Feasibility of non-contrast-enhanced four dimensional (4D) MRA in head and neck tumors, comparison with contrast-enhanced 4D MRA

Abstract

Background: Information of tumor vascular architecture and hemodynamics is important in treating patients with head and neck tumors (HNTs). The purpose of this study is to investigate the feasibility of non-contrast-enhanced four-dimensional magnetic resonance angiography (non-CE 4DMRA) using arterial spin labeling for anatomical and hemodynamic evaluation of vascularity of head and neck tumors. Results: Non-CE 4DMRA images of 15 patients with HNTs were compared with those of contrast-enhanced 4DMRA (CE 4DMRA) by two independent observers. For qualitative evaluation, overall image quality, visualization of arterial branches and main arterial tumor feeders were assessed. For hemodynamic evaluation, signal-intensity-over-time curves within the tumors were compared. The sensitivity of non-CE 4DMRA for the identification of arterial branches and the main arterial tumor feeders was 75 and 20 %, respectively (interobserver agreement, κ = 0.56 and 0.54, respectively), while that of CE 4DMRA was 99 and 95 %, respectively (interobserver agreement, κ = 0.62 and 0.70, respectively). All three arterial/hypervascularized tumors determined on CE 4DMRA showed distinct signal-intensity-over-time curve pattern on non-CE 4DMRA, with distinct peak and wash out phases. Other tumors showed no wash out on non-CE 4DMRA. Conclusions: Use of non-CE 4DMRA for the anatomical and hemodynamic evaluation of vascularity of head and neck tumors is feasible, although the technique needs to be improved.