Article Figures & Data
Figures
- FIG 1.
Concordance between NI-RADS category, T2 SI, and DWIs is demonstrated in this posttreatment MR imaging surveillance scan done after surgery and RTH for sinonasal squamous cell carcinoma. Coronal T2WI (A) and coronal contrast-enhanced T1WI (B) show a surgical bed discrete nodule (black arrow) that displays intermediate T2 SI (A) and postcontrast enhancement (B), fulfilling NI-RADS 3 and confirmed to be squamous cell carcinoma by histopathology. C. Axial ADC map of the surgical bed shows a corresponding low-ADC signal (black arrow). White arrows point to circumferential soft tissue thickening with sheetlike enhancement (B), which shows low T2 SI (A), absent diffusion restriction (D), and was confirmed to be posttreatment fibrous tissue.
- FIG 2.
The first post-CRTH MR imaging follow-up for a known case of nasopharyngeal carcinoma with perineural tumor spread (PNTS) showing discordant findings between NI-RADS category, T2 SI, and DWI. There is a clear primary tumor site at the nasopharynx (not demonstrated here), yet a regional non-nodal target was noted. A, Axial T2WI shows orbital apex dark T2 SI tissue keeping with fibrotic scarring (arrow). B, This lesion show discrete postcontrast enhancement (arrow) (secondary to PNTS along the ophthalmic nerve) categorized as NI-RADS 3. C, Axial ADC map of the surgical bed shows a corresponding facilitated diffusion (arrow). According to our proposed modifying rules, downgrading to category 2 was done. Follow-up by PET/CT showed no FDG uptake (not demonstrated here) that was confirmed to be post-RTH fibrotic scarring by further follow-up. Note the right temporal lobe after RTH injury.
Tables
Patients (n) Patients (%) Subsite Larynx 12 17.4 Oral cavity and oropharynx 25 36.2 Hypopharynx 2 2.9 Sinonasal 10 14.5 Skull base 1 1.4 Nasopharynx 13 18.8 Salivary 6 8.7 Pathologic grade Low 14 20.3 Moderate 37 53.6 High 18 26.1 Tumor stagea Tis 1 1.4 T1 7 10.14 T2 24 34.8 T3 22 31.9 T4 15 21.7 Scan order First follow-up 54 78.3 Second follow-up 8 10.1 Third follow-up 8 11.6 Note:—Tis indicates carcinoma in situ.
↵a American Joint Committee on Cancer.20
- Table 2:
Results of image analysis by T2 SI, DWI (qualitative and quantitative), NI-RADS, and NI-RADS rescoring for the primary targets
Standard of Reference Negative n (%) Positive n (%) NI-RADS NI-RADS 1 20 (46.51) 1 (3.85) NI-RADS 2 15 (34.88) 3 (11.54) NI-RADS 3 8 (18.6) 22 (84.62) T2 SI Isointense to surrounding tissue 4 (9.3) 1 (3.85) Dark 15 (34.88) 1 (3.85) Intermediate 5 (11.63) 24 (92.31) High 19 (44.19) 0 (0) DWI Facilitated 39 (90.7) 2 (7.69) Restricted 4 (9.3) 24 (92.31) NI-RADS combined with T2 and DWI NI-RADS 1 30 (69.77) 1 (3.85) NI-RADS 2 10 (23.26) 2 (7.69) NI-RADS 3 3 (6.98) 23 (88.46) - Table 3:
Diagnostic performance of T2 SI, DWI (qualitative and quantitative), NI-RADS, and NI-RADS rescoring for the detection of LTR for the primary targets
T2 SI DWI with ADC ≤1.3 NI-RADS NI-RADS-DWI-T2 SI TP (n) 24 24 22 23 TN (n) 38 39 35 40 FP (n) 5 4 8 3 FN (n) 2 2 4 3 Sensitivity (%) (95% CI) 92.31 (74.87–99.05) 92.3 (74.87–99.05) 84.62 (65.13–95.64) 88.46 (69.85–97.55) Specificity (%) (95% CI) 88.37 (74.92–96.11) 90.7 (77.86–97.41) 81.4 (66.60–91.61) 93.02 (80.94–98.54) PPV (%) (95% CI) 82.76 (67.64–91.68) 85.71 (70.10–93.89) 73.33 (59.03–84.00) 88.46 (71.84–95.84) NPV (%) (95% CI) 95.00 (83.32–98.64) 95.12 (83.69–98.67) 89.74 (77.84–95.61) 93.02 (82.10–97.49) Accuracy (%) (95% CI) 89.86 (80.21–95.82) 91.30 (82.03–96.74) 82.61 (71.59–90.68) 91.30 (82.03–96.74) Note:—TP indicates true-positive; TN, true-negative.
- Table 4:
Agreement between DWI (qualitative and quantitative), T2 SI, NI-RADS, and NI-RADS combined with DWI and T2 SI for the primary targets and the standard of reference
Standard of Reference Agreement Negative n (%) Positive n (%) Kappa 95% CI P Value DWI Restricted 4 (9.3) 24 (92.31) 0.818 0.68–0.96 <.001 Facilitated 39 (90.7) 2 (7.69) T2 SI Intermediate 5 (11.63) 24 (92.3) 0.789 0.64–0.94 <.001 No abnormality; low or high SI 38 (88.37) 2 (7.69) NI-RADS combined with T2 and DWI Category 3 3 (6.98) 23 (88.46) 0.815 0.67–0.96 <.001 Categories 1 and 2 40 (93.02) 3 (11.54) NI-RADS Category 3 8 (18.6) 22 (84.62) 0.641 9.46–0.82 <.001 Categories 1 and 2 35 (81.4) 4 (15.38)
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