Dynamic Contrast-Enhanced MR Imaging in Head and Neck Cancer: Techniques and Clinical Applications

Abstract

SUMMARY:In the past decade, dynamic contrast-enhanced MR imaging has had an increasing role in assessing the microvascular characteristics of various tumors, including head and neck cancer. Dynamic contrast-enhanced MR imaging allows noninvasive assessment of permeability and blood flow, both important features of tumor hypoxia, which is a marker for treatment resistance for head and neck cancer. Dynamic contrast-enhanced MR imaging has the potential to identify early locoregional recurrence, differentiate metastatic lymph nodes from normal nodes, and predict tumor response to treatment and treatment monitoring in patients with head and neck cancer. Quantitative analysis is in its early stage and standardization and refinement of technique are essential. In this article, we review the techniques of dynamic contrast-enhanced MR imaging data acquisition, analytic methods, current limitations, and clinical applications in head and neck cancer. ABBREVIATIONS:AIF ϭ arterial input function; DCE-MR imaging ϭ dynamic contrast-enhanced MR imaging; EES ϭ extracellular extravascular space; GCA ϭ

Differentiation of olfactory neuroblastomas from nasal squamous cell carcinomas using MR diffusion kurtosis imaging and dynamic contrast‐enhanced MRI

“…We found no difference in iAUC 60 between ONBs and SCCs, revealing that both exhibit similar tumor blood flow. Interestingly, the mean V e value of ONBs was significantly lower than that of SCCs, indicating that the volume of the EES in ONBs was lower than that of SCCs . Previous studies demonstrated that higher V e values were considered to be associated with a rich stroma, which is composed of fibroblasts, endothelium, and extracellular matrix components .…”

“…Quantitative DCE‐MRI with a pharmacokinetic model proposed by Tofts and Kermode is a useful technique to evaluate tumor permeability and angiogenesis and to differentiate various types of tumors. In vivo measurements of K trans , K ep , V e , and iAUC 60 have been shown to correlate with tumor vascularity and serve as an indicator for differential diagnosis of tumors in the head and neck region . K trans is a rate constant, qualifying the contrast agent diffusion from the blood plasma through the capillary wall into the EES, whereas K ep is a reverse rate constant of the contrast agent diffusion from the EES back to the plasma .…”

“…In vivo measurements of K trans , K ep , V e , and iAUC 60 have been shown to correlate with tumor vascularity and serve as an indicator for differential diagnosis of tumors in the head and neck region . K trans is a rate constant, qualifying the contrast agent diffusion from the blood plasma through the capillary wall into the EES, whereas K ep is a reverse rate constant of the contrast agent diffusion from the EES back to the plasma . They both increase with the microvascular blood flow, vascular permeability, and microvessel density of the internal microstructure of the diseased tissue .…”

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

“…DCE-MRI has been used for prediction of treatment response [64] by measuring blood flow–related parameters such as perfusion, permeability, or vascular volume [65–67]. Because the efficacy of chemoradiation therapy relies on effective delivery of therapeutic agents and oxygen to the tumor, the information on tumor vessels and related tumor microenvironment measured by DCE-MRI can provide critical information on selection of the most effective treatment strategy [50, 68, 69].…”

MRI Sequences in Head & Neck Radiology – State of the Art

“…However, K trans emerged as a marker for tumor hypoxia indicating poorer survival or poorer treatment response and has the potential to be a useful biomarker to guide treatment in head & neck squamous cell cancer [32,34,35]. It may also have the potential to identify early locoregional recurrence and differentiate metastatic lymph nodes from normal nodes [36]. DCE MRI may differentiate paraganglioma with high peak enhancement, SER, and short TME from schwannoma which shows a relatively low peak enhancement and SER with a longer TME [37].…”