Functional MRI for the prediction of treatment response in head and neck squamous cell carcinoma: potential and limitations

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Abstract

Pre-treatment or early intra-treatment prediction of patients with head and neck squamous cell carcinomas (HNSCC) who are likely to have tumours that are resistant to chemoradiotherapy (CRT) would enable treatment regimens to be changed at an early time point, or allow patients at risk of residual disease to be targeted for more intensive post-treatment investigation. Research into the potential advantages of using functional-based magnetic resonance imaging (MRI) sequences before or during cancer treatments to predict treatment response has been ongoing for several years. In regard to HNSCC, the reported results from functional MRI research are promising but they have yet to be transferred to the clinical domain. This article will review the functional MRI literature in HNSCC to determine the current status of the research and try to identify areas that are close to application in clinical practice. This review will focus on diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE–MRI) and briefly include proton magnetic resonance spectroscopy ( ¹H-MRS)and blood oxygen level dependent (BOLD) MRI.

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Most cited references 42

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Diffusion-weighted magnetic resonance imaging for predicting and detecting early response to chemoradiation therapy of squamous cell carcinomas of the head and neck.

Laurie Loevner, Gregory Weinstein, Nicholas E. Sherman … (2009)

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). 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. Pretreatment ADC value of complete responders (1.04 +/- 0.19 x 10(-3) mm2/s) was significantly lower (P < 0.05) than that from partial responders (1.35 +/- 0.30 x 10(-3) mm2/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. These results suggest that ADC can be used as a marker for prediction and early detection of response to concurrent chemoradiation therapy in HNSCC.

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Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging.

T Matsushita, Jian Wang, Jennifer A. Saito … (2001)

To evaluate whether apparent diffusion coefficients (ADCs) calculated from diffusion-weighted echo-planar magnetic resonance (MR) images can be used to characterize head and neck lesions. Diffusion-weighted echo-planar MR imaging was performed with a 1.5-T MR unit in 97 head and neck lesions in 97 patients. Images were obtained with a diffusion-weighted factor, factor b, of 0, 500, and 1,000 sec/mm(2), and an ADC map was constructed. The ADCs of lesions, cerebrospinal fluid, and spinal cord were calculated. Acceptable images for ADC measurement were obtained in 81 (84%) patients. The mean ADC of malignant lymphomas, (0.66 +/- 0.17[SD]) x 10(-3) mm(2)/sec (n = 13), was significantly smaller (P <.001) than that of carcinomas. The mean ADC of carcinomas, (1.13 +/- 0.43) x 10(-3) mm(2)/sec (n = 36), was significantly smaller (P =.002) than that of benign solid tumors. The mean ADC of benign solid tumors, (1.56 +/- 0.51) x 10(-3) mm(2)/sec (n = 22), was significantly smaller (P =.035) than that of benign cystic lesions, (2.05 +/- 0.62) x 10(-3) mm(2)/sec (n = 10). No significant differences were seen in the mean ADC of cerebrospinal fluid and of spinal cord among four groups of lesions. When an ADC smaller than 1.22 x 10(-3) mm(2)/sec was used for predicting malignancy, the highest accuracy of 86%, with 84% sensitivity and 91% specificity, was obtained. Measurement of ADCs may be used to characterize head and neck lesions.

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Head and neck squamous cell carcinoma: diagnostic performance of diffusion-weighted MR imaging for the prediction of treatment response.

Ann King, Kwok-Keung Chow, Kwok-Hung Yu … (2013)

To determine the diagnostic performance of diffusion-weighted (DW) imaging for the prediction of treatment failure in primary head and neck squamous cell carcinoma (HNSCC). The study was approved by the local institutional ethics committee and conducted with informed written consent in patients with primary HNSCC treated with radiation therapy and chemotherapy. DW imaging of the primary tumor was performed before treatment in 37 patients and was repeated within 2 weeks of treatment in 30 patients. Histograms of apparent diffusion coefficients (ADCs) were analyzed, and mean ADC, kurtosis, skewness, and their respective percentage change were correlated for local failure and local control at 2 years by using the Student t test. Univariate and multivariate analyses of the ADC parameters, T stage, and tumor volume were performed by using logistic regression for prediction of local failure. Local failure occurred in 16 of 37 (43%) patients and local control occurred in 21 of 37 (57%) patients. Pretreatment ADC parameters showed no correlation with local failure. There was significant intratreatment increase in mean ADC and a decrease in skewness and kurtosis (P < .001, P < .001, P = .024, respectively) for the whole group of patients when compared with those before treatment. During treatment, primary tumors showed a significantly lower increase in percentage change of mean ADC, higher skewness, and higher kurtosis for local failure than for local control (P = .016, .015, and .040, respectively). These ADC parameters also were significant for predicting local failure with use of univariate but not multivariate analysis. Early intratreatment DW imaging has the potential to allow prediction of treatment response at the primary site in patients with HNSCC.

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Author and article information

Contributors

Ann D. King: king2015@cuhk.edu.hk

Harriet C. Thoeny: harriet.thoeny@insel.ch

Journal

Journal ID (nlm-ta): Cancer Imaging

Journal ID (iso-abbrev): Cancer Imaging

Title: Cancer Imaging

Publisher: BioMed Central (London )

ISSN (Print): 1740-5025

ISSN (Electronic): 1470-7330

Publication date (Electronic): 19 August 2016

Publication date PMC-release: 19 August 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 23

Affiliations

[1 ]Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong S.A.R. China

[2 ]Department of Radiology, Neuroradiology and Nuclear Medicine, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland

Article

Publisher ID: 80

DOI: 10.1186/s40644-016-0080-6

PMC ID: 4992206

PubMed ID: 27542718

SO-VID: e4d33ad4-e823-4af0-84c2-7834dfd92ceb

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 18 February 2016

Date accepted : 2 August 2016

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Keywords: mri,dwi,dce,mrs,head and neck,cancer,squamous cell carcinoma,radiotherapy,chemotherapy,response

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Keywords: mri, dwi, dce, mrs, head and neck, cancer, squamous cell carcinoma, radiotherapy, chemotherapy, response

Functional MRI for the prediction of treatment response in head and neck squamous cell carcinoma: potential and limitations

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Karger: Oncology

Most cited references 42

Diffusion-weighted magnetic resonance imaging for predicting and detecting early response to chemoradiation therapy of squamous cell carcinomas of the head and neck.

Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging.

Head and neck squamous cell carcinoma: diagnostic performance of diffusion-weighted MR imaging for the prediction of treatment response.

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