Diffusion-weighted imaging in the head and neck region: usefulness of apparent diffusion coefficient values for characterization of lesions

PURPOSE We aimed to evaluate the role of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging for head and neck lesion characterization in daily routine, in comparison with histopathological results. METHODS Ninety consecutive patients who underwent magnetic resonance imaging (MRI) at a university hospital for diagnosis of neck lesions were included in this prospective study. Diffusion-weighted echo-planar MRI was performed on a 1.5 T unit with b factor of 0 and 1000 s/mm2 and ADC maps were generated. ADC values were measured for benign and malignant whole lesions seen in daily practice. RESULTS The median ADC value of the malignant tumors and benign lesions were 0.72x10(-3) mm(2)/s, (range, 0.39-1.51x10(-3) mm(2)/s) and 1.17x10(-3) mm(2)/s, (range, 0.52-2.38x10(-3) mm(2)/s), respectively, with a significant difference between them (P < 0.001). A cutoff ADC value of 0.98x10(-3) mm(2)/s was used to distinguish between benign and malignant lesions, yielding 85.3% sensitivity and 78.6% specificity. The median ADC value of lymphomas (0.44x10(-3) mm(2)/s; range, 0.39-0.58x10(-3) mm(2)/s) was significantly smaller (P < 0.001) than that of squamous cell carcinomas (median ADC value 0.72x10(-3) mm(2)/s; range, 0.65-1.06x10(-3) mm(2)/s). There was no significant difference between median ADC values of inflammatory (1.13x10(-3) mm(2)/s; range, 0.85-2.38x10(-3) mm(2)/s) and noninflammatory benign lesions (1.26x10(-3) mm(2)/s; range, 0.52-2.33x10(-3) mm(2)/s). CONCLUSION Diffusion-weighted imaging and the ADC values can be used to differentiate and characterize benign and malignant head and neck lesions.