IMPACT OF MAGNETIC-RESONANCE-IMAGING AND COMPUTED-TOMOGRAPHY IN ADVANCED INTRAORAL CANCER - A COMPARATIVE CLINICAL, RADIOLOGICAL AND MORPHOLOGICAL-STUDY
S. Pellissier et al., IMPACT OF MAGNETIC-RESONANCE-IMAGING AND COMPUTED-TOMOGRAPHY IN ADVANCED INTRAORAL CANCER - A COMPARATIVE CLINICAL, RADIOLOGICAL AND MORPHOLOGICAL-STUDY, Journal de radiologie, 75(11), 1994, pp. 577-583
The objective of this prospective study is to assess the impact of mag
netic resonance imaging (MRI) and computed tomography (CT) as compared
to physical examination in the choice of type of surgery for advanced
intraoral cancers (with or without resection of the mandibula). From
1990 to 1993, we operated on 21 intraoral malignant tumors with segmen
tal resection of the mandibula followed by a histological examination.
The preoperative evaluation consisted of an MRI (n = 8), a CT (n = 8)
or both (n = 5). MRI suspected an infiltration of the bone in 9 cases
, CT in 4 and physical examination in 16. This was histologically conf
irmed in 6 of the 21 patients only. MRI and CT both have a high sensit
ivity, as does physical examination, but neither have a good specifici
ty (physical examination: 5 true positive, 4 true negative, 11 false p
ositive, 1 false negative; MRI: 4 true positive, 4 true negative, 5 fa
lse positive, 0 false negative; CT : 3 true positive, 7 true negative,
3 false positive, 0 false negative). In conclusion, the decision of a
mandibular resection can only be taken after a careful physical exami
nation, including palpation under general anesthesia in a fully relaxe
d patient. This is best accomplished during the pretherapy bronchoesop
hagoscopy, routinely performed for the detection of synchromous second
primary tumors using tumors using toluidin blue as a vital staining m
ethod. If this initial evaluation gives a suspicion of a massive infil
tration of the mandible, an MRI, rather than a CT, sould be performed
to determine the extent of the ressection because of a high rate of ar
tefacts with CT.