title: Diffusion-weighted imaging in head and neck squamous cell carcinomas: a systematic review.
abstract: BACKGROUND
  The purpose of this study was for us to review diagnostic accuracy of diffusion-weighted imaging (DWI) in primary head and neck squamous cell carcinomas (HNSCCs), detection of metastatic lymph nodes, and recurrences.
  
  
  METHODS
  A systematic review for studies concerning DWI was performed.
  
  
  RESULTS
  Ten studies fulfilled inclusion criteria. All studies showed significant higher "apparent diffusion coefficient" (ADC) in benign compared to malignant lesions. ADC thresholds for optimal discrimination varied. In detection of primary HNSCC, the accuracy of DWI ranged from 66% to 86%. In metastatic lymph nodes, the accuracy of DWI was 85% to 91% and the negative predictive value (NPV) was higher than 91%. For recurrences, the accuracy of DWI was 78% to 100% and the NPV ranged from 77% to 100%.
  
  
  CONCLUSIONS
  DWI showed consistent high accuracy and high NPV. However, available literature is sparse and varying ADC thresholds were reported. Compared to current imaging techniques, DWI showed the most potential in lymph node staging and detection of recurrences.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands.
authors.forename: Juliette P
authors.initials: JP
authors.lastname: Driessen
authors.forename: Paulina M W
authors.initials: PM
authors.lastname: van Kempen
authors.forename: Geert J
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: Marielle E P
authors.initials: ME
authors.lastname: Philippens
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pameijer
authors.forename: Inge
authors.initials: I
authors.lastname: Stegeman
authors.forename: Chris H J
authors.initials: CH
authors.lastname: Terhaard
authors.forename: Luuk M
authors.initials: LM
authors.lastname: Janssen
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D000077195:Squamous Cell Carcinoma of Head and Neck; D017749:Total Quality Management
keywords: DWI; MRI; diagnostic accuracy; head and neck cancer; imaging