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American Journal of Roentgenology, Vol 164, 981-987, Copyright © 1995 by American Roentgen Ray Society

ARTICLES

Squamous cell carcinoma of the oral cavity: MR findings and value of T1- versus T2-weighted fast spin-echo images

M Yasumoto, H Shibuya, M Takeda and T Korenaga
Department of Radiology, Tokyo Medical and Dental University, Japan.

OBJECTIVE. The purposes of this study were to describe the characteristics of squamous cell carcinomas of the oral cavity on unenhanced and contrast-enhanced T1-weighted spin-echo (SE) MR images and unenhanced T2-weighted fast spin-echo (FSE) MR images and to determine which sequences best delineate the margins and extent of the tumors. MATERIALS AND METHODS. Forty-four patients with proved squamous cell carcinoma of the oral cavity (tongue, 24; floor of mouth, seven; buccal mucosa, four; maxillary gingiva, two; and mandibular gingiva, seven) underwent unenhanced axial T2-weighted FSE MR imaging and unenhanced and enhanced axial and coronal T1-weighted SE MR imaging. The appearance, signal characteristics, and extent of the tumors were assessed, and the delineation of tumor margins with each sequence or combination of sequences was evaluated by use of a grading system ranging from 1 (poor) to 3 (excellent). Three patients were excluded because of artifacts on the MR images caused by dental restorations. RESULTS. Tumors in all 41 patients were depicted on unenhanced T1- weighted SE images, but in four patients, tumors were not visible on T2- weighted FSE images. Except for tumors that invaded the maxillary gingiva, the tumors generally had homogeneous, low signal intensity on unenhanced T1-weighted images and nonhomogeneous, high signal intensity on T2-weighted FSE images. All tumors showed enhancement, 76% with a nonhomogeneous appearance. The delineation of tumor margins was excellent (grade 3) in 31 cases and fair (grade 2) in 10 cases. The highest rating was given for unenhanced T1-weighted images in 10 cases, for contrast-enhanced T1-weighted images in 10 cases, for the combination of both unenhanced and contrast-enhanced T1-weighted images in 18 cases, for the combination of unenhanced T1-weighted and T2- weighted FSE images in five cases, and for T2-weighted FSE images in one case. In three cases, the highest rating was given for both combinations of pulse sequences. CONCLUSION. An unenhanced T1-weighted sequence should be used as the basic pulse sequence for MR imaging of tumors of the oral cavity. When tumor margins are not clearly delineated with this sequence, T2-weighted FSE and contrast-enhanced T1- weighted sequences should be added. Although both of these sequences provide supplementary information, the contrast-enhanced T1-weighted sequence is more useful in delineating the margins and extent of tumors than is the T2-weighted FSE sequence.
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