Clinical Scorecard: A Global Assessment of the Use of Diffusion and Perfusion MRI Techniques in Head and Neck Imaging
At a Glance
Category
Detail
Condition
Head and neck lesions including malignant neoplasms and benign disease
Key Mechanisms
Diffusion-weighted imaging (DWI) measures molecular diffusivity and tissue microstructure; Perfusion-weighted imaging (PWI), especially dynamic contrast-enhanced (DCE) MRI, evaluates microcirculatory tissue characteristics and vascular architecture
Target Population
Patients undergoing head and neck MRI for diagnosis, lesion characterization, and treatment monitoring
Care Setting
Radiology departments in public, academic, and private institutions internationally
Key Highlights
DWI is a fast, widely available MRI sequence providing qualitative and quantitative (ADC) data on tissue diffusivity.
DCE-PWI evaluates tumour neo-angiogenesis and tissue hypoxia but is more technically challenging and less standardized than DWI.
Survey of 294 head and neck radiologists from 44 countries revealed variable adoption influenced by resources, technical challenges, and lack of standardization.
Guideline-Based Recommendations
Diagnosis
Use DWI to evaluate cellular tumours and lesions with restricted diffusion such as purulent fluid or cholesteatoma.
Apply DCE-PWI to assess tumour vascularity and differentiate lesions based on perfusion characteristics.
Management
Incorporate DWI routinely in head and neck MRI protocols for lesion characterization.
Consider DCE-PWI increasingly for clinical use to monitor treatment response and tumour angiogenesis.
Monitoring & Follow-up
Use DWI and DCE-PWI to monitor treatment response in malignant head and neck neoplasms.
Risks
Technical challenges and time constraints may limit the acquisition and analysis of DCE-PWI.
Lack of universal standardization in measurement and reporting of functional MRI parameters may affect consistency.
Patient & Prescribing Data
Patients undergoing head and neck MRI for diagnostic and treatment monitoring purposes
DWI is routinely incorporated in clinical practice; DCE-PWI is increasingly adopted but limited by technical and resource barriers.
Clinical Best Practices
Incorporate both qualitative and quantitative analysis of DWI (including ADC measurements) for comprehensive assessment.
Employ DCE-PWI with appropriate post-processing and reporting protocols where resources and expertise allow.
Address barriers such as lack of standardization, technical challenges, and resource limitations to improve adoption.
Engage in continuous education and training to enhance knowledge and implementation of advanced MRI techniques.
by Steve Connor, Alexander Christoforou, Philip Touska, Soraya Robinson, Nancy J. Fischbein, Pim de Graaf, Anne R. J. Péporté, Jussi Hirvonen, Darka Hadnadjev Šimonji, Gloria J. Guzmán Pérez-Carrillo, Xin (Cynthia) Wu, Christine Glastonbury, Kristine M. Mosier, Ashok Srinivasan
