title: Diffusion-weighted-preparation (D-prep) MRI as a future extension of SPECT/CT based surgical planning for sentinel node procedures in the head and neck area?
abstract: Even when guided by SPECT/CT planning of nodal resection in the head-and-neck area is challenging due to the many critical anatomical structures present within the surgical field. In this study the potential of a (SPECT/)MRI-based surgical planning method was explored. Hereby MRI increases the identification of SNs within clustered lymph nodes (LNs) and vital structures located adjacent to the SN (such as cranial nerve branches).
  
  
  
  SPECT/CT and pathology reports from 100 head-and-neck melanoma and 40 oral cavity cancer patients were retrospectively assessed for SN locations in levels I-V and degree of nodal clustering. A diffusion-weighted-preparation magnetic resonance neurography (MRN) sequence was used in eight healthy volunteers to detect LNs and peripheral nerves.
  
  
  
  In 15% of patients clustered nodes were retrospectively shown to be present at the location where the SN was identified on SPECT/CT (level IIA: 37.2%, level IIB: 21.6% and level III: 15.5%). With MRN, improved LN delineation enabled discrimination of individual LNs within a cluster. Uniquely, this MRI technology also provided insight in LN distribution (23.2±4 LNs per subject) and size (range 21-372mm(3)), and enabled non-invasive assessment of anatomical variances in the location of the LNs and facial nerves.
  
  
  
  Diffusion-weighted-preparation MRN enabled improved delineation of LNs and their surrounding delicate anatomical structures in the areas that most often harbor SNs in the head-and-neck. Based on our findings a combined SPECT/MRI approach is envisioned for future surgical planning of complex SN resections in this region.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: Buckle
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Gijs H
authors.initials: GH
authors.lastname: KleinJan
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: Engelen
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Nynke S
authors.initials: NS
authors.lastname: van den Berg
authors.affiliation: Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marco C
authors.initials: MC
authors.lastname: DeRuiter
authors.affiliation: Department of Radiotherapy, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Uulke
authors.initials: U
authors.lastname: van der Heide
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Renato A
authors.initials: RA
authors.lastname: Valdes Olmos
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Andrew
authors.initials: A
authors.lastname: Webb
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.affiliation: Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Alfons J
authors.initials: AJ
authors.lastname: Balm
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: f.w.b.van_leeuwen@lumc.nl.
authors.forename: Fijs W B
authors.initials: FW
authors.lastname: van Leeuwen
mesh_terms: D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000473:pathology*; D064368:Healthy Volunteers; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D064847:Multimodal Imaging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
keywords: Diffusion-weighted-preparation MRI; Head-and-neck cancer; Nerve imaging; Sentinel node biopsy; Surgical planning