title: Differentiating laryngeal carcinomas from precursor lesions by diffusion-weighted magnetic resonance imaging at 3.0 T: a preliminary study.
abstract: BACKGROUND
  Diffusion-weighted magnetic resonance imaging (DWI) has been introduced in head and neck cancers. Due to limitations in the performance of laryngeal DWI, including the complex anatomical structure of the larynx leading to susceptibility effects, the value of DWI in differentiating benign from malignant laryngeal lesions has largely been ignored. We assessed whether a threshold for the apparent diffusion coefficient (ADC) was useful in differentiating preoperative laryngeal carcinomas from precursor lesions by turbo spin-echo (TSE) DWI and 3.0-T magnetic resonance.
  
  
  METHODS
  We evaluated DWI and the ADC value in 33 pathologically proven laryngeal carcinomas and 17 precancerous lesions.
  
  
  RESULTS
  The sensitivity, specificity, and accuracy were 81.8%, 64.7%, 76.0% by laryngostroboscopy, respectively. The sensitivity, specificity, and accuracy of conventional magnetic resonance imaging were 90.9%, 76.5%, 86.0%, respectively. Qualitative DWI analysis produced sensitivity, specificity, and accuracy values of 100.0, 88.2, and 96.0%, respectively. The ADC values were lower for patients with laryngeal carcinoma (mean 1.195±0.32×10(-3) mm(2)/s) versus those with laryngeal precancerous lesions (mean 1.780±0.32×10(-3) mm(2)/s; P<0.001). ROC analysis showed that the area under the curve was 0.956 and the optimum threshold for the ADC was 1.455×10(-3) mm(2)/s, resulting in a sensitivity of 94.1%, a specificity of 90.9%, and an accuracy of 92.9%.
  
  
  CONCLUSIONS
  Despite some limitations, including the small number of laryngeal carcinomas included, DWI may detect changes in tumor size and shape before they are visible by laryngostroboscopy. The ADC values were lower for patients with laryngeal carcinoma than for those with laryngeal precancerous lesions. The proposed cutoff for the ADC may help distinguish laryngeal carcinomas from laryngeal precancerous lesions.
authors.affiliation: Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: De-Sheng
authors.initials: DS
authors.lastname: Shang
authors.forename: Ling-Xiang
authors.initials: LX
authors.lastname: Ruan
authors.forename: Shui-Hong
authors.initials: SH
authors.lastname: Zhou
authors.forename: Yang-Yang
authors.initials: YY
authors.lastname: Bao
authors.forename: Ke-Jia
authors.initials: KJ
authors.lastname: Cheng
authors.forename: Qin-Ying
authors.initials: QY
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000175:diagnosis; D012372:ROC Curve; D015203:Reproducibility of Results