Prediction of distant metastases in patients with squamous cell carcinoma of head and neck using DWI and DCE‐MRI

Abstract

Background: The primary purpose was to evaluate the prognostic potential of diffusion imaging (DWI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in predicting distant metastases in squamous cell carcinoma of head and neck (HNSCC) patients. The secondary aim was to examine differences in DWI and DCE-MRI-derived parameters on the basis of human papilloma virus (HPV) status, differentiation grade, and nodal stage of HNSCC. Methods: Fifty-six patients underwent pretreatment DWI and DCE-MRI. Patients were divided into groups who subsequently did (n = 12) or did not develop distant metastases (n = 44). Median values of apparent diffusion coefficient (ADC), volume transfer constant (K trans), and mean intracellular waterlifetime (τ i) and volume were computed from metastatic lymph nodes and were compared between two groups. Prognostic utility of HPV status, differentiation grading, and nodal staging was also evaluated both in isolation or in combination with MRI parameters in distinguishing patients with and without distant metastases. Additionally, MRI parameters were compared between two groups based on dichotomous HPV status, differentiation grade, and nodal stage. Results: Lower but not significantly different K trans (0.51 ± 0.15 minute −1 vs 0.60 ± 0.05 minute −1) and not significantly different τ i (0.13 ± 0.03 second vs 0.19 ± 0.02 second) were observed in patients who developed distant metastases than those who did not. Additionally, no significant differences in ADC or volume were found. τ i, was the best parameter in discriminating two groups with moderate sensitivity (67%) and specificity (61.4%). Multivariate logistic regression analyses did not improve the overall prognostic performance for combination of all variables. A trend toward higher τ i was observed in HPVpositive patients than those with HPV-negative patients. Also, a trend toward Abbreviation List: ADC, apparent diffusion coefficient; AIF, arterial input function; AUC, area under the ROC curve; CRT, chemoradiation therapy; CT, computer tomography; DCE-MRI, dynamic contrast enhanced-MRI; DWI, diffusion weighted imaging; FDG, 18 F-fluorodeoxyglucose; HIF-1α, hypoxia inducible transcription factor; HNSCC, squamous cell carcinomas of head and neck; HPV, human papilloma virus; K trans , volume transfer constant; MRI, magnetic resonance imaging; PET, positron emission tomography; ROC, receiver operating characteristic curve; ROI, region of interest; SSM, shutter speed model; SUV, standard uptake value; τ i , mean intracellular water molecule lifetime ; VEGF, vascular endothelial growth factor.

MRI for Differentiation between HPV-Positive and HPV-Negative Oropharyngeal Squamous Cell Carcinoma: A Systematic Review

“…Overall, low risk of bias was selected most often in all assessment categories, except for the reference standard, for which high risk was most prevalent. For the reference standard, the main concern was the use of different HPV determination methods for different patients or the exclusive use of p16 immunohistochemistry for HPV determination [ 20 , 21 , 22 , 23 , 26 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The main concern for patient selection was the lack of information on consecutive or random patient selection and the exclusion of patients with lower-stage OPSCC [ 20 , 25 , 27 , 35 , 36 , 37 , 38 , 39 , 45 , 46 , 47 ].…”

“…For the reference standard, the main concern was the use of different HPV determination methods for different patients or the exclusive use of p16 immunohistochemistry for HPV determination [ 20 , 21 , 22 , 23 , 26 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The main concern for patient selection was the lack of information on consecutive or random patient selection and the exclusion of patients with lower-stage OPSCC [ 20 , 25 , 27 , 35 , 36 , 37 , 38 , 39 , 45 , 46 , 47 ]. Regarding the index test, the main concern was the lack of pre-specification of thresholds or independent validation [ 21 , 25 , 26 , 27 , 31 , 39 , 40 , 41 , 46 , 47 , 48 ].…”

“…Eleven studies used 1.5T MRI scanners [19,25,27,28,38,43,[45][46][47]49,50], nine studies used 3.0T MRI scanners [20,22,26,29,32,37,40,41,44], and eight studies used a combination of 1.5T and 3.0T MRI scanners [2,21,23,31,35,39,42,48]. Of the twenty-eight studies, nineteen investigated OPSCC exclusively [19][20][21][22][23]27,29,31,32,37,38,40,42,[44][45][46][47][48][49], three studies investigated oral cavity (OC)SCC as well as OPSCC [2,26,28], and ...…”

“…Twelve studies delineated the entire tumour volume, and one did not specify [25,27,28,31,32,35,39,41,42,[46][47][48]50]. Seven out of nineteen studies excluded areas of necrosis and cysts [25,28,35,41,42,44,49]. Eleven out of thirteen studies found that the ADC mean for HPV− was significantly higher than for HPV+ OPSCC (Figure 3) [2,25,[27][28][29]38,39,[41][42][43][44][45][46]49].…”

Dynamic contrast‐enhanced MRI and Doppler sonography in patients with squamous cell carcinoma of head and neck treated with induction chemotherapy

“…11,12 Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) is another promising imaging technique that provides quantitative and biologically relevant information related to perfusion characteristics of metastatic lymph nodes in the entire neck region. 13,14 Numerous studies have shown the clinical potential of DCE-MRI derived parameters in predicting and evaluating treatment response to induction chemotherapy 15 and concurrent chemo-radiation therapy [16][17][18][19][20][21][22] in HNSCC. Collectively, these studies have suggested that patients harboring high pretreatment tumor perfusion respond more favorably to therapies and demonstrate improved disease-free and overall survival outcomes.…”