DCE-MRI for Pre-Treatment Prediction and Post-Treatment Assessment of Treatment Response in Sites of Squamous Cell Carcinoma in the Head and Neck

Abstract

Background and PurposeIt is important to identify patients with head and neck squamous cell carcinoma (SCC) who fail to respond to chemoradiotherapy so that they can undergo post-treatment salvage surgery while the disease is still operable. This study aimed to determine the diagnostic performance of dynamic contrast enhanced (DCE)-MRI using a pharmacokinetic model for pre-treatment predictive imaging, as well as post-treatment diagnosis, of residual SCC at primary and nodal sites in the head and neck.Material and MethodsForty-nine patients with 83 SCC sites (primary and/or nodal) underwent pre-treatment DCE-MRI, and 43 patients underwent post-treatment DCE-MRI, of which 33 SCC sites had a residual mass amenable to analysis. Pre-treatment, post-treatment and % change in the mean Ktrans, kep, ve and AUGC were obtained from SCC sites. Logistic regression was used to correlate DCE parameters at each SCC site with treatment response at the same site, based on clinical outcome at that site at a minimum of two years.ResultsNone of the pre-treatment DCE-MRI parameters showed significant correlations with SCC site failure (SF) (29/83 sites) or site control (SC) (54/83 sites). Post-treatment residual masses with SF (14/33) had significantly higher kep (p = 0.05), higher AUGC (p = 0.02), and lower % reduction in AUGC (p = 0.02), than residual masses with SC (19/33), with the % change in AUGC remaining significant on multivariate analysis.ConclusionPre-treatment DCE-MRI did not predict which SCC sites would fail treatment, but post-treatment DCE-MRI showed potential for identifying residual masses that had failed treatment.

Potential Role of PET/MRI for Imaging Metastatic Lymph Nodes in Head and Neck Cancer

“…In distinction, King et al [84] observed that the posttherapy residual masses with persistent tumors had higher permeability or perfusion measures, including higher k ep and area under the contrast curve, than those with complete response. These studies show the feasibility of using DCE-MRI for surveillance imaging.…”

Longitudinal Assessment of Intravoxel Incoherent Motion Diffusion Weighted Imaging in Evaluating the Radio-sensitivity of Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiation Therapy

“…However, perfusion measured by MRI has been used to assess the therapeutic effects and long-term prognosis for patients with malignancies. The perfusion level of tissues was suggested to potentially predict the tumor sensitivity of CRT [26,27]. Lai et al [12,13] reported that f could effectively distinguish residual tumors of NPC from radiation-related fibrous tissues, as well as tumor stages.…”

Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Advanced Cervical Carcinoma: The Advantage of Perfusion Parameters From the Peripheral Region in Predicting the Early Response to Radiotherapy

“…First, due to precontrast inflow phenomenon and postcontrast induced signal loss from high concentration of contrast agent at peak arterial enhancement, it was difficult to obtain an accurate AIF with perfusion MR imaging, which might make an adverse influence on the measurement of perfusion parameters. 32,33 Second, we did not investigate the reproducibility of perfusion parameters across different MR devices, field strengths or centers, therefore, further study is necessary before this imaging technique is extensively applied in clinical practice. Finally, there is no linear relationship between concentration of contrast agent and signal intensity, this nonlinearity is most pronounced at higher contrast concentration, which might undermine the value of perfusion parameters in reflecting tumor vasculature.…”