Polish radiologist Dr. Agnieszka Trojanowska will shed light on human papilloma virus (HPV)-induced squamous cell cancer of the head and neck, a common yet long neglected type of cancer. In an interview with ECR Today, she also explained the origins of her passion for head and neck imaging, and how radiologists will increasingly benefit from computer science.

Dr. Agnieszka Trojanowska, assistant professor in the department of radiology and nuclear medicine at Lublin University Hospital, is an internationally recognised specialist in head and neck imaging. Her special interest for oncology and her natural curiosity led her to agree to deliver the Josef Lissner Honorary Lecture on HPV-induced squamous cell cancer of the head and neck (HNSCC) at ECR 2018.

Agnieszka Trojanowska from Lublin, Poland, will speak on HPV-induced squamous cell cancer of the head and neck in her Honorary Lecture today.

“HNSCC behaves differently than more well-known forms of SCC, and it is becoming more and more prevalent. It affects young, well-educated people with high socioeconomic status, and is a quickly rising sexually transmitted entity with peculiar clinical and molecular characteristics. In particular the rise of HPV-induced cancer has been observed in the United States since the beginning of 21^st century,” she said.

It was important for her to talk about this long overlooked topic, for which much remains to be done. “It has been under-estimated for many years in many countries. Nowadays, we can speak about an HPV epidemic, leading to a significant rise of oropharyngeal cancer incidences worldwide. These cancers are quite unique and, in my opinion, knowledge of their physiology and treatment options is essential,” she said.

New research shows that, compared with environmental-related head and neck squamous cell carcinomas, patients with HPV-related malignancies display a better response to treatment and a lower risk of death and progression, Dr. Trojanowska pointed out. It is also noteworthy that, according to the 2017 TNM classification, HPV+ cancers are evaluated with a separate grading scale, she added.

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Watch this session on ECR Live: Wednesday, March 4, 08:30–10:00, Room E1
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Hearing loss can present many difficulties and obstacles to sufferers, and with ageing populations it’s set to become a major healthcare challenge. Many conditions such as congenital malformation of the inner ear or hypoplastic cochlear nerve can also lead to hearing loss, and sometimes deafness.

Fortunately, many new treatments are available to recover hearing, both partially and completely. Imaging plays an increasingly important role in therapy planning and follow-up, and there is hope on the research front, experts will show during a dedicated Special Focus session on Wednesday morning.

Microtia – congenital anomaly of external and middle ear, resulting in
conductive hearing loss. External auditory canal is not patent (arrow),
mastoid process is underdeveloped (arrowhead)

The prevalence of auditory problems in the Western world has doubled over the past 30 years. It is estimated that between 15 and 17% of the population will suffer hearing loss, due to ageing or congenital malformation, but also bad habits, according to Agnieszka Trojanowska, a radiologist at Lublin University Medical School, Poland, who will
chair the session.

“We start to see young adults in their early 30s with sensorineural hearing loss or other related problems because of high frequency noise, which is typical for listening to music. Twenty years ago, such a condition was linked with working in fabrics or on the street. But the good news is that even if you use your iPod a lot, the degree of hearing
loss is light to moderate, so this is not something that will considerably affect your life,” she said.

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B-0158 Initial clinical results of simultaneous PET/MRI in comparison with PET/CT in patients with head and neck cancer

P. Stumpp, K. Kubiessa, S. Purz, M. Gawlitza, A. Kühn, K.G. Steinhoff, A. Boehm, R. Kluge, T. Kahn | Thursday, March 7, 14:00 – 15:30 / Room C

Purpose: Describing diagnostic capability of simultaneous PET/MRI in comparison with PET/CT and their single components CT, MRI and PET in an initial prospective study based on 17 patients with head-and-neck cancer.
Methods and Materials: 17 patients with head-and-neck cancer received an ¹⁸F-FDG-PET/CT for staging or follow-up and an additional simultaneous PET/MRI scan with a whole body imaging part and a dedicated examination of the neck. Sole MRI, CT and PET components of the multimodal acquisitions plus the PET/MRI and PET/CT examinations were evaluated independently, blinded and in a randomised order by two readers. Results were compared with the reference standard, and sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were calculated.
Results: 23 malignant tumours and 55 benign changes were found with the reference standard. For PET/CT the two reader groups showed a sensitivity of 78.3% and 87 %, a specificity of 85.5% and 89.1%, a PPV of 71.4% and 75 % and a NPV of 90.7% and 94 %. For PET/MRI sensitivity was 78.3% and 82.6%, specificity 81.8% and 94.5%, PPV 65.5% and 85.7% and NPV 91.2% and 93.8%. Evaluation of the single PET part from PET/CT revealed highest sensitivity of 95.7%, whereas evaluation of the sole MRI component from PET/MRI showed best specificity of 96.4%. There was a high interrater agreement in all modalities (Cohen’s kappa coefficient: 0.61 – 0.82).
Conclusion: PET/MRI of patients with head and neck cancer yielded good diagnostic capability, similar to PET/CT. Further studies on larger cohorts to prove these first results seem justified.

A-117 Pitfalls in neck imaging

F.A. Pameijer | Friday, March 8, 10:30 – 12:00 / Room C

Pitfall: “a hidden or unexpected danger or difficulty”. Imaging methods can provide an extraordinary amount of useful data to specialists treating head and neck (cancer) patients. It is crucial that these data are used to full advantage of individual patients. The most important factor in this process is mutual cooperation between the physicians in charge of patient care and the diagnostic imaging specialist. Pitfalls in the head and neck may present in various ways: normal variants may look like disease, incidental findings are frequently encountered, suboptimal technique may obscure important findings. Moreover, many pitfalls are directly related to technical errors. In this potential ‘minefield’, the post-treatment patient presents a major challenge to the imaging specialist. Ablative surgery usually results in distortion of the anatomy, especially when combined with flap reconstruction. When adequate preoperative and/or baseline postoperative imaging is lacking, determination of recurrence on a single postoperative examination may well be impossible. PET CT (MR) and advanced MR-techniques; e.g. Diffusion Weighted Imaging (DWI) or Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) can be helpful in this setting. The presentation aims to familiarize general radiologists, who have an interest in head and neck imaging, with common pitfalls encountered on CT and MR studies focussing on the neck. Both the pre-therapeutic, as well as the post-treatment setting, will be discussed using examples from daily practice.

Watch this session on ECR Live: Monday, March 11, 08:30–10:00, Room N/O
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Organ-sparing surgery and radiation treatment such as intensity-modulated radiotherapy (IMRT) – often combined with chemotherapy – have increased the need for advanced imaging in the head and neck during pre-treament and post-treatment stages. Precision is vital as any tumour that remains undetected outside the treatment field could adversely affect the patients’ prognosis and survival, according to Professor Vincent Vandecaveye, from the department of radiology at the University Hospitals Leuven in Belgium.

It is important to spot any tumour recurrence as early as possible, especially in the post-treatment phase, in order give the patient the best possible chance of salvage treatment. The most common imaging methods in the head and neck area remain CT, MRI and PET-CT; each comes with its own advantages and disadvantages.

Multiparametric MRI for early treatment prediction of chemoradiation in oropharyngeal cancer: Upper row is pre-treatment MRI of right base of tongue cancer (a=contrast enhanced T1 as anatomical correlate; b=native b1000 diffusion-weighted image; c= ADC-map; d=perfusion-map of IUAC). Middle row is 2 weeks during chemoradiation: same imaging sets, tumour volume will not help. No significant change in b1000, ADC nor perfusion-MRI indicate non-response and thus high risk of tumour relapse after end of treatment. Tumour relapse at PET-CT 8 months after end of treatment, proven by histology (k). (Provided by Professor Vincent Vandecaveye)

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