Associations between ¹⁸F-FDG-PET, DWI, and DCE Parameters in Patients with Head and Neck Squamous Cell Carcinoma Depend on Tumor Grading

Abstract

Our purpose was to analyze associations between positron emission tomography (PET), diffusion weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging in patients with head and neck squamous cell carcinoma (HNSCC). The study involved 34 patients (9 women, 25 men, mean age: 56.7 ± 10.2 years). In all patients a simultaneous 18F-FDG-PET/MR was performed. DWI was obtained by using of an axial EPI sequence. Minimal ADC values (ADCmin), mean ADC values (ADCmean), and maximal ADC values (ADCmax) were estimated. DCE MRI was performed by using dynamic T1w DCE sequence. The following parameters were estimated: Ktrans, Ve, and Kep. Spearman's correlation coefficient was used to analyze associations between investigated parameters. In overall sample, ADCmean correlated significantly with Ve and Ktrans, ADCmin correlated with Ve, and ADCmax correlated with Ktrans and Ve. SUVmean tended to correlate slightly with Ktrans. In G1/2 tumors, only Ktrans correlated well with ADCmax and SUVmean. In G3 tumors, Ktrans correlated well with Kep and Ve. Ve showed significant correlations with ADCmean and ADCmax. Ktrans correlated with ADCmax. Kep was higher in cancers with N2/3 stages. Tumor metabolism, water diffusion, and tumor perfusion have complex relationships in HNSCC. Furthermore, these associations depend on tumor grading. Kep may predict lymphonodal metastasizing.

Predictive value of quantitative diffusion-weighted imaging and 18-F-FDG-PET in head and neck squamous cell carcinoma treated by (chemo)radiotherapy

“…Hypoxia may inhibit dividing tumor cells or lead to cell death (increased ADC), due to insufficient oxygen supply, but it may directly induce tumoral progression (high FDG-uptake with reduced apoptosis, high production of VEGF, glycolic enzymes and signaling molecules [12,38]) with radioresistance. This however, was dependent on tumor grading with different relations between parenchyma, stroma and microvascular density [14,39]. Surov et al [14] described that SUV max and SUV mean were correlated with cellularity in advanced stage tumours (G3) and only HIF-1α tended to correlate with FDG-uptake.…”

Quantitative dynamic contrast-enhanced MR imaging can be used to predict the pathologic stages of oral tongue squamous cell carcinoma

“…In our study, the MFA method for T1 measurement, individual AIF, higher temporal resolution and 3-D VOI were applied. These data acquisition and DCE-MRI data analysis methods made our results more reliable than the previous studies, which used the dual ip angle method, population AIF, and temporal resolution of 3.5 ms [8] and 6 ms [16]. Additionally, the pathologic TNM stage was used in our study, which is different from the study by Chikui et al [8], which applied the clinical TNM stage.…”

“…In contrast, Leifels et al reported that the K ep was higher in HNSCC cancers with N2-3 stages; however, no differences were observed in DCE-MRI parameters between T1-2 and T3-4 tumors [16]. In our study, K trans , K ep and V p were found to be lower in pathologic stage III-IV lesions than in stage I-II lesions; these results are similar to that of Chikui et al [8] but different from that of Leifels et al [16]. This discrepancy might be related to the different protocol of DCE-MRI scanning as well as different method of pharmacokinetic analysis.…”

“…For example, Chikui et al found that the clinical T stage of oral squamous cell carcinoma is negatively correlated with K trans and the N stage showed a negative correlation with K trans and V p [8]. In contrast, Leifels et al reported that the K ep was higher in HNSCC cancers with N2-3 stages; however, no differences were observed in DCE-MRI parameters between T1-2 and T3-4 tumors [16]. In our study, K trans , K ep and V p were found to be lower in pathologic stage III-IV lesions than in stage I-II lesions; these results are similar to that of Chikui et al [8] but different from that of Leifels et al [16].…”

“…In addition to the above key points in data acquisition, a 3-D VOI was used in our study. To date, most of previous studies have used a twodimensional ROI (2-D ROI) derive the pharmacokinetic parameters from DCE-MRI for tumor assessment in head and neck cancer, while few studies have used a 3-D VOI for analysis [8,16]. Compared with 2-D ROI for tumor analysis, 3-D VOI can obtain the volumetric parameters and the heterogeneity data of the whole tumor, thus theoretically can more accurately describe the physiological characteristics of lesions [17].…”