A Study to Assess the Usefulness of a Magnetic Resonance Imaging Technique for Staging of Head and Neck Cancer

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Before a patient with head and neck cancer can be treated, it is important to know how far the cancer has spread. For example, it is important to know if the cancer has spread to any of the lymph nodes in the neck. To make this determination currently, doctors examine patients, and they order tests such as MRI (magnetic resonance imaging) and PET/CT (positron emission tomography/computed tomography). Although these tests are good at detecting cancer spread, they are not perfect. Recent research has shown that an MRI technique called DWI (diffusion weighted imaging) can improve the detection of cancer. With DWI, it is possible to measure the apparent diffusion coefficient (ADC) of tissues such as lymph nodes. The ADC is reduced in lymph nodes that have been infiltrated by cancer cells. We have been using DWI clinically for a long time. However, we have not yet used DWI for staging of head and neck cancer. The major drawback of DWI is that the images generated by this technique can be degraded by motion, such as breathing and swallowing, and by signal disturbance from the airways. This is particularly problematic in the neck. We have available to us a variant of DWI, called PROPELLER-DWI. This technique was designed to overcome image degradation by motion and signal disturbances from air and bone. We have used PROPELLER-DWI clinically to diagnose some patients who had difficulty holding still in the MRI scanner or who had disease at the skull base. To our knowledge, no-one has tried to use PROPELLER-DWI to stage patients with head and neck cancer. Because of the benefits of DWI demonstrated by others, and because of the theoretical additional benefits of PROPELLER-DWI, we wish to conduct a pilot study to test the feasibility of PROPELLER-DWI for staging of head and neck cancer, comparing it to conventional DWI in this setting. If PROPELLER-DWI shows promise in this pilot project, we will have the justification and the necessary information to plan a larger, prospective study, involving more patients. Ultimately, we hope to improve outcomes for patients with head and neck cancer through more accurate staging.

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