Perfusion CT for head and neck tumors: pilot study

Differentiation of malignant from benign head and neck lesions is often very difficult on imaging studies, especially in patients with treated cancer. We evaluated the feasibility and reproducibility of perfusion CT (CTP) after enhanced head and neck CT and attempted to differentiate benign from malignant processes.

CTP was attempted in 17 patients after head and neck contrast-enhanced CT. Data were postprocessed by using deconvolution-based perfusion analysis. Ipsilateral and contralateral internal, external, and common carotid arteries were used as arterial input vessels. Postprocessing-generated maps showed mean transit time (MTT), blood volume, blood flow, and capillary permeability surface product. Two readers independently placed regions of interest through the primary site, salivary glands, thyroid gland, paraspinous muscles, muscles of mastication, sternocleidomastoid muscle, base of tongue, and subcutaneous fat. One reader repeated the measurements on separate dates. Data were statistically analyzed, and histologic specimens were obtained.

CTP was not possible in four patients, and one was lost to follow-up. Of the remaining 12, five had cancer, and seven had benign processes. We found no significant interreader or intrareader differences and no significant difference between various input vessels. Differentiation between malignant and nonmalignant lesions was most reliable by using MTTs. Measurements were comparable to those in the literature.

CTP after enhanced head and neck CT is feasible, except perhaps at the laryngeal level. It appears to be reader independent and reproducible regardless of the input vessel. CTP shows promise in distinguishing benign and malignant processes, primarily by means of MTTs.