Cutting-Edge Head and Neck Imaging Optimizes Healthcare in Clinical Practice

Radiation treatment such as intensity-modulated radiotherapy (IMRT) and organ-sparing surgery—frequently combined with chemotherapy—have increased the need for cutting-edge imaging applications in the head and neck during pre- and post-treatment stages. The increasing capability of magnetic resonance imaging (MRI) to provide functional imaging evaluation of head and neck cancers for primary staging, recurrence imaging, or treatment prediction has been shown to have great potential.

Prof. Vincent Vandecaveye, from the department of radiology at the University Hospital Leuven (Belgium), presented his findings March 11, 2013, at the European Congress of Radiology (ECR), held in Vienna (Austria). “I believe functional MRI techniques can provide a better correlate to metabolic imaging than the classic anatomical imaging sequences. The latter are of major interest in the development of hybrid PET [positron emission tomography]-MRI systems. Functional MRI [fMRI] is quite difficult to perform in the head and neck, from a technical point of view, but the vast progress made in MRI technology, including hardware and software developments, and the gradual increase in knowledge and experience in several centers will improve it,” said Prof. Vandecaveye, who chaired the session.

In the fight against cancer, physicians have a tendency to look only at the approaches offered by technology and science, which have unquestionably become very sophisticated and effective in modern medicine. However, modern clinical practice also depends on a multidisciplinary approach, which is only possible through the establishment of clear communication strategies and teamwork within a hospital or department, Prof. Vandecaveye explained.

“I think the single most important component is direct communication with your clinician. Although there are clear guidelines for diagnosis and treatment, techniques and habits may vary depending on the individual surgeon, oncologist, or radiation oncologist. Your report should of course primarily contain what we usually do in the majority of cases, such as describing the extent of lesions. In addition to that, it is useful to indicate abnormalities that are decisive for treatment and highlight them,” Prof. Vandecaveye recommended, adding that radiologists should join tumor boards to discuss cases and become more involved in diagnostic management and treatment planning.

Radiologists must also realize the need for cost efficiency and its influence on the quality of diagnosis. It is important to combine knowledge of the different imaging modalities’ abilities with clinical guidelines, which are quite well defined for head and neck cancer. For instance, the risk of distant metastases increases substantially with nodal metastases at the lower neck levels, and for these patients more stringent staging should be conducted to rule out distant metastases before beginning local therapy, which should be done with PET-computed tomography (CT). However, there is no need to carry out advanced imaging for distant staging in patients with low-risk locoregional disease, and in these cases, costs can be safely decreased by just using chest X-ray and ultrasound of the liver for distant staging.

“Sometimes these discussions about cost-effectiveness worry me as they create a false idea of a so-called one-stop-shop imaging modality that can solve all diagnostic problems. Of course, this would be the Holy Grail, but I have rarely seen this happen in clinical reality. Radiologists should combine their knowledge of guidelines with their common sense, clinical abilities, and reasoning. We should be aware, however, to what extent advanced imaging truly helps the patient and clinician. We probably have a better chance of reducing costs by trying to avoid overdiagnosis,” Prof. Vandecaveye concluded.

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University Hospital Leuven