# Comparison of Diagnostic Performance Between CT and MRI for Detection of Cartilage Invasion and Tumor Staging in Patients with Laryngeal Cancer: A Systematic Review and Meta-Analysis

## TL;DR

MRI is better than CT scans for detecting cancer spread in laryngeal cancer patients, leading to more accurate treatment decisions.

## Contribution

This study is the first to systematically compare and meta-analyze the diagnostic performance of CT and MRI in laryngeal cancer staging.

## Key findings

- MRI showed significantly higher sensitivity than CT in detecting cartilage invasion in multiple laryngeal structures.
- MRI provided more accurate tumor staging with lower understaging rates compared to CT.
- Both imaging methods had similarly high specificity across all structures evaluated.

## Abstract

Laryngeal cancer is a serious disease affecting the voice box, and accurate staging before treatment is crucial for determining the best approach. Two main imaging techniques—computed tomography (CT scan) and magnetic resonance imaging (MRI)—are used to assess whether the cancer has invaded surrounding cartilage and tissues. However, it remains unclear which method is more reliable. This study systematically compared the diagnostic accuracy of CT and MRI in detecting cartilage invasion in laryngeal cancer patients. We found that MRI was significantly more sensitive than CT in detecting invasion of the thyroid cartilage, cricoid cartilage, and other important structures, while both methods showed similarly high specificity. MRI also provided more accurate tumor staging overall. These findings suggest that MRI should be considered the preferred imaging method for pre-treatment evaluation of laryngeal cancer, as it reduces the risk of missing hidden invasion and helps doctors make better treatment decisions, particularly when organ-preserving therapies are being considered.

Background: Laryngeal cancer constitutes a major burden. Accurate staging is important to determine the optimal treatment approach. However, a head-to-head comparison of diagnostic performance between CT and MRI in patients with laryngeal cancer is lacking. Furthermore, the performance of CT and MRI in detecting the invasion of different laryngeal structures is yet to be determined. Objective: To compare the diagnostic performance of CT and MRI in patients with laryngeal cancer. Methods: We searched PubMed, Scopus, and Web of Science in November 2025 for cohort studies that compared both index tests (CT and MRI) to histopathological examination of laryngeal cancer. We assessed the quality of the included studies using the QUADAS 2 tool. A bivariate meta-analysis was performed using R and RevMan software to compare pooled sensitivity and specificity, with summary receiver operating characteristic (SROC) curves generated for each outcome. Results: We included eight studies. The pooled data showed that CT was significantly less sensitive compared to MRI in detecting invasion of the thyroid cartilage with an absolute difference of −0.43 (95% CI −0.59 to −0.26), cricoid cartilage −0.65 (95% CI −1.14 to −0.15), paraglottic space −0.5 (95% CI −0.68 to −0.32), and anterior commissure −0.48 (95% CI −0.1 to −0.86). Specificity was similarly high for both modalities across all structures. For arytenoid cartilage and epiglottis invasion, MRI showed a non-significant trend towards higher sensitivity. Summary receiver operating characteristic (SROC) curves indicated superior overall diagnostic accuracy for MRI. In T-staging, MRI consistently demonstrated a lower rate of understaging compared to CT across five studies. Conclusions: MRI had superior diagnostic performance compared to CT in detecting laryngeal cartilage and deep space invasion; it had significantly higher sensitivity, comparable specificity, and lower risk of understaging, thus supporting the use of MRI for accurate pretreatment T-staging. However, given the limited number of studies, the results should be interpreted with caution, and further studies are needed to confirm our findings.