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

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

Human papillomavirus (HPV) is an important risk factor for oropharyngeal squamous cell carcinoma (OPSCC). HPV-positive (HPV+) cases are associated with a different pathophysiology, microstructure, and prognosis compared to HPV-negative (HPV-) cases. This review aimed to investigate the potential of magnetic resonance imaging (MRI) to discriminate between HPV+ and HPV- tumours and predict HPV status in OPSCC patients. A systematic literature search was performed on 15 December 2022 on EMBASE, MEDLINE ALL, Web of Science, and Cochrane according to PRISMA guidelines. Twenty-eight studies (n = 2634 patients) were included. Five, nineteen, and seven studies investigated structural MRI (e.g., T1, T2-weighted), diffusion-weighted MRI, and other sequences, respectively. Three out of four studies found that HPV+ tumours were significantly smaller in size, and their lymph node metastases were more cystic in structure than HPV- ones. Eleven out of thirteen studies found that the mean apparent diffusion coefficient was significantly higher in HPV- than HPV+ primary tumours. Other sequences need further investigation. Fourteen studies used MRI to predict HPV status using clinical, radiological, and radiomics features. The reported areas under the curve (AUC) values ranged between 0.697 and 0.944. MRI can potentially be used to find differences between HPV+ and HPV- OPSCC patients and predict HPV status with reasonable accuracy. Larger studies with external model validation using independent datasets are needed before clinical implementation.

Imaging of human papilloma virus (HPV) related oropharynx tumour: what we know to date

The tumours of head and neck district are around 3% of all malignancies and squamous cell carcinoma is the most frequent histotype, with rapid increase during the last two decades because of the increment of the infection due to human papilloma virus (HPV). Even if the gold standard for the diagnosis is histological examination, including the detection of viral DNA and transcription products, imaging plays a fundamental role in the detection and staging of HPV + tumours, in order to assess the primary tumour, to establish the extent of disease and for follow-up. The main diagnostic tools are Computed Tomography (CT), Positron Emission Tomography-Computed Tomography (PET-CT) and Magnetic Resonance Imaging (MRI), but also Ultrasound (US) and the use of innovative techniques such as Radiomics have an important role. Aim of our review is to illustrate the main imaging features of HPV + tumours of the oropharynx, in US, CT and MRI imaging. In particular, we will outline the main limitations and strengths of the various imaging techniques, the main uses in the diagnosis, staging and follow-up of disease and the fundamental differential diagnoses of this type of tumour. Finally, we will focus on the innovative technique of texture analysis, which is increasingly gaining importance as a diagnostic tool in aid of the radiologist.

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

In view of the inherent limitations associated with performing dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in clinical settings, current study was designed to provide a proof of principle that Doppler sonography and DCE-MRI derived perfusion parameters yield similar hemodynamic information from metastatic lymph nodes in squamous cell carcinomas of head and neck (HNSCCs). Strong positive correlations between volume fraction of plasma space in tissues (V_p ) and blood volume (r = 0.72, p = 0.02) and between V_p and %area perfused (r = 0.65, p = 0.04) were observed. Additionally, a moderate positive correlation trending towards significance was obtained between volume transfer constant (K^trans ) and %area perfused (r = 0.49, p = 0.09).

Quantitative parameters derived from 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging can accurately estimate the histologic grade of hypopharyngeal squamous cell carcinoma preoperatively

PURPOSE

Among head and neck cancers, hypopharyngeal squamous cell carcinoma (HSCC) shows the highest malignancy, which is associated with histologic grading. This study was designed to investigate whether quantitative parameters derived from ¹⁸F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (¹⁸F-FDG PET/MRI) can preoperatively estimate the histologic grade of HSCC.

METHODS

¹⁸F-FDG PET/MRI of neck was successfully performed in 21 patients with histologically proven HSCC including poorly differentiated group (ten patients) and well-moderately differentiated group (eleven patients). Quantitative parameters derived from FDG-PET, diffusion-weighted imaging (DWI), and dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) were calculated based on volume of interest drawn on the tumor and compared between two groups. The efficacy of quantitative parameters for the estimation of histologic grades of HSCC was evaluated.

RESULTS

There were statistically significant differences in mean value of standard uptake value (SUV), apparent diffusion coefficient (ADC), and K^trans derived from ¹⁸F-FDG PET/MRI of HSCC between two groups (p < 0.05). There was no statistically significant difference in other quantitative parameters derived from ¹⁸F-FDG PET/MRI of HSCC between two groups. The area under the curve (AUC) of the combination of SUV_mean, ADC_mean, and K^trans in the estimation of histologic grade of HSCC was 0.936 with sensitivity of 90.0% and specificity of 81.8%.

CONCLUSION

The combination of SUV_mean, ADC_mean, and K^trans derived from ¹⁸F-FDG PET/MRI can accurately predict the histologic grade of HSCC preoperatively.

The impact of radiomics for human papillomavirus status prediction in oropharyngeal cancer: systematic review and radiomics quality score assessment

Purpose

Human papillomavirus (HPV) status assessment is crucial for decision making in oropharyngeal cancer patients. In last years, several articles have been published investigating the possible role of radiomics in distinguishing HPV-positive from HPV-negative neoplasms. Aim of this review was to perform a systematic quality assessment of radiomic studies published on this topic.

Methods

Radiomics studies on HPV status prediction in oropharyngeal cancer patients were selected. The Radiomic Quality Score (RQS) was assessed by three readers to evaluate their methodological quality. In addition, possible correlations between RQS% and journal type, year of publication, impact factor, and journal rank were investigated.

Results

After the literature search, 19 articles were selected whose RQS median was 33% (range 0–42%). Overall, 16/19 studies included a well-documented imaging protocol, 13/19 demonstrated phenotypic differences, and all were compared with the current gold standard. No study included a public protocol, phantom study, or imaging at multiple time points. More than half (13/19) included feature selection and only 2 were comprehensive of non-radiomic features. Mean RQS was significantly higher in clinical journals.

Conclusion

Radiomics has been proposed for oropharyngeal cancer HPV status assessment, with promising results. However, these are supported by low methodological quality investigations. Further studies with higher methodological quality, appropriate standardization, and greater attention to validation are necessary prior to clinical adoption.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00234-022-02959-0.

Histogram analysis of diffusion-weighted imaging and dynamic contrast-enhanced MRI for predicting occult lymph node metastasis in early-stage oral tongue squamous cell carcinoma

OBJECTIVES

To investigate the feasibility of whole-tumor histogram analysis of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI for predicting occult lymph node metastasis (LNM) in early-stage oral tongue squamous cell cancer (OTSCC).

MATERIALS AND METHODS

This retrospective study included 55 early-stage OTSCC (cT1-2N0M0) patients; 34 with pathological LNM and 21 without. Eight whole-tumor histogram features were extracted from quantitative apparent diffusion coefficient (ADC) maps and two semi-quantitative DCE parametric maps (wash-in and wash-out). The clinicopathological factors and histogram features were compared between the two groups. Stepwise logistic regression was used to identify independent predictors. Receiver operating characteristic curves were generated to assess the performances of significant variables and a combined model for predicting occult LNM.

RESULTS

MRI-determined depth of invasion and ADC_entropy was significantly higher in the LNM group, with respective areas under the curve (AUCs) of 0.67 and 0.69, and accuracies of 0.73 and 0.73. ADC_10th. ADC_uniformity and wash-in_skewness were significantly lower in the LNM group, with respective AUCs of 0.68, 0.71, and 0.69, and accuracies of 0.65, 0.71, and 0.64. Histogram features from wash-out maps were not significantly associated with cervical node status. In the logistic regression analysis, ADC_10th, ADC_uniformity, and wash-in_skewness were independent predictors. The combined model yielded the best predictive performance, with an AUC of 0.87 and an accuracy of 0.82.

CONCLUSIONS

Whole-tumor histogram analysis of ADC and wash-in maps is a feasible tool for preoperative evaluation of cervical node status in early-stage OTSCC.

KEY POINTS

• Histogram analysis of parametric maps from DWI and DCE-MRI may assist the prediction of occult LNM in early-stage OTSCC. • ADC_10th, ADC_uniformity, and wash-in_skewness were independent predictors. • The combined model exhibited good predictive performance, with an accuracy of 0.82.

Advances in Imaging for HPV-Related Oropharyngeal Cancer: Applications to Radiation Oncology

While there has been an overall decline of tobacco and alcohol-related head and neck cancer in recent decades, there has been an increased incidence of HPV-associated oropharyngeal cancer (OPC). Recent research studies and clinical trials have revealed that the cancer biology and clinical progression of HPV-positive OPC is unique relative to its HPV-negative counterparts. HPV-positive OPC is associated with higher rates of disease control following definitive treatment when compared to HPV-negative OPC. Thus, these conditions should be considered unique diseases with regards to treatment strategies and survival. In order to sufficiently characterize HPV-positive OPC and guide treatment strategies, there has been a considerable effort to diagnose, prognose, and track the treatment response of HPV-associated OPC through advanced imaging research. Furthermore, HPV-positive OPC patients are prime candidates for radiation de-escalation protocols, which will ideally reduce toxicities associated with radiation therapy and has prompted additional imaging research to detect radiation-induced changes in organs at risk. This manuscript reviews the various imaging modalities and current strategies for tackling these challenges as well as provides commentary on the potential successes and suggested improvements for the optimal treatment of these tumors.