Diagnostic performance of dynamic volume perfusion CT for differentiation of head and neck cancer from healthy tissue and post-therapeutic changes

Abstract

BACKGROUND: Post-therapeutic tissue is bradytrophic and thus has low perfusion values in PCT. In contrast, malignant tissue is expected to show higher perfusion values as cancer growth partially depends on angiogenesis. OBJECTIVES: This prospective study investigates perfusion computed tomography (PCT) for the post-therapeutic detection of cancer in the head and neck region. METHODS: 85 patients underwent PCT for 1) initial work-up of head and neck cancer (HNC; n=22) or 2) for follow-up (n=63). Regions of interest (ROIs) were placed in confirmed tumour, a corresponding location of benign tissue, and reference tissue. Perfusion was calculated using a single input maximum slope algorithm. Statistical analysis was performed with the Mann-Whitney U-test. RESULTS: PCT allowed significant differentiation of malignant tissue from post-therapeutic tissue after treatment for HNC (p=0.018). Significance was even greater after normalization of perfusion values (p=0.007). PCT allowed highly significant differentiation of HNC from reference tissue (p<0.001). CONCLUSIONS: PCT provides significantly distinct perfusion values for malignant and benign as well as post-therapeutically altered tissue in the head and neck area, thus allowing differentiation of cancer from healthy tissue. Our results show that PCT in conjunction with a standard algorithm is a potentially powerful HNC diagnostic tool.