title: Diffusion-weighted and PET/MR Imaging after Radiation Therapy for Malignant Head and Neck Tumors.
abstract: Interpreting imaging studies of the irradiated neck constitutes a challenge because of radiation therapy-induced tissue alterations, the variable appearances of recurrent tumors, and functional and metabolic phenomena that mimic disease. Therefore, morphologic magnetic resonance (MR) imaging, diffusion-weighted (DW) imaging, positron emission tomography with computed tomography (PET/CT), and software fusion of PET and MR imaging data sets are increasingly used to facilitate diagnosis in clinical practice. Because MR imaging and PET often yield complementary information, PET/MR imaging holds promise to facilitate differentiation of tumor recurrence from radiation therapy-induced changes and complications. This review focuses on clinical applications of DW and PET/MR imaging in the irradiated neck and discusses the added value of multiparametric imaging to solve diagnostic dilemmas. Radiologists should understand key features of radiation therapy-induced tissue alterations and potential complications seen at DW and PET/MR imaging, including edema, fibrosis, scar tissue, soft-tissue necrosis, bone and cartilage necrosis, cranial nerve palsy, and radiation therapy-induced arteriosclerosis, brain necrosis, and thyroid disorders. DW and PET/MR imaging also play a complementary role in detection of residual and recurrent disease. Interpretation pitfalls due to technical, functional, and metabolic phenomena should be recognized and avoided. Familiarity with DW and PET/MR imaging features of expected findings, potential complications, and treatment failure after radiation therapy increases diagnostic confidence when interpreting images of the irradiated neck. Online supplemental material is available for this article.
authors.affiliation: From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Arthur
authors.initials: A
authors.lastname: Varoquaux
authors.affiliation: From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rager
authors.affiliation: From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Pavel
authors.initials: P
authors.lastname: Dulguerov
authors.affiliation: From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Karim
authors.initials: K
authors.lastname: Burkhardt
authors.affiliation: From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Ailianou
authors.affiliation: From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Minerva
authors.initials: M
authors.lastname: Becker
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016477:Artifacts; D001918:Brachytherapy / Q000009:adverse effects; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D003131:Combined Modality Therapy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D005355:Fibrosis; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006402:Hematologic Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D033162:Incidental Findings; D064847:Multimodal Imaging / Q000379:methods*; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D061766:Proton Therapy / Q000009:adverse effects; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012793:Sialadenitis / Q000000981:diagnostic imaging / Q000473:pathology; D013961:Thyroid Gland / Q000528:radiation effects
chemical_list: D000970:Antineoplastic Agents