Table 1. Characteristics of included studies.
| Reference | N | Study type | Age mean (range) | % male | Tumor locations | Treatment | Selection | Reference standard definition tumor | MRI sequences Field strength; sequence orientation slice thickness/ gap in mm (TR/TE in ms); b values and DWI analysis method |
Time point MRI | Diagnostic accuracy | TP | FP | FN | TN |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Berrak et al., 2011 (+unpub. data) | 18 | Retro | 57 (48–72) | 89 | LN of 13 oropharynx; 4 nasopharynx; 1 hypopharynx | 18 neoadj chemo + CCRT | All patients with neoadj chemo without other cancers, previous treatment or high comorbidity. | Histology/ imaging or clinical follow-up with responders showing ≥50% reduction and <50% was considered partial responder. All were confirmed with neck dissection at a later stage. | aMRI; 1.5–3.0 T; T1 tra 5/- (600/10); T2 tra 5/- (2000-4000/13, 53, 80, 110, 131); T1C tra 5/- | 3 weeks after end neoadj chemo | aMRI LN (T2) aMRI LN (volume) ADC (>50%) |
13 1 11 |
2 0 0 |
2 14 4 |
1 3 3 |
| Bhatia et al., 2010 | 69 | Retro | 59 (45–75) | 91 | Primary site of 24 oral cavity or oropharynx; 24 hypopharynx; 18 larynx; 3 nasal cavity | 69 CCRT | All patient that received CCRT. Patients with <1 year follow-up (N = 19) or primary and nodal site not separate (N = 1) excluded. | Histology/ definite disease progression on serial MRI | aMRI; 1.5 T; T1 tra 4/0 (477/12) T2 fs tra 4/0 (2500/100); T1C tra | 2 weeks after start treatment; 6 weeks after end treatment |
aMRI primary (Δabsolute volume >10.6 cm3) aMRI primary (Δabsolute volume >5.7 cm3) |
13 11 |
8 4 |
4 8 |
23 38 |
| Chan et al., 2006 group A | 34 | Pros | 48 (SD ± 11) | 69 | Primary site of 34 nasopharynx | 21 RT; 13 CCRT; 5 addition ICBT | Suspected local recurrence. Exclusion if <6 mo follow-up (N≤5) or high glucose (N≤1) | Outcome MDT discussion using; histology or if not available >6 mo imaging and clinical follow-up with a 5 point probability scale. | aMRI; 1.5 T; T1 tra 5/1, sag 4/1 (500/20); T2 fs tra 5/1, cor 4/1 (3000/85); T1C fs tra 5/1, sag 4/1, cor 4/1 (500/20) | 17 (6–108) mo after end treatment | aMRI primary | 21 | 3 | 1 | 9 |
| Chan et al., 2006 group B | 212 | Pros | 48 (±12) | 72 | Primary site of 112 nasopharynx | 19 RT; 93 CCRT; 13 addition ICBT | All nasopharyngeal tumors. Exclusion if <6 mo follow-up (N≤5) or high glucose (N≤1) | Outcome MDT discussion using; histology or if not available >6 mo imaging and clinical follow-up with a 5 point probability scale. | aMRI; 1.5 T; T1 tra 5/1, sag 4/1 (500/20); T2 fs tra 5/1, cor 4/1 (3000/85); T1C fs tra 5/1, sag 4/1, cor 4/1 (500/20) | 3 mo after end treatment | aMRI primary | 3 | 11 | 1 | 197 |
| Chong and Fan, 1997 | 34 | Retro | 46 (28–66) | 65 | Primary site of 34 nasopharynx | 34 RT | Availability of follow-up, excluded in no follow-up (N = 80) | Histology for abnormal clinical or radiology finding; clinical and imaging follow-up for unequivocal clinical or imaging; clinical follow-up for normal clinical and imaging. Recurrence on MRI classified as mass intermediate on T1 with enhancement or high on T2. Borderline imaging were described as mucosal asymmetry. | aMRI; 1.0 T; T1 tra 5/2 (700/15), cor 5/2 (580/15), sag 4/1 (580/15); T2 tra 5/2 (2730/80); T1C cor 5/2 (580/15), sag 4/1 (580/15) | 19 (5–30) mo after end treatment | aMRI primary | 5 | 7 | 4 | 29 |
| Comoretto et al., 2008 | 63 | Retro cons | 52 (13–79) | 70 | Primary site and LN of 63 nasopharynx | 63 RT + neoadj chemo | Availability of follow-up | Histology or >6 mo imaging follow-up. Primary site judged by two head and neck radiologists in consensus. LN are metastatic if >10 mm short-axis or >5 mm short-axis for retropharyngeal according to American Joint Committee on Cancer staging criteria for NPC (2002) | aMRI; 1.5 T; T1 tra 5/0.5 (600/15); T2 tra 4/0.4 (4200/102); T1C fs tra, cor (± sag) 5/0.5 (600/15) | 2–14 mo after end treatment | aMRI primary aMRI LN |
27 19 |
4 4 |
1 2 |
31 38 |
| Gouhar and El-Harir, 2011 | 21 | Pros | 59 (47–66) | 76 | Primary site; 21 larynx | 21 RT | Suspected of tumor recurrence without MRI contra-indications. | Histology 2–5 days after MRI | aMRI; 1.5 T; T1 tra (± cor, sag) 4/0.4 (500-600/8-9); T2 tra (± cor, sag) 4/0.4 (3000/100); T1C tra (± cor, sag) 4/0.4 (500-600/8-9). DWI; 1.5T; tra 3-4/1 (2000-2600/64-70); b 0, 1000; ROI |
2–6 mo after end treatment | ADC primary 0.85 1.01 1.16 1.49 2.22 |
— — 11 — — |
— — 1 — — |
— — 2 — — |
— — 7 — — |
| Hong et al., 2013 | 134 | Pros | 47 (18–79) | 70 | Primary site of 134 nasopharynx | 121 chemo + IMRT; 13 IMRT | All nasopharyngeal tumors for RT. Excluded if stop or switch of treatment (N = 4), not all MRI data acquired (N = 13) | Histology or imaging follow-up suggesting residual soft tissues or thickening of the mucous membrane of the nasopharynx with local bulges as indication of residual mass | DWI; 1.5 T; (600/min) b 0, 800, ROI | 2 weeks after start treatment | ADC primary ΔADC 53% |
16 | 40 | 7 | 71 |
| Hwang et al., 2013 | 33 | Retro | 60 (30–78) | 55 | Primary site of 16 oral cavity; 4 oropharynx; 5 sinonasal cavity; 3 nasopharynx; 2 hypopharynx; 3 external auditory canal | 9 OP; 7 chemo and RT; 13 OP and RT; 4 OP, chemo and RT | Availability of follow-up and new enhancing region suspicious of tumor recurrence or indeterminate and > 6 mm | Histology or imaging follow-up were recurrence was growth of an enhancing lesion (>20% or continuous growth on second follow-up) and posttreatment changes are defined as no further growth in the contrast enhancing area for at least 1 year | aMRI; 1.5 T; T1 tra 4/1.2 (550-560/10-12); T1C fs tra, cor and sag 4/1.2 (550-560/10-12); DWI; 1.5 T; tra 4/1.2 (8000-10000/62-78); b 0, 1000, 2000; ROI |
> 6 weeks after end treatment, mean 12 mo | ADC primary; ADC 1.46 ADC ratio 63% |
17 19 |
2 4 |
3 1 |
11 9 |
| King et al., 2013a | 37 | Retro | 57 (45–71) | 92 | Primary site of 17 oral cavity/ oropharynx; 13 hypopharynx; 5 larynx; 2 esophagus | 36 CCRT; 1 RT | Primary tumors collected from two other studies | Histology, endoscopy or serial imaging with increasing mass; no mass (pattern 0), fibrosis with flat-edged/ retracted low signal mass (pattern 1) and indeterminate mass (pattern 3) are compared with focal expansile mass ≥ 1 cm with intermediate T2 signal. Pattern 0, 1 and 2 are negative MRI, pattern 3 is positive MRI. | aMRI; 1.5T; T1; T2 fs tra 4/0 (2500/100); T1C | 6 weeks after end treatment | aMRI primary (T2 pattern) | 9 | 7 | 0 | 21 |
| King et al., 2013b | 37 | Pros | 57 (45–71) | 86 | Primary site of 14 oropharynx, oral cavity; 20 hypopharynx, larynx; 2 nasal cavity; 1 maxillary sinus | CCRT or CRT | Biopsy proven untreated stage III or IV tumor. Exclusion if artefacts (N = 9), tumor <6 mm (N = 2), <2 year follow-up (N = 7), or tumor and nodal metastasis not separate (N = 1) | Histology or clinical and radiological follow-up with new mass or increasing mass defined as tumor. | aMRI; 1.5 T; T1; T2; T1C DWI; 1.5 T; fs tra; 4/0 (2000/75); b 0, 100, 200, 300, 400, 500; ROI |
2 weeks after start treatment | ADC primary Skewness (>0.4) Kurtosis (>0.9) |
10 10 |
4 6 |
3 3 |
13 11 |
| Ljumanovic et al., 2008 | 80 | Retro | 60 (45–71) | 79 | Primary site of 32 supraglottic; 48 glottic | 68 RT; 12 neoadj chemo + RT | All larynx SCC patients with RT with curative intent with ≥24 mo follow-up. Otherwise excluded (N = 80) | Histology or imaging follow-up with laryngoscopy every 2 mo for the first 2 years. Three point MRI scale with complete resolution of tumor and no asymmetry, focal mass <1 cm or asymmetry or focal mass >1 cm or less than 50% reduction of tumor volume | aMRI; 1.0–1.5 T; T1 3-1/1 (310-800/15); T2 3-7/1 (2200-4550/90-98); T1C 3-7/1 (310-800/15) | 5 (1–16) mo after end treatment | aMRI primary | 25 | 13 | 1 | 41 |
| Ng et al., 2010 | 179 | Pros | 27 (19–84) | 89 | Primary site and LN of 179 nasopharynx | 174 CCRT; 3 RT; 2 RT + intra-cavity RT | Patients at high risk for recurrence or with suspected recurrence | Histology for suspected lesion if possible or imaging follow-up for at least 12 months. MRI with 5 point probability scale | cMR; 3.0 T; T1 tra 4/2 (562/10); T2 fs tra 4/2 (6640/88); T1C tra 4/2 (550/10), cor 4/2 (600/10) | 6,5 (3–25) mo after end treatment | aMRI primary aMRI LN |
25 22 |
7 5 |
4 3 |
143 149 |
| Tshering Vogel et al., 2013 | 46 | Pros | 60 (41–83) | 89 | Primary site of hypopharynx 16; larynx 30 | 16 RT; 7 OP + RT; 19 chemo + RT; 1 OP + chemo + RT; 1 RT + LR; 2 OP + LR + RT + chemo | Patients with new or worsening symptoms after treatment. Excluded if susceptibility artefacts (N = 4) | Histology or imaging follow-up of at least 1 year with focal enhancement or increase in size of lesion was considered tumor on aMRI and high DWI with low ADC for diffusion MRI. | aMRI; 1.5 T; T1 tra 3/0.6 (624/12); T2 tra 3/0.6 (3630/76); T1C fs tra 3/0.6 (624/12, cor and sag 3/0,75 (630/18) DWI; 1.5 T; tra 3/0.6 (3500/69); b 0, 50, 100, 500, 750, 1000; ROI |
31 (2–96) mo after end treatment | aMRI primary ADC primary, ADC visual ADCT (1,30) ADCD (1,30) Fp (23%) |
13 17 12 14 17 |
12 0 3 6 6 |
5 1 6 4 1 |
16 21 18 15 15 |
| Vandecaveye et al., 2010 and Vandecaveye et al., 2012 | 30 | Pros | 53 (38–66) | 93 | Primary site and LN of 5 tonsil; 7 piriform sinus; 7 supraglottic; 3 base of tongue; 6 oropharynx | 27 CCRT, 3 RT | All patients with histological proven SCC. Exclusion if distant metastasis before treatment (N = 1) or claustrophobia (N = 1). | Histology of imaging follow-up for 2 years with volume increase of persisting mass ≥ 65% and recurrent mass indicating tumor. MRI scoring of primary lesion was done on 3 point scale, no focal abnormality, asymmetry or mass <10 mm and mass >10 mm or <50% reduction. | aMRI; 1.5 T; T1 tra 4/0.4 (775/8.3); T2 tra 4/0.4 (3080/106); T1C tra, cor, sag 4/0.4 (775/8.3) DWI; 1.5 T; tra 4/0.4 (7100/84); b 0, 50, 100, 500, 750, 1000; ROI |
2 weeks after start treatment 4 weeks after start treatment 3 weeks after end treatment |
aMRI primary Δvolume 20%; ADC primary ΔADC 14%; aMRI LN Δvolume 33%; ADC LN ΔADC 15% aMRI primary Δvolume 65%; ADC primary ΔADC 25%; aMRI LN Δvolume 50%; ADC LN ΔADC 19% aMRI primary ADC primary ΔADC 25%; aMRI LN ADC LN ΔADC 20% |
7 7 9 8 6 8 7 8 6 8 6 7 |
10 2 23 5 10 2 17 2 6 1 11 5 |
1 1 1 2 2 0 3 2 2 0 3 2 |
13 21 21 39 13 21 27 42 16 21 30 36 |
| Yen et al., 2003 | 67 | Pros | 47 (16–75) | 79 | Primary site of 67 nasopharynx | RT or CCRT | Patients with clinical suspicion of residual or recurrence. Exclusion if pregnant or diabetic. | Histology for positive PET or MRI findings or clinical follow-up >6 mo for others. MRI done by visual interpretation not specified. | aMRI; 1.5 T; T1 cor, sag; T2 tra; PD tra; T1C fs tra, cor; T1C tra | 4–70 mo after end treatment | aMRI primary | 13 | 26 | 8 | 20 |
Characteristics of the 15 included studies are shown. Abbreviation: aMRI = anatomical MRI; OP = operation; RT = radiotherapy; CCRT = concomitant chemoradiotherapy; tra = transversal; cor = coronal; sag = sagittal; mo = months; TP = true positive; TN = true negative; FP = false positive; FN = false negative; SCC = squamous cell carcinoma; TR = repetition time; TE = echo time; T = Tesla; ICBT = intracavitary brachytherapy; IMRT = intensity modulated radiotherapy; ca = carcinoma; undif = undifferentiated; neoadj = neoadjuvant; chemo = chemotherapy; ROI = region of interest analysis; min = minimal; LR = laser resection; mm = millimeter; ms = milliseconds; ADC cut-off (x10-3 mm2/s); pros = prospective; retro = retrospective; LN = lymph nodes; cons = consecutive