 2017/12/31; Humans
Comments on
The Evidence
Validity: The limitation of the MRI modality is the variability among the available MRI methods, which has affected their selection for clinical use. This was evident in the studies included in the systematic reviews (Moreira/2017 and Li/2014) since the type of MRI and the magnetic field strength used were not standardized, nor were the criteria for malignancy (various stages and levels of cancer). In addition to variation in the magnetic field strength applied, the imaging analysis protocols varied among the included studies. Another limitation is that in patients with prostheses in the facial skeleton such as as amalgam fillings, dental crowns, tooth bridges, etc., MRI can be disturbed by these artifacts. In the systematic review by Li/2014 there was possible bias during the review process as the authors may have unintentionally failed to include all eligible studies, which may influence the credibility of the conclusion. Another limitation is the clinical heterogeneities among the included studies. Although they conducted a meta-regression analysis, still some variables could not be quantitatively detected. Other limitations were inherent diversity of studies, small sample sizes, high risk for biases as well as the low number of studies for assessing MRI's ability to identify mandibular medullary and inferior alveolar canal invasion. Further studies in this area are needed. Perspective: Both CT and MRI have acceptable diagnostic value when used to detect or diagnose head and neck cancer, but MRI provides more detail when grading cancer as it has more sensitivity in assessing soft tissues and lymph nodes. It has the ability to determine the extent of metastasis and subsequently it can better grade cancer. However, both modalities can be used for initial diagnosis.
Applicability MRI is widely available at public health services and is feasible for patients, but the limitations of this modality such as discomfort has affected its selection for clinical use. However, the advantages of MRI outweigh these limitations. Besides its high sensitivity and accuracy in detecting and grading cancer and metastases, it can assist in treatment planning - such as planning the scope of resection and further reconstruction, graft implantation, and differentiation between disease recurrence and scars after surgery - giving the patients optimum benefits and providing them with helpful results.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery)
Keywords MRI, head and neck cancer, diagnosis, grading, malignancy, CT, CBCT
ID# 3292
Date of submission: 11/20/2017spacer
E-mail sharaf@uthscsa.edu
Author Rana Sharaf, B.D.S
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