Pretreatment diffusion-weighted and dynamic contrast-enhanced MRI for prediction of local treatment response in squamous cell carcinomas of the head and neck

Sanjeev Chawla, Sungheon Kim, Lawrence Dougherty, Sumei Wang, Laurie A. Loevner, Harry Quon, Harish Poptani

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Abstract

OBJECTIVE. The objective of our study was to predict response to chemoradiation therapy in patients with head and neck squamous cell carcinoma (HNSCC) by combined use of diffusion-weighted imaging (DWI) and high-spatial-resolution, high-temporal-resolution dynamic contrast-enhanced MRI (DCE-MRI) parameters from primary tumors and metastatic nodes. SUBJECTS AND METHODS. Thirty-two patients underwent pretreatment DWI and DCE-MRI using a modified radial imaging sequence. Postprocessing of data included motion-correction algorithms to reduce motion artifacts. The median apparent diffusion coefficient (ADC), volume transfer constant (Ktrans), extracellular extravascular volume fraction (ve), and plasma volume fraction (vp) were computed from primary tumors and nodal masses. The quality of the DCE-MRI maps was estimated using a threshold median chi-square value of 0.10 or less. Multivariate logistic regression and receiver operating characteristic curve analyses were used to determine the best model to discriminate responders from nonresponders. RESULTS. Acceptable χ2 values were observed from 84% of primary tumors and 100% of nodal masses. Five patients with unsatisfactory DCE-MRI data were excluded and DCE-MRI data for three patients who died of unrelated causes were censored from analysis. The median follow-up for the remaining patients (n = 24) was 23.72 months. When ADC and DCE-MRI parameters (Ktrans, ve, vp) from both primary tumors and nodal masses were incorporated into multivariate logistic regression analyses, a considerably higher discriminative accuracy (area under the curve [AUC] = 0.85) with a sensitivity of 81.3% and specificity of 75% was observed in differentiating responders (n = 16) from nonresponders ( n = 8). CONCLUSION. The combined use of DWI and DCE-MRI parameters from both primary tumors and nodal masses may aid in prediction of response to chemoradiation therapy in patients with HNSCC.

Original languageEnglish (US)
Pages (from-to)35-43
Number of pages9
JournalAmerican Journal of Roentgenology
Volume200
Issue number1
DOIs
StatePublished - Jan 1 2013

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Keywords

  • Diffusion-weighted imaging
  • Dynamic contrast-enhanced MRI
  • Metastatic lymph nodes
  • Primary tumors
  • Squamous cell carcinomas of head and neck

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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