Dynamic contrast-enhanced magnetic resonance imaging for head and neck cancers

Multiparametric MRI for characterization of the tumour microenvironment

Our understanding of tumour biology has evolved over the past decades and cancer is now viewed as a complex ecosystem with interactions between various cellular and non-cellular components within the tumour microenvironment (TME) at multiple scales. However, morphological imaging remains the mainstay of tumour staging and assessment of response to therapy, and the characterization of the TME with non-invasive imaging has not yet entered routine clinical practice. By combining multiple MRI sequences, each providing different but complementary information about the TME, multiparametric MRI (mpMRI) enables non-invasive assessment of molecular and cellular features within the TME, including their spatial and temporal heterogeneity. With an increasing number of advanced MRI techniques bridging the gap between preclinical and clinical applications, mpMRI could ultimately guide the selection of treatment approaches, precisely tailored to each individual patient, tumour and therapeutic modality. In this Review, we describe the evolving role of mpMRI in the non-invasive characterization of the TME, outline its applications for cancer detection, staging and assessment of response to therapy, and discuss considerations and challenges for its use in future medical applications, including personalized integrated diagnostics.

Repeatability of tumor perfusion kinetics from dynamic contrast-enhanced MRI in glioblastoma

Background

Dynamic contrast-enhanced MRI (DCE-MRI) parameters have been shown to be biomarkers for treatment response in glioblastoma (GBM). However, variations in analysis and measurement methodology complicate determination of biological changes measured via DCE. The aim of this study is to quantify DCE-MRI variations attributable to analysis methodology and image quality in GBM patients.

Methods

The Extended Tofts model (eTM) and Leaky Tracer Kinetic Model (LTKM), with manually and automatically segmented vascular input functions (VIFs), were used to calculate perfusion kinetic parameters from 29 GBM patients with double-baseline DCE-MRI data. DCE-MRI images were acquired 2-5 days apart with no change in treatment. Repeatability of kinetic parameters was quantified with Bland-Altman and percent repeatability coefficient (%RC) analysis.

Results

The perfusion parameter with the least RC was the plasma volume fraction (v _p ), with a %RC of 53%. The extra-cellular extra-vascular volume fraction (v _e ) %RC was 82% and 81%, for extended Tofts-Kety Model (eTM) and LTKM respectively. The %RC of the volume transfer rate constant (K ^trans ) was 72% for the eTM, and 82% for the LTKM, respectively. Using an automatic VIF resulted in smaller %RCs for all model parameters, as compared to manual VIF.

Conclusions

As much as 72% change in K ^trans (eTM, autoVIF) can be attributable to non-biological changes in the 2-5 days between double-baseline imaging. Poor K ^trans repeatability may result from inferior temporal resolution and short image acquisition time. This variation suggests DCE-MRI repeatability studies should be performed institutionally, using an automatic VIF method and following quantitative imaging biomarkers alliance guidelines.

Primary pharyngeal synovial sarcoma in a pediatric patient: A case report

RATIONALE

Synovial sarcoma is a rare malignant tumor that typically originates from the soft tissue of the extremities. The occurrence of primary pharyngeal synovial sarcoma is even rarer, and few studies have reported its radiological features. Here, we report a case of pediatric primary pharyngeal synovial sarcoma and describe the conventional and advanced magnetic resonance imaging (MRI) findings with pathologic correlation.

PATIENT CONCERNS

An 11-year-old girl presented to the otolaryngologic clinic with dysphagia.

DIAGNOSIS

Laryngoscopy revealed a large mass in the oropharynx. MRI revealed a well-defined soft tissue mass with a maximal diameter of approximately 5 cm originating from the submucosal space of the oropharynx. The mass was primarily solid and showed homogeneous contrast-enhancement. The mass was hypointense on T1-weighted images and hyperintense on T2-weighted images. The mass showed a homogeneously low apparent diffusion coefficient value on diffusion-weighted imaging, which indicated high tumor cellularity. Dynamic contrast-enhanced MRI revealed a hypovascular tumor with low values of the volume transfer constant between the extracellular extravascular space and blood plasma and blood plasma volume per unit tissue volume. Amide proton transfer-weighted MRI revealed a relatively high amide proton transfer signal in the tumor, indicating a high protein/peptide component. The patient underwent partial surgical resection of the tumor, and the diagnosis of biphasic synovial sarcoma was confirmed on postoperative pathological examination.

INTERVENTION

The patient was started on chemotherapy with vincristine, ifosfamide, doxorubicin, and etoposide.

OUTCOMES

The tumor did not respond to the 3 cycles of the chemotherapy. Thus, the patient underwent second surgery and subsequent radiation therapy. The patient is now under ifosfamide/carboplatin/etoposide chemotherapy.

LESSON

Synovial sarcoma should be considered in the differential diagnosis of pediatric oropharyngeal submucosal tumors. Multimodal MRI may aid diagnosis, although the final diagnosis should be based on the postoperative pathological examination findings.

Dynamic contrast-enhanced magnetic resonance imaging in correlation with tongue cancer stages

BACKGROUND

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) plays a significant role in tumor stage as it can be used to measure tissue perfusion and permeability of tumors.

PURPOSE

To investigate the relationships between both quantitative and semi-quantitative variables obtained from DCE-MRI and tongue cancer stages.

MATERIAL AND METHODS

Mean values of K^trans, enhancement ratio (ER), wash-in slope (slope), and the 95th percentile (95%) values of the distribution for K^trans, ER, and slope values (K^trans (95%), ER (95%), and slope (95%), respectively) were calculated for 53 patients with tongue cancers (American Joint Committee on Cancer 8th Edition stage group: 10 in stages I and II, 14 in stage III, 21 in stage IVa, and eight in stage IVb as determined by histopathologic assessment). The relationship between tumor staging and each of the six DCE-MRI parameters was assessed separately using ordinal logistic regression.

RESULTS

The logistic regression analysis revealed that both mean and 95th percentile values of K^trans were significantly and positively correlated with tongue cancer stage (P < 0.01). More aggressive tumor stages had larger kinetic parameter. Moreover, the semi-quantitative parameters, such as ER (95%) and slope (95%), may be more significant predictors for evaluating tongue cancer stages than the mean ER and mean slope.

CONCLUSION

Both quantitative and semi-quantitative imaging biomarkers are useful for evaluating the stages of tongue cancer, and the indices obtained from DCE-MRI were positively correlated with the tumor stages. These parameters have the potential to non-invasively evaluate the stages of tongue cancer in the clinical setting.

Comparison of Segmentation Methods in Assessing Background Parenchymal Enhancement as a Biomarker for Response to Neoadjuvant Therapy

Breast parenchymal enhancement (BPE) has shown association with breast cancer risk and response to neoadjuvant treatment. However, BPE quantification is challenging, and there is no standardized segmentation method for measurement. We investigated the use of a fully automated breast fibroglandular tissue segmentation method to calculate BPE from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for use as a predictor of pathologic complete response (pCR) following neoadjuvant treatment in the I-SPY 2 TRIAL. In this trial, patients had DCE-MRI at baseline (T0), after 3 weeks of treatment (T1), after 12 weeks of treatment and between drug regimens (T2), and after completion of treatment (T3). A retrospective analysis of 2 cohorts was performed: one with 735 patients and another with a final cohort of 340 patients, meeting a high-quality benchmark for segmentation. We evaluated 3 subvolumes of interest segmented from bilateral T1-weighted axial breast DCE-MRI: full stack (all axial slices), half stack (center 50% of slices), and center 5 slices. The differences between methods were assessed, and a univariate logistic regression model was implemented to determine the predictive performance of each segmentation method. The results showed that the half stack method provided the best compromise between sampling error from too little tissue and inclusion of incorrectly segmented tissues from extreme superior and inferior regions. Our results indicate that BPE calculated using the half stack segmentation approach has potential as an early biomarker for response to treatment in the hormone receptor–negative and human epidermal growth factor receptor 2–positive subtype.

Dynamic contrast-enhanced magnetic resonance imaging for differentiating head and neck paraganglioma and schwannoma

BACKGROUND AND PURPOSE

Morphological assessment with conventional magnetic resonance imaging (MRI) sequences has limited specificity to distinguish between paragangliomas and schwannomas. Assessing the differences in microvascular properties through pharmacokinetic parameters of dynamic contrast-enhanced (DCE)-MRI can provide additional information to aid in this differentiation.

MATERIALS AND METHODS

A prospective study on MR characterization of neck masses was performed between January 2017 and March 2019 in our department, out of which 40 patients with head and neck paragangliomas (HNPGLs) (33 lesions) and schwannomas (15 lesions) were included in this analysis. MR perfusion using dynamic axial T1WI fat suppressed fast spoiled gradient recalled sequence with parallel imaging was performed in all the patients, in addition to single-shot turbo spin-echo axial diffusion weighted imaging (DWI) and routine MRI. ROI-based method was used to obtain signal-time curves, permeability measurements, and mean apparent diffusion coefficient (ADC) to differentiate paragangliomas from schwannomas. Statistical analysis was done to assess the significance and establish a cutoff to distinguish between the two entities. The available images of DOTANOC PET/CT (34 lesions) were analyzed retrospectively. Correlations between the perfusion, diffusion, and molecular PET/CT parameters were done.

RESULTS

Paragangliomas had a higher wash-in rate, wash-out rate, K_trans, K_ep , and V_p (p < 0.001); while schwannomas had a higher relative enhancement (p < 0.012), time to peak, time of onset, brevity of enhancement, and V_e (p < 0.001). Among the perfusion parameters, K_ep (area under curve (AUC) 0.994) and V_p (AUC 0.992) were found to have the highest diagnostic value. In diffusion-weighted imaging, paragangliomas had a lower mean ADC compared to schwannomas (p < 0.001). The SUV_max and SUV_mean were significantly associated with K_trans , K_ep , and V_p in paragangliomas.

CONCLUSION

DCE-MRI in addition to DWI-MRI can accurately distinguish HNPGL from schwannoma and may replace the need for any additional imaging and preoperative biopsy in most cases.

Diagnostic value of 3D dynamic contrast-enhanced magnetic resonance imaging in lymph node metastases of head and neck tumors: a correlation study with histology

Background

Accurate staging of cervical lymph nodes (LN) is pivotal for further clinical management of patients with head and neck cancer. Functional magnetic resonance imaging (MRI) such as three-dimensional (3D) dynamic contrast-enhanced (DCE) acquisition might improve the diagnosis of cervical LN metastases.

Purpose

To evaluate the additional diagnostic value of high-resolution 3D T1-weighted DCE in detecting LN metastasis compared to standard morphological imaging criteria in patients with head and neck tumors as correlated to histopathology.

Material and Methods

Standard MRI with 3D DCE acquisition at voxel sizes of 1 × 1×1 mm was performed in 15 patients before surgery; 92 LN of the head and neck were histopathologically analyzed. A logistic regression analysis of semi-quantitative DCE parameters, time-intensity curve (TIC) shapes, and morphological criteria was performed to differentiate benign from malignant LN.

Results

Standard MRI was sufficient for diagnosis of malignancy in LN with a short-axis diameter ≥ 15 mm (n = 17). For LN metastases with a short-axis diameter <15 mm (n = 12), however, the combination of 3D DCE MRI parameters, TIC shapes, and LN diameter significantly increased the sensitivity and specificity of diagnosing metastases (DCE + TIC shape + LN diameter: 92% and 88% vs. DCE only: 83% and 68% (P < 0.01) vs. LN diameter only: 83% and 77% (P = 0.04).

Conclusion

MRI including isotropic high-resolution 3D DCE acquisition combined with morphological criteria allows an accurate assessment of small cervical LN metastases in patients with head and neck cancer. For LN ≥ 15 mm diameter, morphologic imaging may suffice to diagnose metastatic disease to the LN.

Patient-Centric Head and Neck Cancer Radiation Therapy: Role of Advanced Imaging

The traditional 'one-size-fits-all' approach to H&N cancer therapy is archaic. Advanced imaging can identify radioresistant areas by using biomarkers that detect tumor hypoxia, hypercellularity etc. Highly conformal radiotherapy can target resistant areas with precision. The critical information that can be gleaned about tumor biology from these advanced imaging modalities facilitates individualized radiotherapy. The tumor imaging world is pushing its boundaries. Molecular imaging can now detect protein expression and genotypic variations across tumors that can be exploited for tailoring treatment. The exploding field of radiomics and radiogenomics extracts quantitative, biologic and genetic information and further expands the scope of personalized therapy.

Data from a terminated study on iron oxide nanoparticle magnetic resonance imaging for head and neck tumors

Node positive head and neck squamous cell carcinomas (HNSCCs) patients exhibit worse outcomes in terms of regional neck control, risk for distant metastases and overall survival. Smaller non-palpable lymph nodes may be inflammatory or may harbor clinically occult metastases, a characterization that can be challenging to make using routine imaging modalities. Ferumoxytol has been previously investigated as an intra-tumoral contrast agent for magnetic resonance imaging (MRI) for intracranial malignancies and lymph node agent in prostate cancer. Hence, our group was motivated to carry out a prospective feasibility study to assess the feasibility of ferumoxytol dynamic contrast enhanced (DCE)-weighted MRI relative to that of gadolinium-based DCE-MRI for nodal and primary tumor imaging in patients with biopsy-proven node-positive HNSCC or melanoma. Although this institutional review board (IRB)-approved study was prematurely terminated because of an FDA black box warning, the investigators sought to curate and publish this unique dataset of matched clinical, and anatomical and DCE MRI data for the enrolled five patients to be available for scientists interested in molecular imaging.

Measurement(s)	imaging assay • head and neck squamous cell carcinoma
Technology Type(s)	magnetic resonance imaging
Factor Type(s)	contrast agent
Sample Characteristic - Organism	Homo sapiens

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.11409516