La radiologia medica

, Volume 121, Issue 9, pp 704–710 | Cite as

Pre-surgical assessment of mandibular bone invasion from oral cancer: comparison between different imaging techniques and relevance of radiologist expertise

  • Mario SilvaEmail author
  • Eleonora I. Zambrini
  • Gianfranco Chiari
  • Ilaria Montermini
  • Carmelinda Manna
  • Tito Poli
  • Davide Lanfranco
  • Enrico Sesenna
  • Elena Thai
  • Nicola Sverzellati



To compare diagnostic performance between computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone infiltration from oral cancer, and to test interobserver agreement between radiologists with different expertises.

Materials and methods

Pre-surgical CT and MRI were reviewed independently by two radiologists with different expertises in head and neck oncology. A third radiologist reviewed CT and MRI simultaneously. Interobserver agreement was calculated by Cohen test. Association between radiological evidence of bone infiltration and histological reference was tested by Fisher’s exact test or Chi-squared test, as appropriate. Receiving operator curve was calculated and area under the curve (AUC) was compared between CT, MRI, and both methods together.


Interobserver agreement was moderate: the trainee under-reported periosteal reaction on CT and inferior alveolar canal involvement on MRI. Imaging findings associated with histologic evidence of bone infiltration were: periosteal reaction and cortical erosion on CT; bone marrow involvement, contrast enhancement within bone; and inferior alveolar canal involvement on MRI. Sensitivity of MRI alone (74 %) was higher than CT (52 %). Simultaneous review of CT and MRI showed the highest specificity (91 %), with the increase of diagnostic performance in the subgroup of subjects with positive MRI (AUC = 0.689; p = 0.044).


Higher expertise allows pre-surgical detection of clinically relevant signs of bone infiltration sensitivity of MRI alone is higher than CT for the detection of bone infiltration from oral cancer. In MRI positive cases, diagnostic integration with combined review of CT and MRI is suggested for optimal diagnostic performance.


Oral cancer Bone infiltration Computed tomography Magnetic resonance imaging Diagnostic performance Interobserver agreement 


Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Medical Radiology 2016

Authors and Affiliations

  • Mario Silva
    • 1
    Email author
  • Eleonora I. Zambrini
    • 2
  • Gianfranco Chiari
    • 1
  • Ilaria Montermini
    • 1
  • Carmelinda Manna
    • 1
  • Tito Poli
    • 3
  • Davide Lanfranco
    • 3
  • Enrico Sesenna
    • 3
  • Elena Thai
    • 4
  • Nicola Sverzellati
    • 1
  1. 1.Sezione di Radiologia, Dipartimento di Scienze ChirurgicheUniversità degli Studi di ParmaParmaItaly
  2. 2.Sezione di Radiologia, Dipartimento di Diagnostica per Immagini e Medicina di LaboratorioIRCCS Arcispedale S. Maria NuovaReggio EmiliaItaly
  3. 3.Unità Operativa di Chirurgia Maxillo Facciale, Dipartimento di Scienze Biomediche, Biotecnologiche e TraslazionaliUniversità degli Studi di ParmaParmaItaly
  4. 4.Unità Operativa di Anatomia e Istologia PatologicaAzienda Ospedaliero-Universitaria di ParmaParmaItaly

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