Diffusion-Weighted Magnetic Resonance Imaging for Predicting and Detecting Early Response to Chemoradiation Therapy of Squamous Cell Carcinomas of the Head and Neck

Abstract

Purpose: The aim of this study was to investigate the utility of apparent diffusion coefficient (ADC) for prediction and early detection of treatment response in head and neck squamous cell carcinomas (HNSCC). Experimental Design: Diffusion-weighted magnetic resonance imaging studies were performed on 40 patients with newly diagnosed HNSCC before, during, and after the end of chemoradiation therapy. Analysis was done on data from 33 patients after exclusion of 7 patients that had incomplete data. Results: Pretreatment ADC value of complete responders (1.04 F 0.19 Â 10 -3 mm 2 /s) was significantly lower (P < 0.05) than that from partial responders (1.35 F 0.30 Â 10 -3 mm 2 /s). A significant increase in ADC was observed in complete responders within 1 week of treatment (P < 0.01), which remained high until the end of the treatment. The complete responders also showed significantly higher increase in ADC than the partial responders by the first week of chemoradiation (P < 0.01). When pretreatment ADC value was used for predicting treatment response, the area under the receiver operating characteristic curve was 0.80 with a sensitivity of 65% and a specificity of 86%. However, change in ADC within the first week of chemoradiation therapy resulted in an area under the receiver operating characteristic curve of 0.88 with 86% sensitivity and 83% specificity for prediction of treatment response. Conclusions: These results suggest that ADC can be used as a marker for prediction and early detection of response to concurrent chemoradiation therapy in HNSCC.

Intravoxel incoherent motion diffusion‐weighted MRI during chemoradiation therapy to characterize and monitor treatment response in human papillomavirus head and neck squamous cell carcinoma

“…Our findings regarding the D and f values are consistent with previous studies 18, 19. Kim et al found that the median nodal tumor volume of the PR group was higher, but not significantly different from that of the CR group 11. In addition, the median volumes decreased significantly in the CR group at weeks 1 and post‐TX compared with the volumes at pre‐TX 11.…”

“…Also, King et al13 reported a significant correlation between local failure and post‐TX ADC, but not pre‐ or intra‐TX ADC values. Kim et al11 reported a significant increase in ADC values observed in the CR group within 1 week of treatment in HNSCC. Our results also showed an increase in ADC values in the CR group at the intra‐TX week 3 compared with the non‐CR group.…”

Complementary Roles of Whole-Body Diffusion-Weighted MRI and18F-FDG PET: The State of the Art and Potential Applications

“…The biologic basis for this finding remains unclear, but it can be speculated that a higher ADC is observed in necrotic tissue and in tissue with loss of cell membrane integrity, which may correspond to a more aggressive phenotype. It has also been reported that responding lesions show a significantly higher increase in ADC early after initiation of therapy than do nonresponding lesions (19)(20)(21)(22); this finding can be attributed to changes in cell density, resulting from cytotoxic therapy-induced necrosis or apoptotic processes. More studies with larger sample sizes are required to establish the utility of this technique in predicting overall survival or long-term disease-free survival.…”

“…Pretherapy ADCs in responding lesions have been reported to be significantly lower than those of nonresponding lesions in several cancers (20)(21)(22). The biologic basis for this finding remains unclear, but it can be speculated that a higher ADC is observed in necrotic tissue and in tissue with loss of cell membrane integrity, which may correspond to a more aggressive phenotype.…”

“…The LSR or a similar measure has the potential to replace or complement the ADC for the characterization of lesions. On the other hand, when quantitative diffusion measurements are required (e.g., in the follow-up of lesions, such as in the early prediction of response to therapy (19)(20)(21)(22)), ADC measurements may still be preferred.…”