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Habrich J, Boeke S, Fritz V, Koerner E, Nikolaou K, Schick F, Gani C, Zips D, Thorwarth D. Reproducibility of diffusion-weighted magnetic resonance imaging in head and neck cancer assessed on a 1.5 T MR-Linac and comparison to parallel measurements on a 3 T diagnostic scanner. Radiother Oncol 2024; 191:110046. [PMID: 38070687 DOI: 10.1016/j.radonc.2023.110046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND AND PURPOSE Before quantitative imaging biomarkers (QIBs) acquired with magnetic resonance imaging (MRI) can be used for interventional trials in radiotherapy (RT), technical validation of these QIBs is necessary. The aim of this study was to assess the reproducibility of apparent diffusion coefficient (ADC) values, derived from diffusion-weighted (DW) MRI, in head and neck cancer using a 1.5 T MR-Linac (MRL) by comparison to a 3 T diagnostic scanner (DS). MATERIAL AND METHODS DW-MRIs were acquired on MRL and DS for 15 head and neck cancer patients before RT and in week 2 and rigidly registered to the planning computed tomography. Mean ADC values were calculated for submandibular (SG) and parotid (PG) glands as well as target volumes (TV, gross tumor volume and lymph nodes), which were delineated based on computed tomography. Mean absolute ADC differences as well as within-subject coefficient of variation (wCV) and intraclass correlation coefficients (ICCs) were calculated for all volumes of interest. RESULTS A total of 23 datasets were analyzed. Mean ADC difference (DS-MRL) for SG, PG and TV resulted in 142, 254 and 93·10-6 mm2/s. wCVs/ICCs, comparing MRL and DS, were determined as 13.7 %/0.26, 24.4 %/0.23 and 16.1 %/0.73 for SG, PG and TV, respectively. CONCLUSION ADC values, measured on the 1.5 T MRL, showed reasonable reproducibility with an ADC underestimation in contrast to the DS. This ADC shift must be validated in further experiments and considered for future translation of QIB candidates from DS to MRL for response adaptive RT.
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Affiliation(s)
- Jonas Habrich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany.
| | - Simon Boeke
- German Cancer Consortium (DKTK), partner site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Victor Fritz
- Section for Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Elisa Koerner
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Fritz Schick
- Section for Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Zips
- German Cancer Consortium (DKTK), partner site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Becker M, de Vito C, Dulguerov N, Zaidi H. PET/MR Imaging in Head and Neck Cancer. Magn Reson Imaging Clin N Am 2023; 31:539-564. [PMID: 37741640 DOI: 10.1016/j.mric.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) can either be examined with hybrid PET/MR imaging systems or sequentially, using PET/CT and MR imaging. Regardless of the acquisition technique, the superiority of MR imaging compared to CT lies in its potential to interrogate tumor and surrounding tissues with different sequences, including perfusion and diffusion. For this reason, PET/MR imaging is preferable for the detection and assessment of locoregional residual/recurrent HNSCC after therapy. In addition, MR imaging interpretation is facilitated when combined with PET. Nevertheless, distant metastases and distant second primary tumors are detected equally well with PET/MR imaging and PET/CT.
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Affiliation(s)
- Minerva Becker
- Diagnostic Department, Division of Radiology, Unit of Head and Neck and Maxillofacial Radiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland.
| | - Claudio de Vito
- Diagnostic Department, Division of Clinical Pathology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland
| | - Nicolas Dulguerov
- Department of Clinical Neurosciences, Clinic of Otorhinolaryngology, Head and Neck Surgery, Unit of Cervicofacial Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland
| | - Habib Zaidi
- Diagnostic Department, Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland; Geneva University Neurocenter, University of Geneva, Geneva, Switzerland; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
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Prognostic Value of 18F-Fluorodeoxyglucose–Positron Emission Tomography/Magnetic Resonance Imaging in Patients With Hypopharyngeal Squamous Cell Carcinoma. J Comput Assist Tomogr 2022; 46:968-977. [DOI: 10.1097/rct.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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de Koekkoek-Doll PK, Roberti S, Smit L, Vogel WV, Beets-Tan R, van den Brekel MW, Castelijns J. ADC Values of Cytologically Benign and Cytologically Malignant 18 F-FDG PET-Positive Lymph Nodes of Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14164019. [PMID: 36011013 PMCID: PMC9406365 DOI: 10.3390/cancers14164019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary In squamous cell carcinoma of the head and neck, 18F-fluordeoxyglucose positron emission tomography (FDG-PET), diffusion-weighted magnetic resonance imaging (DW-MRI) and ultrasound-guided fine needle aspiration are commonly used imaging tools for nodal staging (N-staging). Although FDG-PET has good performance in nodal detection, it is still difficult to distinguish between PET-positive reactive and malignant nodes for the purpose of selecting nodes to be aspirated. DW-MRI can help to detect small lymph node metastases, and an inverse correlation with FDG uptake is expected. We found a mild negative correlation between SUVmax and ADC. Comparing the apparent diffusion coefficient (ADC) values between PET-positive and PET-negative nodes, ADC was significantly higher in PET-negative nodes. Whereas no significantly lower ADC value of cytological malignant nodes could be found overall, in the subgroup of non-HPV-related nodes, the ADC values of cytologically malignant PET-positive nodes were significantly lower than in cytologically benign nodes. This finding might be helpful in selecting nodes for puncture. Abstract Nodal staging (N-staging) in head and neck squamous cell carcinoma (HNSCC) is essential for treatment planning and prognosis. 18F-fluordeoxyglucose positron emission tomography (FDG-PET) has high performance for N-staging, although the distinction between cytologically malignant and reactive PET-positive nodes, and consequently, the selection of nodes for ultrasound-guided fine needle aspiration cytology (USgFNAC), is challenging. Diffusion-weighted magnetic resonance imaging (DW-MRI) can help to detect nodal metastases. We aim to investigate the potential of the apparent diffusion coefficient (ADC) as a metric to distinguish between cytologically reactive and malignant PET-positive nodes in order to improve node selection criteria for USgFNAC. PET-CT, real-time image-fused USgFNAC and DW-MRI to calculate ADC were available for 78 patients offered for routine N-staging. For 167 FDG-positive nodes, differences in the ADC between cytologically benign and malignant PET-positive nodes were evaluated, and both were compared to the ADC values of PET-negative reference nodes. Analyses were also performed in subsets of nodes regarding HPV status. A mild negative correlation between SUVmax and ADC was found. No significant differences in ADC values were observed between cytologically malignant and benign PET-positive nodes overall. Within the subset of non-HPV-related nodes, ADCb0-200-1000 was significantly lower in cytologically malignant PET-positive nodes when compared to benign PET-positive nodes. ADCb0-1000 and ADCb0-200-1000 were significantly lower (p = 0.018, 0.016, resp.) in PET-negative reference nodes than in PET-positive nodes. ADC was significantly higher in PET-negative reference nodes than in PET-positive nodes. The non-HPV-related subgroup showed significantly (p = 0.03) lower ADC values in cytologically malignant than in cytologically benign PET-positive nodes, which should help inform the node selection procedure for puncture.
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Affiliation(s)
- Petra K. de Koekkoek-Doll
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Correspondence:
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Laura Smit
- Department of Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Wouter V. Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Regina Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Michiel W. van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Jonas Castelijns
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Habrich J, Boeke S, Nachbar M, Nikolaou K, Schick F, Gani C, Zips D, Thorwarth D. Repeatability of diffusion-weighted magnetic resonance imaging in head and neck cancer at a 1.5 T MR-Linac. Radiother Oncol 2022; 174:141-148. [PMID: 35902042 DOI: 10.1016/j.radonc.2022.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Functional information acquired through diffusion-weighted magnetic resonance imaging (DW-MRI) may be beneficial for personalized head and neck cancer (HNC) radiotherapy. Technical validation is required before DW-MRI based radiotherapy interventions can be realized clinically. The aim of this study was to assess the repeatability of apparent diffusion coefficients (ADC) derived from DW-MRI in HNC using echo-planar imaging (EPI) on a 1.5 T MR-Linac. MATERIAL AND METHODS A total of eleven HNC patients underwent test/retest DW-MRI scans at least once per week during fractionated radiotherapy at the MR-Linac. An EPI DW-MRI test scan (b=0, 150, 500 s/mm2) was acquired before the start of adaptive MR-guided radiotherapy in addition to an identical retest scan after irradiation. Volumes-of-interest (VOI) were defined manually for parotid (PTs) and submandibular glands (SMs), gross tumor volume (GTV) and lymph nodes (LNs). Mean ADC was calculated for all VOI in all test/retest scans. Absolute/relative repeatability coefficients (RCs/relRCs) as well as intraclass correlation coefficients (ICCs) were determined for all VOI. RESULTS A total of 81 datasets were analyzed. Mean test ADC values were 1380/1416, 950/1010, 1520 and 1344·10-6 mm2/s for left/right SM and PT, GTV and LNs, respectively. Accordingly, RC (relRC) values were determined as 271/281 (19.4/21.8%) and 138/155 (13.3/15.2%), 457 (31.3%) and 310·10-6 mm2/s (23.5%). ICC resulted in 0.80/0.87, 0.97/0.94, 0.75 and 0.83 for left/right SM and PT, GTV and LNs, respectively. CONCLUSION The repeatability of ADC derived from EPI DW-MRI at the 1.5 T MR-Linac appears reasonable to be used for future biologically adapted MR-guided radiotherapy.
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Affiliation(s)
- Jonas Habrich
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany.
| | - Simon Boeke
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University of Tübingen, Germany
| | - Marcel Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Fritz Schick
- Section for Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University of Tübingen, Germany
| | - Daniel Zips
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University of Tübingen, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Freihat O, Zoltán T, Pinter T, Kedves A, Sipos D, Repa I, Kovács Á, Zsolt C. Correlation between Tissue Cellularity and Metabolism Represented by Diffusion-Weighted Imaging (DWI) and 18F-FDG PET/MRI in Head and Neck Cancer (HNC). Cancers (Basel) 2022; 14:cancers14030847. [PMID: 35159115 PMCID: PMC8833888 DOI: 10.3390/cancers14030847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/02/2023] Open
Abstract
Simple Summary We report on the correlation between the diffusion-weighted imaging (DWI) and the metabolic volume parameters derived from a PET scan, to determine the correlation between these parameters and the tumor cellularity in head and neck primary tumors. Our findings implied that there was no correlation between the information derived from the DWI and the information derived from the FDG metabolic parameters. Thus, both imaging techniques might play a complementary role in HNC diagnosis and assessment. This is significant because the treatment plan of patients with HNC should be well evaluated by using all the available diagnosis techniques, for a better understanding of how the tumor will react. Abstract Background: This study aimed to assess the association of 18F-Fluorodeoxyglucose positron-emission-tomography (18F-FDG/PET) and DWI imaging parameters from a primary tumor and their correlations with clinicopathological factors. Methods: We retrospectively analyzed primary tumors in 71 patients with proven HNC. Primary tumor radiological parameters: DWI and FDG, as well as pathological characteristics were analyzed. Spearman correlation coefficient was used to assess the correlation between DWI and FDG parameters, ANOVA or Kruskal–Wallis, independent sample t-test, Mann–Whitney test, and multiple regression were performed on the clinicopathological features that may affect the 18F- FDG and apparent-diffusion coefficient (ADC) of the tumor. Results: No significant correlations were observed between DWI and any of the 18F-FDG parameters (p > 0.05). SUVmax correlated with N-stages (p = 0.023), TLG and MTV correlated with T-stages (p = 0.006 and p = 0.001), and ADC correlated with tumor grades (p = 0.05). SUVmax was able to differentiate between N+ and N− groups (p = 0.004). Conclusions: Our results revealed a non-significant correlation between the FDG-PET and ADC-MR parameters. FDG-PET-based glucose metabolic and DWI-MR-derived cellularity data may represent different biological aspects of HNC.
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Affiliation(s)
- Omar Freihat
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Correspondence: (O.F.); (Á.K.); Tel.: +36-52-411-600 (Á.K.)
| | - Tóth Zoltán
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, 7400 Kaposvár, Hungary
| | - Tamas Pinter
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, 7400 Kaposvár, Hungary;
| | - András Kedves
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, 7400 Kaposvár, Hungary;
- Institute of Information Technology and Electrical Technology, Faculty of Engineering and Information Technology, University of Pécs, 7621 Pécs, Hungary
| | - Dávid Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, 7400 Kaposvár, Hungary;
| | - Imre Repa
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, 7400 Kaposvár, Hungary;
| | - Árpád Kovács
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Correspondence: (O.F.); (Á.K.); Tel.: +36-52-411-600 (Á.K.)
| | - Cselik Zsolt
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (T.Z.); (A.K.); (I.R.); (C.Z.)
- Csolnoky Ferenc County Hospital, 8200 Veszprém, Hungary
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Bülbül HM, Bülbül O, Sarıoğlu S, Özdoğan Ö, Doğan E, Karabay N. Relationships Between DCE-MRI, DWI, and 18F-FDG PET/CT Parameters with Tumor Grade and Stage in Patients with Head and Neck Squamous Cell Carcinoma. Mol Imaging Radionucl Ther 2021; 30:177-186. [PMID: 34658826 PMCID: PMC8522517 DOI: 10.4274/mirt.galenos.2021.25633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives Properties of head and neck squamous cell carcinoma (HNSCC) such as cellularity, vascularity, and glucose metabolism interact with each other. This study aimed to investigate the associations between diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and positron emission tomography/computed tomography (PET/CT) in patients with HNSCC. Methods Fourteen patients who were diagnosed with HNSCC were investigated using DCE-MRI, DCE, and 18fluoride-fluorodeoxyglucose PET/CT and evaluated retrospectively. Ktrans, Kep, Ve, and initial area under the curve (iAUC) parameters from DCE-MRI, ADCmax, ADCmean, and ADCmin parameters from DWI, and maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) parameters from PET were obtained. Spearman's correlation coefficient was used to analyze associations between these parameters. In addition, these parameters were grouped according to tumor grade and T and N stages, and the difference between the groups was evaluated using the Mann-Whitney U test. Results Correlations at varying degrees were observed in the parameters investigated. ADCmean moderately correlated with Ve (p=0.035; r=0.566). Ktrans inversely correlated with SUVmax (p=0.017; r=-0.626). iAUC inversely correlated with SUVmax, SUVmean, TLG, and MTV (p<0.05, r≤-0.700). MTV (40% threshold) was significantly higher in T4 tumors than in T1-3 tumors (p=0.020). No significant difference was found in the grouping made according to tumor grade and N stage in terms of these parameters. Conclusion Tumor cellularity, vascular permeability, and glucose metabolism had significant correlations at different degrees. Furthermore, MTV may be useful in predicting T4 tumors.
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Affiliation(s)
- Hande Melike Bülbül
- Recep Tayyip Erdoğan Training and Research Hospital, Clinic of Radiology, Rize, Turkey
| | - Ogün Bülbül
- Recep Tayyip Erdoğan Training and Research Hospital, Clinic of Nuclear Medicine, Rize, Turkey
| | - Sülen Sarıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Medical Pathology, İzmir, Turkey
| | - Özhan Özdoğan
- Dokuz Eylül University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | - Ersoy Doğan
- Dokuz Eylül University Faculty of Medicine, Department of Otorhinolaryngology, İzmir, Turkey
| | - Nuri Karabay
- Dokuz Eylül University Faculty of Medicine, Department of Radiology, İzmir, Turkey
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Bos P, van der Hulst HJ, van den Brekel MWM, Schats W, Jasperse B, Beets-Tan RGH, Castelijns JA. Prognostic functional MR imaging parameters in head and neck squamous cell carcinoma: A systematic review. Eur J Radiol 2021; 144:109952. [PMID: 34562743 DOI: 10.1016/j.ejrad.2021.109952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/10/2021] [Accepted: 08/31/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Functional MR imaging has demonstrated potential for predicting treatment response. This systematic review gives an extensive overview of the current level of evidence for pre-treatment MR-based perfusion and diffusion imaging parameters that are prognostic for treatment outcome in head and neck squamous cell carcinoma (HNSCC) (PROSPERO registrationCRD42020210689). MATERIALS AND METHODS According to the PRISMA statements, Medline, Embase and Scopus were queried for articles with a maximum date of October 19th, 2020. Studies investigating the predictive performance of pre-treatment MR-based perfusion and/or diffusion imaging parameters in HNSCC treatment response were included. All prognosticators were extracted from the primary tumor. Risk of bias was assessed using the QUIPS tool. Results were summarized in tables and forest plots. RESULTS 31 unique studies met the inclusion criteria; among them, 11 articles described perfusion (n = 529 patients) and 28 described diffusion (n = 1626 patients) MR-imaging, eight studies were included in both categories. Higher Ktrans and Kep were associated with better treatment response for OS and DFS, respectively. Study findings for Vp and Ve were inconsistent or not significant. High-level controversy was observed between studies examining the MR diffusion parameters mean and median ADC. CONCLUSION For HNSCC patients, the accurate and consistent results of pre-treatment MR-based perfusion parameters Ktrans and Kep are potential for clinical applicability predictive of OS and DFS and treatment decision guidance. Significant heterogeneity in study designs might affect high discrepancy in study results for parameters extracted from diffusion imaging. Furthermore, recommendations for future research were summarized.
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Affiliation(s)
- Paula Bos
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, the Netherlands.
| | - Hedda J van der Hulst
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, the Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Winnie Schats
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Bas Jasperse
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, the Netherlands; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Jonas A Castelijns
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Paudyal R, Grkovski M, Oh JH, Schöder H, Nunez DA, Hatzoglou V, Deasy JO, Humm JL, Lee NY, Shukla-Dave A. Application of Community Detection Algorithm to Investigate the Correlation between Imaging Biomarkers of Tumor Metabolism, Hypoxia, Cellularity, and Perfusion for Precision Radiotherapy in Head and Neck Squamous Cell Carcinomas. Cancers (Basel) 2021; 13:3908. [PMID: 34359810 PMCID: PMC8345739 DOI: 10.3390/cancers13153908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
The present study aimed to investigate the correlation at pre-treatment (TX) between quantitative metrics derived from multimodality imaging (MMI), including 18F-FDG-PET/CT, 18F-FMISO-PET/CT, DW- and DCE-MRI, using a community detection algorithm (CDA) in head and neck squamous cell carcinoma (HNSCC) patients. Twenty-three HNSCC patients with 27 metastatic lymph nodes underwent a total of 69 MMI exams at pre-TX. Correlations among quantitative metrics derived from FDG-PET/CT (SUL), FMSIO-PET/CT (K1, k3, TBR, and DV), DW-MRI (ADC, IVIM [D, D*, and f]), and FXR DCE-MRI [Ktrans, ve, and τi]) were investigated using the CDA based on a "spin-glass model" coupled with the Spearman's rank, ρ, analysis. Mean MRI T2 weighted tumor volumes and SULmean values were moderately positively correlated (ρ = 0.48, p = 0.01). ADC and D exhibited a moderate negative correlation with SULmean (ρ ≤ -0.42, p < 0.03 for both). K1 and Ktrans were positively correlated (ρ = 0.48, p = 0.01). In contrast, Ktrans and k3max were negatively correlated (ρ = -0.41, p = 0.03). CDA revealed four communities for 16 metrics interconnected with 33 edges in the network. DV, Ktrans, and K1 had 8, 7, and 6 edges in the network, respectively. After validation in a larger population, the CDA approach may aid in identifying useful biomarkers for developing individual patient care in HNSCC.
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Affiliation(s)
- Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (R.P.); (M.G.); (J.H.O.); (D.A.N.); (J.O.D.); (J.L.H.)
| | - Milan Grkovski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (R.P.); (M.G.); (J.H.O.); (D.A.N.); (J.O.D.); (J.L.H.)
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (R.P.); (M.G.); (J.H.O.); (D.A.N.); (J.O.D.); (J.L.H.)
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (H.S.); (V.H.)
| | - David Aramburu Nunez
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (R.P.); (M.G.); (J.H.O.); (D.A.N.); (J.O.D.); (J.L.H.)
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (H.S.); (V.H.)
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (R.P.); (M.G.); (J.H.O.); (D.A.N.); (J.O.D.); (J.L.H.)
| | - John L. Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (R.P.); (M.G.); (J.H.O.); (D.A.N.); (J.O.D.); (J.L.H.)
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (R.P.); (M.G.); (J.H.O.); (D.A.N.); (J.O.D.); (J.L.H.)
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (H.S.); (V.H.)
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Connor S, Sit C, Anjari M, Szyszko T, Dunn J, Pai I, Cook G, Goh V. Correlations between DW-MRI and 18 F-FDG PET/CT parameters in head and neck squamous cell carcinoma following definitive chemo-radiotherapy. Cancer Rep (Hoboken) 2021; 4:e1360. [PMID: 33960739 PMCID: PMC8388179 DOI: 10.1002/cnr2.1360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Posttreatment diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxygluocose (18 F-FDG) positron emission tomography (PET) with computed tomography (PET/CT) have potential prognostic value following chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Correlations between these PET/CT (standardized uptake value or SUV) and DW-MRI (apparent diffusion coefficient or ADC) parameters have only been previously explored in the pretreatment setting. AIM To evaluate stage III and IV HNSCC at 12-weeks post-CRT for the correlation between SUVmax and ADC values and their interval changes from pretreatment imaging. METHODS Fifty-six patients (45 male, 11 female, mean age 59.9 + - 7.38) with stage 3 and 4 HNSCC patients underwent 12-week posttreatment DW-MRI and 18 F-FDG PET/CT studies in this prospective study. There were 41/56 patients in the cohort with human papilloma virus-related oropharyngeal cancer (HPV OPC). DW-MRI (ADCmax and ADCmin) and 18 F-FDG PET/CT (SUVmax and SUVmax ratio to liver) parameters were measured at the site of primary tumors (n = 48) and the largest lymph nodes (n = 52). Kendall's tau evaluated the correlation between DW-MRI and 18 F-FDG PET/CT parameters. Mann-Whitney test compared the post-CRT PET/CT and DW-MRI parameters between those participants with and without 2-year disease-free survival (DFS). RESULTS There was no correlation between DW-MRI and 18 F-FDG PET/CT parameters on 12-week posttreatment imaging (P = .455-.794; tau = -0.075-0.25) or their interval changes from pretreatment to 12-week posttreatment imaging (P = .1-.946; tau = -0.194-0.044). The primary tumor ADCmean (P = .03) and the interval change in nodal ADCmin (P = .05) predicted 2-year DFS but none of the 18 F-FDG PET/CT parameters were associated with 2-year DFS. CONCLUSIONS There is no correlation between the quantitative DWI-MRI and 18 F-FDG PET/CT parameters derived from 12-week post-CRT studies. These parameters may be independent biomarkers however in this HPV OPC dominant cohort, only selected ADC parameters demonstrated prognostic significance. Study was prospectively registered at http://www.controlled-trials.com/ISRCTN58327080.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of NeuroradiologyKing's College Hospital NHS Foundation TrustLondonUK
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Cherry Sit
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Mustafa Anjari
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Teresa Szyszko
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Joel Dunn
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of OtolaryngologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Gary Cook
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Vicky Goh
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
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11
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Garau LM, Manca G, Bola S, Aringhieri G, Faggioni L, Volterrani D. Correlation between 18F-FDG PET/CT and diffusion-weighted MRI parameters in head and neck squamous cell carcinoma at baseline and after chemo-radiotherapy. A retrospective single institutional study. Oral Radiol 2021; 38:199-209. [PMID: 34133000 DOI: 10.1007/s11282-021-00545-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The relationship between glucose metabolism and tumor cellularity before chemo-radiotherapy in patients with head and neck squamous cell carcinoma (SCC) has never been compared with that of patients evaluated after treatment. This retrospective study analyzed the correlation between glucose metabolism parameters expressed by standardized uptake value (SUV) derived from 18F-fluorodeoxyglucose (18F-FDG) PET/CT and cellularity tumor parameters expressed by apparent diffusion coefficients (ADC) derived from diffusion-weighted (DW) MRI in untreated and treated patients with head and neck SCC. METHODS In 19 patients with no previous exposure to any treatment and 17 different chemo-radiotreated patients with head and neck SCC, we correlated the semi-quantitative uptake values (SUVmax, SUVpeak, and SUVmean) with the ADC functional parameters (ADCmin, ADCmean) including the standard deviation of ADC values (ADCsd). RESULTS No significant correlation was found between glucose metabolism parameters and ADCmin or ADCmean in untreated and treated patient groups. However, in untreated patients, significant inverse correlations were found between ADCsd and SUVmax (P = 0.039, r = -0.476), SUVpeak (P = 0.003, r = -0.652) and SUVmean (P = 0.039, r = -0.477). Analyses after chemo-radiotherapy in 17 patients showed no significant correlation between glucose metabolism parameters and DW MRI values, excluding a persistent significant (but lower intensity) inverse correlation between SUVpeak and ADCsd (P = 0.033, r = -0.519). CONCLUSIONS The demonstrated relationships suggest complex interactions especially between metabolic activity and heterogeneity of tumoral tissue, which might play a complementary role in the assessment of head and neck SCC. TRIAL DATE OF REGISTRATION AND REGISTRATION NUMBER Our retrospective study was registered on April 9th, 2020 by the Ethics Committee of the Coordinating Center "Area Vasta Nord Ovest" (CEAVNO) with Registration Number CEAVNO09042020.
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Affiliation(s)
- Ludovico M Garau
- Department of Radiology, Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy.
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
| | - Gianpiero Manca
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Stefano Bola
- Department of Radiology, Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giacomo Aringhieri
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
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12
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Connor S, Anjari M, Burd C, Guha A, Lei M, Guerrero-Urbano T, Pai I, Bassett P, Goh V. The impact of human papilloma virus status on the prediction of head and neck cancer chemoradiotherapy outcomes using the pre-treatment apparent diffusion coefficient. Br J Radiol 2021; 95:20210333. [PMID: 34111977 PMCID: PMC8822554 DOI: 10.1259/bjr.20210333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To determine the impact of Human Papilloma Virus (HPV) oropharyngeal cancer (OPC) status on the prediction of head and neck squamous cell cancer (HNSCC) chemoradiotherapy (CRT) outcomes with pre-treatment quantitative diffusion-weighted magnetic resonance imaging (DW-MRI). Methods: Following ethical approval, 65 participants (53 male, age 59.9 ± 7.86) underwent pre-treatment DW-MRI in this prospective cohort observational study. There were 46 HPV OPC and 19 other HNSCC cases with Stage III/IV HNSCC. Regions of interest (ROIs) (volume, largest area, core) at the primary tumour (n = 57) and largest pathological node (n = 59) were placed to analyse ADCmean and ADCmin. Unpaired t-test or Mann–Whitney test evaluated the impact of HPV OPC status and clinical parameters on their prediction of post-CRT 2 year locoregional and disease-free survival (LRFS and DFS). Multivariate logistic regression compared significant variables with 2 year outcomes. Results: On univariate analysis of all participants, the primary tumour area ADCmean was predictive of 2 year LRFS (p = 0.04). However, only the HPV OPC diagnosis (LFRS p = 0.03; DFS p = 0.02) predicted outcomes on multivariate analysis. None of the pre-treatment ADC values were predictive of 2 year DFS in the HPV OPC subgroup (p = 0.21–0.68). Amongst participants without 2 year disease-free survival, HPV-OPC was found to have much lower primary tumour ADCmean values than other HNSCC. Conclusion: Knowledge of HPV OPC status is required in order to determine the impact of the pre-treatment ADC values on post-CRT outcomes in HNSCC. Advances in knowledge: Pre-treatment ADCmean and ADCmin values acquired using different ROI methods are not predictive of 2 year survival outcomes in HPV OPC.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, United Kingdom.,Department of Neuroradiology, King's College Hospital, London, SE5 9RS, United Kingdom.,Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Mustafa Anjari
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Christian Burd
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Amrita Guha
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Mary Lei
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT UK5, United Kingdom
| | - Teresa Guerrero-Urbano
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT UK5, United Kingdom
| | - Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, United Kingdom.,Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Paul Bassett
- Freelance medical statistician, London, United Kingdom
| | - Vicky Goh
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, United Kingdom.,Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, United Kingdom
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13
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Boucher F, Liao E, Srinivasan A. Diffusion-Weighted Imaging of the Head and Neck (Including Temporal Bone). Magn Reson Imaging Clin N Am 2021; 29:205-232. [PMID: 33902904 DOI: 10.1016/j.mric.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diffusion techniques provide valuable information when performing head and neck imaging. This information can be used to detect the presence or absence of pathology, refine differential diagnosis, determine the location for biopsy, assess response to treatment, and prognosticate outcomes. For example, when certain technical factors are taken into consideration, diffusion techniques prove indispensable in assessing for residual cholesteatoma following middle ear surgery. In other scenarios, pretreatment apparent diffusion coefficient values may assist in prognosticating outcomes in laryngeal cancer and likelihood of response to radiation therapy. As diffusion techniques continue to advance, so too will its clinical utility.
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Affiliation(s)
- Felix Boucher
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 East Medical Center Drive, B1D502, Ann Arbor 48109-5030, USA
| | - Eric Liao
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 East Medical Center Drive, Taubman Center B1-132, Ann Arbor 48109-5030, USA
| | - Ashok Srinivasan
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 East Medical Center Drive, B2A209, Ann Arbor 48109-5030, USA.
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Prognostic Value of Apparent Diffusion Coefficient in Oropharyngeal Carcinoma. Clin Neuroradiol 2021; 31:1037-1048. [PMID: 33877396 PMCID: PMC8648632 DOI: 10.1007/s00062-021-01014-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
Purpose To investigate clinical and radiological factors predicting worse outcome after (chemo)radiotherapy ([C]RT) in oropharyngeal squamous cell carcinoma (OPSCC) with a focus on apparent diffusion coefficient (ADC). Methods This retrospective study included 67 OPSCC patients, treated with (C)RT with curative intent and diagnosed during 2013–2017. Human papilloma virus (HPV) association was detected with p16 immunohistochemistry. Of all 67 tumors, 55 were p16 positive, 9 were p16 negative, and in 3 the p16 status was unknown. Median follow-up time was 38 months. We analyzed pretreatment magnetic resonance imaging (MRI) for factors predicting disease-free survival (DFS) and locoregional recurrence (LRR), including primary tumor volume and the largest metastasis. Crude and p16-adjusted hazard ratios were analyzed using Cox proportional hazards model. Interobserver agreement was evaluated. Results Disease recurred in 13 (19.4%) patients. High ADC predicted poor DFS, but not when the analysis was adjusted for p16. A break in RT (hazard ratio, HR = 3.972, 95% confidence interval, CI 1.445–10.917, p = 0.007) and larger metastasis volume (HR = 1.041, 95% CI 1.007–1.077, p = 0.019) were associated with worse DFS. A primary tumor larger than 7 cm3 was associated with increased LRR rate (HR = 4.861, 1.042–22.667, p = 0.044). Among p16-positive tumors, mean ADC was lower in grade 3 tumors compared to lower grade tumors (0.736 vs. 0.883; p = 0.003). Conclusion Low tumor ADC seems to be related to p16 positivity and therefore should not be used independently to evaluate disease prognosis or to choose patients for treatment deintensification.
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Orsatti G, Zucchetta P, Varotto A, Crimì F, Weber M, Cecchin D, Bisogno G, Spimpolo A, Giraudo C, Stramare R. Volumetric histograms-based analysis of apparent diffusion coefficients and standard uptake values for the assessment of pediatric sarcoma at staging: preliminary results of a PET/MRI study. Radiol Med 2021; 126:878-885. [PMID: 33683542 DOI: 10.1007/s11547-021-01340-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the relationship between apparent diffusion coefficients (ADC) and standard uptake values (SUV) of pediatric sarcomas at staging by using volumetric histograms analyses. METHODS Children with histologically proven sarcoma, referring to our tertiary center for a whole-body 18F-FDG PET/MRI for staging and including diffusion weighted imaging in the MRI protocol were investigated. Firstly, turbo inversion recovery magnitude (TIRM) and PET images were resliced and resampled according to the ADC maps. Regions of interests were drawn along tumor margins on TIRM images and then copied on PET and ADC datasets. Pixel-based SUVs and ADCs were collected from the entire volume of each lesion. Mean, median, skewness, and kurtosis of SUVs and ADCs values were computed, and the Pearson correlation coefficient was then applied (for the entire population and for histological subgroups with more than five patients). RESULTS Thirteen patients met the inclusion criteria (six females; mean age 8.31 ± 6.03 years). Histology revealed nine rhabdomyosarcomas, three Ewing sarcomas, and one chondroblastic osteosarcoma. A significant negative correlation between ADCs' and SUVs' mean (rmean = - 0.501, P < 0.001), median (rmedian = - 0.519, P < 0,001), and skewness (rskewness = - 0.550, P < 0.001) emerged for the entire population and for rhabdomyosarcomas (rmean = - 0.541, P = 0.001, rmedian = - 0.597, P < 0.001, rskewness = - 0.568, P < 0.001), whereas a significant positive correlation was found for kurtosis (rkurtosis = 0.346, P < 0.001, and rkurtosis = 0.348, P < 0.001 for the entire population and for rhabdomyosarcomas, respectively). CONCLUSION Our preliminary results demonstrate that, using volumetric histograms, simultaneously collected SUVs and ADCs are dependent biomarkers in pediatric FDG-avid sarcomas. Further studies, on a larger population, are necessary to confirm this evidence and assess its clinical implications.
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Affiliation(s)
- Giovanna Orsatti
- Department of Medicine - DIMED, Institute of Radiology, Padova University, Via Giustiniani 2, 35100, Padua, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | | | - Filippo Crimì
- Department of Medicine - DIMED, Institute of Radiology, Padova University, Via Giustiniani 2, 35100, Padua, Italy
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Gianni Bisogno
- Hematology and Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Alessandro Spimpolo
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Chiara Giraudo
- Department of Medicine - DIMED, Institute of Radiology, Padova University, Via Giustiniani 2, 35100, Padua, Italy.
| | - Roberto Stramare
- Department of Medicine - DIMED, Institute of Radiology, Padova University, Via Giustiniani 2, 35100, Padua, Italy
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Yoon H, Ha S, Kwon SJ, Park SY, Kim J, O JH, Yoo IR. Prognostic value of tumor metabolic imaging phenotype by FDG PET radiomics in HNSCC. Ann Nucl Med 2021; 35:370-377. [PMID: 33554314 DOI: 10.1007/s12149-021-01586-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Tumor metabolic phenotype can be assessed with integrated image pattern analysis of 18F-fluoro-deoxy-glucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT), called radiomics. This study was performed to assess the prognostic value of radiomics PET parameters in head and neck squamous cell carcinoma (HNSCC) patients. METHODS 18F-fluoro-deoxy-glucose (FDG) PET/CT data of 215 patients from HNSCC collection free database in The Cancer Imaging Archive (TCIA), and 122 patients in Seoul St. Mary's Hospital with baseline FDG PET/CT for locally advanced HNSCC were reviewed. Data from TCIA database were used as a training cohort, and data from Seoul St. Mary's Hospital as a validation cohort. With the training cohort, primary tumors were segmented by Nestles' adaptive thresholding method. Segmental tumors in PET images were preprocessed using relative resampling of 64 bins. Forty-two PET parameters, including conventional parameters and texture parameters, were measured. Binary groups of homogeneous imaging phenotypes, clustered by K-means method, were compared for overall survival (OS) and disease-free survival (DFS) by log-rank test. Selected individual radiomics parameters were tested along with clinical factors, including age and sex, by Cox-regression test for OS and DFS, and the significant parameters were tested with multivariate analysis. Significant parameters on multivariate analysis were again tested with multivariate analysis in the validation cohort. RESULTS A total of 119 patients, 70 from training, and 49 from validation cohort, were included in the study. The median follow-up period was 62 and 52 months for the training and the validation cohort, respectively. In the training cohort. binary groups with different metabolic radiomics phenotypes showed significant difference in OS (p = 0.036), and borderline difference in DFS (p = 0.086). Gray-Level Non-Uniformity for zone (GLNUGLZLM) was the most significant prognostic factor for both OS (hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.4-7.3, p = 0.008) and DFS (HR 4.5, CI 1.3-16, p = 0.020). Multivariate analysis revealed GLNUGLZLM as an independent prognostic factor for OS (HR 3.7, 95% CI 1.1-7.5, p = 0.032). GLNUGLZLM remained as an independent prognostic factor in the validation cohort (HR 14.8. 95% CI 3.3-66, p < 0.001). CONCLUSIONS Baseline FDG PET radiomics contain risk information for survival prognosis in HNSCC patients. The metabolic heterogeneity parameter, GLNUGLZLM, may assist clinicians in patient risk assessment as a feasible prognostic factor.
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Affiliation(s)
- Hyukjin Yoon
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seunggyun Ha
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Soo Jin Kwon
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sonya Youngju Park
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jihyun Kim
- Division of Nuclear Medicine, Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea
| | - Joo Hyun O
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ie Ryung Yoo
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Multiparametric functional MRI and 18F-FDG-PET for survival prediction in patients with head and neck squamous cell carcinoma treated with (chemo)radiation. Eur Radiol 2020; 31:616-628. [PMID: 32851444 PMCID: PMC7813703 DOI: 10.1007/s00330-020-07163-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022]
Abstract
Objectives To assess (I) correlations between diffusion-weighted (DWI), intravoxel incoherent motion (IVIM), dynamic contrast-enhanced (DCE) MRI, and 18F-FDG-PET/CT imaging parameters capturing tumor characteristics and (II) their predictive value of locoregional recurrence-free survival (LRFS) and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC) treated with (chemo)radiotherapy. Methods Between 2014 and 2018, patients with histopathologically proven HNSCC, planned for curative (chemo) radiotherapy, were prospectively included. Pretreatment clinical, anatomical, and functional imaging parameters (obtained by DWI/IVIM, DCE-MRI, and 18F-FDG-PET/CT) were extracted for primary tumors (PT) and lymph node metastases. Correlations and differences between parameters were assessed. The predictive value of LRFS and OS was assessed, performing univariable, multivariable Cox and CoxBoost regression analyses. Results In total, 70 patients were included. Significant correlations between 18F-FDG-PET parameters and DWI-/DCE volume parameters were found (r > 0.442, p < 0.002). The combination of HPV (HR = 0.903), intoxications (HR = 1.065), PT ADCGTV (HR = 1.252), Ktrans (HR = 1.223), and Ve (HR = 1.215) was predictive for LRFS (C-index = 0.546; p = 0.023). N-stage (HR = 1.058), HPV positivity (HR = 0.886), hypopharyngeal tumor location (HR = 1.111), ADCGTV (HR = 1.102), ADCmean (HR = 1.137), D* (HR = 0.862), Ktrans (HR = 1.106), Ve (HR = 1.195), SUVmax (HR = 1.094), and TLG (HR = 1.433) were predictive for OS (C-index = 0.664; p = 0.046). Conclusions Functional imaging parameters, performing DWI/IVIM, DCE-MRI, and 18F-FDG-PET/CT, yielded complementary value in capturing tumor characteristics. More specific, intoxications, HPV-negative status, large tumor volume-related parameters, high permeability (Ktrans), and high extravascular extracellular space (Ve) parameters were predictive for adverse locoregional recurrence-free survival and adverse overall survival. Low cellularity (high ADC) and high metabolism (high SUV) were additionally predictive for decreased overall survival. These different predictive factors added to estimated locoregional and overall survival. Key Points • Parameters of DWI/IVIM, DCE-MRI, and 18F-FDG-PET/CT were able to capture complementary tumor characteristics. • Multivariable analysis revealed that intoxications, HPV negativity, large tumor volume and high vascular permeability (Ktrans), and extravascular extracellular space (Ve) were complementary predictive for locoregional recurrence. • In addition to predictive parameters for locoregional recurrence, also high cellularity (low ADC) and high metabolism (high SUV) were complementary predictive for overall survival. Electronic supplementary material The online version of this article (10.1007/s00330-020-07163-3) contains supplementary material, which is available to authorized users.
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Ravanelli M, Grammatica A, Maddalo M, Ramanzin M, Agazzi GM, Tononcelli E, Battocchio S, Bossi P, Vezzoli M, Maroldi R, Farina D. Pretreatment DWI with Histogram Analysis of the ADC in Predicting the Outcome of Advanced Oropharyngeal Cancer with Known Human Papillomavirus Status Treated with Chemoradiation. AJNR Am J Neuroradiol 2020; 41:1473-1479. [PMID: 32732272 DOI: 10.3174/ajnr.a6695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased in the period from the 1970s to 2004, due to increase of infection with human papilloma virus (HPV). This study aimed to examine the role of histogram analysis of the ADC in treatment response and survival prediction of patients with oropharyngeal squamous cell carcinoma and known human papillomavirus status. MATERIALS AND METHODS This was a retrospective single-center study. Following inclusion and exclusion criteria, data for 59 patients affected by T2-T4 (according to the 8th edition of the AJCC Cancer Staging Manual) oropharyngeal squamous cell carcinoma were retrieved. Twenty-eight had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 had human papillomavirus-negative oropharyngeal squamous cell carcinoma. All patients underwent a pretreatment MR imaging. Histogram analysis of ADC maps obtained by DWI (b = 0-1000 mm/s2) was performed on the central section of all of tumors. The minimum follow-up period was 2 years. Histogram ADC parameters were associated with progression-free survival and overall survival. Univariable and multivariable Cox models were applied to the data; P values were corrected using the Benjamini-Hochberg method. RESULTS At univariable analysis, both human papillomavirus status and mean ADC were associated with progression-free survival (hazard ratio = 0.267, P < .05, and hazard ratio = 1.0028, P ≤ .05, respectively), while only human papillomavirus status was associated with overall survival (hazard ratio = 0.213, P ≤ .05) before correction. At multivariable analysis, no parameter was included (in fact, human papillomavirus status lost significance after correction). If we separated the patients into 2 subgroups according to human papillomavirus status, ADC entropy was associated with overall survival in the human papillomavirus-negative group (hazard ratio = 4.846, P = .01). CONCLUSIONS ADC and human papillomavirus status are related to progression-free survival in patients treated with chemoradiation for advanced oropharyngeal squamous cell carcinoma; however, this association seems to result from the strong association between ADC and human papillomavirus status.
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Affiliation(s)
- M Ravanelli
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | | | | | - M Ramanzin
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - G M Agazzi
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - E Tononcelli
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | | | | | - M Vezzoli
- Molecular and Translational Medicine (M.V.), University of Brescia, Brescia, Italy
| | - R Maroldi
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - D Farina
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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Shukla M, Forghani R, Agarwal M. Patient-Centric Head and Neck Cancer Radiation Therapy: Role of Advanced Imaging. Neuroimaging Clin N Am 2020; 30:341-357. [PMID: 32600635 DOI: 10.1016/j.nic.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Monica Shukla
- Department of Radiation Oncology, Froedtert and Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Reza Forghani
- Augmented Intelligence & Precision Health Laboratory, Department of Radiology, Research Institute of McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Mohit Agarwal
- Department of Radiology, Section of Neuroradiology, Froedtert and Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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20
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Correlation between apparent diffusion coefficients and metabolic parameters in hypopharyngeal squamous cell carcinoma: A prospective study with integrated PET/MRI. Eur J Radiol 2020; 129:109070. [PMID: 32454330 DOI: 10.1016/j.ejrad.2020.109070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/03/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Apparent diffusion coefficients (ADCs) derived from diffusion-weighted magnetic resonance imaging (DW-MRI) and metabolic parameters derived from 18F-FDG positron emission tomography (PET) are promising prognostic indicators for head and neck squamous cell carcinoma (SCC). However, the relationship between them remains unclear. This study aimed to investigate the relationship between ADCs and metabolic parameters in hypopharyngeal SCC (HSCC) using integrated PET/MRI. MATERIALS AND METHODS Twenty-seven patients with biopsy-proven HSCC underwent integrated 18F-FDG neck PET/MRI. ADCs of HSCC, including the mean and minimum ADC values (ADCmean and ADCmin), were measured manually on ADC maps. Metabolic parameters of HSCC, including maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), were calculated automatically on PET images. Spearman correlation coefficients were used to assess the relationships between ADCs and metabolic parameters in HSCC tumors as well as in tumor groups with different histological grading, clinical staging, and anatomical subsites. P values < 0.05 were considered statistically significant. RESULTS No significant correlation was observed between ADCs and 18F-FDG PET metabolic parameters in the entire cohort, except for a significant inverse correlation between ADCmean and MTV (r = -0.556, P = 0.003). Furthermore, a significant inverse correlation was observed between ADCmean and MTV of HSCC in the moderately to well differentiated group (rADCmean/MTV = -0.692, P = 0.006), stage III group (rADCmean/MTV = -0.758, P = 0.003), and pyriform sinus group (rADCmean/MTV = -0.665, P = 0.007), whereas no significant correlation was observed in the poorly differentiated group, stage IV group, or non-pyriform sinus group. CONCLUSIONS Inverse correlation between ADCmean and MTV in the HSCC population was observed and the correlativity depended on histological grading, clinical staging, and anatomical subsites of HSCC.
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Cheng Y, Bai L, Shang J, Tang Y, Ling X, Guo B, Gong J, Wang L, Xu H. Preliminary clinical results for PET/MR compared with PET/CT in patients with nasopharyngeal carcinoma. Oncol Rep 2019; 43:177-187. [PMID: 31746412 PMCID: PMC6908933 DOI: 10.3892/or.2019.7392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/09/2019] [Indexed: 12/23/2022] Open
Abstract
The present study aimed to assess the performance of positron emission tomography-magnetic resonance imaging (PET/MR) for the visualization and characterization of lesions. In addition, the present study investigated whether the apparent diffusion coefficient (ADC) and intravoxel incoherent motion parameters exhibited any significant correlation with standardized uptake values (SUV) in patients with nasopharyngeal carcinoma (NPC). A total of 35 patients with NPC underwent whole body PET-computed tomography (CT) and head and neck MR imaging (MRI) scans using the PET/CT-MRI system. Image quality, lesion conspicuity and the diagnostic confidence of PET/CT, T1 weighted (T1w) PET/MR and T2w PET/MR imaging were assessed. The true diffusion coefficient (D), the pseudo-diffusion coefficient or diffusion within the microcirculation (D*), and the perfusion fraction or the contribution of water moving in the capillaries (f), and ADC, were calculated. The correlation between the ADC, D*, D and f values and the SUV were analyzed using Pearson's correlation analysis. Similar image quality was obtained using PET/CT, T1w PET/MR and T2w PET/MR imaging. However, the T1w PET/MR and T2w PET/MR imaging were more effective than PET/CT in analyzing the lesion conspicuity of the primary tumors and lymph nodes. In addition, T2w PET/MR imaging was more efficient than T1w PET/MR imaging in analyzing primary tumors and lymph nodes. Pearson's correlation analysis showed no significant correlation between the SUV and ADC, and D*, D and f values in NPC. The present results suggested that the application of PET/MR is feasible and could serve as a reliable alternative to PET/CT, while SUV and ADC, D*, D and f values were identified as independent biomarkers in NPC.
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Affiliation(s)
- Yong Cheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Le Bai
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Jingjie Shang
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Yongjin Tang
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Xueying Ling
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Bin Guo
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Jian Gong
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Lu Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Hao Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
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Ozturk K, Gencturk M, Caicedo-Granados E, Li F, Cayci Z. Prediction of survival with combining quantitative 18 F-FDG PET/CT and DW-MRI parameters in sinonasal malignancies. Head Neck 2019; 41:3080-3089. [PMID: 31041831 DOI: 10.1002/hed.25799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We aimed to establish the prognostic value of 18 F-fluoro-deoxy-glucose positron emission/CT (18 F-FDG PET/CT) and diffusion-weighted (DW) MRI in determining overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) of sinonasal malignancies. METHODS Sixty-eight patients with sinonasal cancer who underwent both pretreatment 18 F-FDG PET/CT scan and head-neck MRI from January 2009 through August 2017 were retrospectively reviewed. Kaplan-Meier survival analysis of 18 F-FDG PET/CT and DW-MRI parameters were performed for OS, PFS, and DMFS. RESULTS Cox regression analysis determined that all the quantitative 18 F-FDG PET/CT and DW-MRI parameters were independently correlated with PFS, DMFS, and OS (P < .05). After controlling for imaging variables, perineural invasion (P = .02) and ill-defined margin (P = .02) were found to be significantly correlated with shorter OS; while the perineural invasion was significantly correlated with shorter PFS (P = .02). CONCLUSIONS The pretreatment DW-MRI and 18 F-FDG PET/CT parameters could be substantial surrogate markers for sinonasal malignancies.
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Mehmet Gencturk
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Emiro Caicedo-Granados
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Faqian Li
- Department of Pathology and Laboratory Medicine, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
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Martens RM, Noij DP, Koopman T, Zwezerijnen B, Heymans M, de Jong MC, Hoekstra OS, Vergeer MR, de Bree R, Leemans CR, de Graaf P, Boellaard R, Castelijns JA. Predictive value of quantitative diffusion-weighted imaging and 18-F-FDG-PET in head and neck squamous cell carcinoma treated by (chemo)radiotherapy. Eur J Radiol 2019; 113:39-50. [PMID: 30927958 DOI: 10.1016/j.ejrad.2019.01.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/28/2018] [Accepted: 01/29/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE In head and neck squamous cell carcinoma (HNSCC) (chemo)radiotherapy is increasingly used to preserve organ functionality. The purpose of this study was to identify predictive pretreatment DWI- and 18F-FDG-PET/CT-parameters for treatment failure (TF), locoregional recurrence (LR) and death in HNSCC patients treated by (chemo)radiotherapy. MATERIALS AND METHODS We retrospectively included 134 histologically proven HNSCC patients treated with (chemo)radiotherapy between 2012-2017. In 58 patients pre-treatment DWI and 18F-FDG-PET/CT were performed, in 31 patients DWI only and in 45 patients 18F-FDG-PET/CT only. Primary tumor (PT) and largest lymph node (LN) metastasis were quantitatively assessed for TF, LR and death. Multivariate analysis was performed for 18F-FDG-PET/CT and DWI separately and thereafter combined. In patients with both imaging modalities, positive and negative predictive value in TF and differences in LR and death, were assessed. RESULTS Mean follow-up was 25.6 months (interquartile-range; 14.0-37.1 months). Predictors of treatment failure, corrected for TNM-stage and HPV-status, were SUVmax-PT, ADCmax-PT, total lesion glycolysis (TLG-LN), ADCp20-LN (P = 0.049, P = 0.024, P = 0.031, P = 0.047, respectively). TLG-PT was predictive for LR (P = 0.003). Metabolic active tumor volume (MATV-PT) (P = 0.003), ADCGTV-PT (P < 0.001), ADCSD (P = 0.048) were significant predictors for death. In patients with both imaging modalities SUVmax-PT remained predictive for treatment failure (P = 0.049), TLG-LN for LR (P = 0.003) and ADCGTV-PT for death (P < 0.001). Higher predictive value for treatment failure was found for the combination of SUVmax-PT and ADCmax-PT, compared to either one separately. CONCLUSION Both DWI- and 18F-FDG-PET/CT-parameters appear to have predictive value for treatment failure, locoregional recurrence and death. Combining SUVmax-PT and ADCmax-PT resulted in better prediction of treatment failure compared to single parameter assessment.
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Affiliation(s)
- Roland M Martens
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
| | - Daniel P Noij
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Thomas Koopman
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ben Zwezerijnen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn Heymans
- Department of Epidemiology and Biostatistics, the Netherlands
| | - Marcus C de Jong
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Marije R Vergeer
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands; Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Jonas A Castelijns
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
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Peschmann AL, Beer M, Ammann B, Dreyhaupt J, Kneer K, Beer AJ, Beltinger C, Steinbach D, Cario H, Neubauer H. Quantitative DWI predicts event-free survival in children with neuroblastic tumours: preliminary findings from a retrospective cohort study. Eur Radiol Exp 2019; 3:6. [PMID: 30701332 PMCID: PMC6353978 DOI: 10.1186/s41747-019-0087-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/04/2019] [Indexed: 01/18/2023] Open
Abstract
Background Quantitative diffusion-weighted imaging (DWI) probes into tissue microstructure in solid tumours. In this retrospective ethically approved study, we investigated DWI as a potential non-invasive predictor of tumour dignity and prognosis in paediatric patients with neuroblastic tumours. Methods Nineteen consecutive patients with neuroblastoma (NB, n = 15), ganglioneuroblastoma (GNB, n = 1) and ganglioneuroma (GN, n = 3) underwent 3-T magnetic resonance imaging at first diagnosis and after 3-month follow-up, following a protocol including DWI (b = 50 and 800 s/mm2) in addition to standard sequences. All DWI scans were analysed for tumour volume assessment and apparent diffusion coefficient (ADC) calculation. Correlation with tumour pathology and risk factors (bone-marrow metastases, MYCN-amplification and 1p-deletion), therapeutic regime (observation versus chemotherapy) and clinical follow-up was evaluated. Results At baseline, mean ADC in NB was lower than in GNB/GN (0.76 vs. 1.47 × 10−3 mm2/s, p = 0.003). An ADC cutoff ≤ 1.05 identified malignant disease with 100.0% sensitivity (95% confidence interval [CI] 29.2–100.0%) and 93.8% specificity (95% CI 69.8–99.8%). Initial ADC was < 0.80 in all NB patients with eventual tumour relapse. During follow-up, tumour ADC values increased in the observation group (NB/GN) without relapse (p = 0.043). In eventually relapsing tumours, ADC values at follow-up tended to decrease further despite reduction in tumour volume. Conclusions ADC values at first presentation differed significantly between malignant and benign neuroblastic tumours. Low baseline ADC was predictive of tumour progression and relapse in NB patients. With therapy, increasing ADC values appeared to predict relapse-free survival, while a decreasing ADC during therapy was an indicator of poor prognosis.
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Affiliation(s)
- Anna-Lydia Peschmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Schweitzer-Allee 23, 89081, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Schweitzer-Allee 23, 89081, Ulm, Germany
| | - Bettina Ammann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Schweitzer-Allee 23, 89081, Ulm, Germany
| | - Jens Dreyhaupt
- Department of Biometrics, University Hospital Ulm, 89081, Ulm, Germany
| | - Katharina Kneer
- Department of Nuclear Medicine, University Hospital Ulm, 89081, Ulm, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, University Hospital Ulm, 89081, Ulm, Germany
| | - Christian Beltinger
- Department of Paediatrics and Adolescent Medicine, University Hospital Ulm, 89081, Ulm, Germany
| | - Daniel Steinbach
- Department of Paediatrics and Adolescent Medicine, University Hospital Ulm, 89081, Ulm, Germany
| | - Holger Cario
- Department of Paediatrics and Adolescent Medicine, University Hospital Ulm, 89081, Ulm, Germany
| | - Henning Neubauer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Schweitzer-Allee 23, 89081, Ulm, Germany.
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Payabvash S. Quantitative diffusion magnetic resonance imaging in head and neck tumors. Quant Imaging Med Surg 2018; 8:1052-1065. [PMID: 30598882 DOI: 10.21037/qims.2018.10.14] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In patients with head and neck cancer, conventional anatomical magnetic resonance imaging (MRI) scans are commonly used for identification of primary lesion, assessment of structural distortion, and presence of metastatic lymph nodes. However, quantitative analysis of diffusion MRI can provide added value to structural and anatomical evaluation of head and neck tumors (HNT), by differentiation of primary malignant process, prognostic prediction, and treatment monitoring. In this article, we will review the applications of quantitative diffusion MRI in identification of primary malignant tissue, differentiation of tumor pathology, prediction of molecular phenotype, monitoring of treatment response, and evaluation of posttreatment changes in patient with HNT.
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Affiliation(s)
- Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
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Surov A, Meyer HJ, Höhn AK, Sabri O, Purz S. Combined Metabolo-Volumetric Parameters of 18F-FDG-PET and MRI Can Predict Tumor Cellularity, Ki67 Level and Expression of HIF 1alpha in Head and Neck Squamous Cell Carcinoma: A Pilot Study. Transl Oncol 2018; 12:8-14. [PMID: 30240972 PMCID: PMC6143720 DOI: 10.1016/j.tranon.2018.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND: Our purpose was to evaluate associations of combined 18F-FDG-PET and MRI parameters with histopathological features in head and neck squamous cell carcinoma (HNSCC). METHODS: Overall, 22 patients with HNSCC were acquired (10 with G1/2 tumors and 12 with G3 tumors).18F-FDG-PET/CT and MRI was performed and maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG) and metabolic tumor volume (MTV) were estimated. Neck MRI was obtained on a 3 T scanner. Diffusion weighted imaging was performed with estimation of apparent diffusion coefficient (ADC). Perfusion parameters Ktrans,Ve, and Kep were derived from dynamic contrast-enhanced (DCE) imaging. Different combined PET/MRI parameters were calculated as ratios: PET parameters divided by ADC or DCE MRI parameters. The following histopathological features were estimated: Ki 67, EGFR, VEGF, p53, hypoxia-inducible factor (HIF)-1α, and cell count. Spearman's correlation coefficient (p) was used for correlation analysis. P < .05 was taken to indicate statistical significance. RESULTS: In overall sample, cellularity correlated with SUVmax/ADCmin (P = .558, P = .007), TLG/ADCmin (P = .546, P = .009), and MTV/ADCmin (P = .468, P = .028). MTV/Kep correlated with expression of HIF-1α (P = .450, P = 0,047). In G1/2 tumors, SUVmax/ADCmin correlated with HIF-1α (P = −.648, P = .043); MTV/Kep (P = −.669, P = .034) and TLG/Kep (P = −.644, P = .044) with Ki67. In G3 tumors, cellularity correlated with SUVmax/ADCmin (P = .832, P = .001), SUVmax/ADCmean (P = .741, P = .006), and TLG/ADCmin (P = .678, P = .015). MTV/ADCmin and TLG/ADCmin tended to correlate with HIF-1α. CONCLUSION: Combined parameters of 18F-FDG-PET and MRI can reflect Ki 67, tumor cellularity and expression of HIF-1α in HNSCC. Associations between parameters of 18F-FDG-PET and MRI and histopathology depend on tumor grading.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Anne Kathrin Höhn
- Department of Pathology University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
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Meyer HJ, Purz S, Sabri O, Surov A. Relationships between histogram analysis of ADC values and complex 18F-FDG-PET parameters in head and neck squamous cell carcinoma. PLoS One 2018; 13:e0202897. [PMID: 30188926 PMCID: PMC6126801 DOI: 10.1371/journal.pone.0202897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 08/10/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose Histogram analysis is an emergent imaging technique to further analyze radiological images and to obtain imaging biomarker. In head and neck cancer, MRI and PET are routinely used in clinical practice. The aim of this study was to analyze associations between histogram based ADC parameters and complex FDG-PET derived parameters in head and neck squamous cell carcinoma (HNSCC). Methods 34 patients (26% female, mean age, 56.7 ± 10.2 years) with primary HNSCC were prospectively included into the study. ADC histogram parameters were calculated by inhouse made matlab software using a whole lesion measurement. For each tumor, maximum and mean standardized uptake values (SUVmax, SUVmean), Total Lesion Glycolysis (TLG) and Metabolic Tumor Volume (MTV) were determined on PET-images. Spearman's correlation coefficient (ρ) was used to analyze associations between investigated parameters. Benjamini-Hochberg correction was used to adjust for multiple testing. Mann-Whitney test was used for group discrimination. P-values < 0.05 were taken to indicate statistical significance. Results The correlation analysis in the whole tumor group revealed a statistically significant correlation between entropy and MTV as well as TLG (ρ = 0.67, P<0.0001 and ρ = 0.61, P = 0.0002 respectively). There were statistically significant differences between T1/2 and T3/4 tumors in the following parameters: entropy (2.07 ± 0.36 vs 2.61 ± 0.43, P = 0.007), SUVmax (10.79 ± 4.13 vs 17.93 ± 5.89, P = 0.007), SUVmean (6.39 ± 2.48 vs 9.81 ± 4.49, P = 0.01), SUVmin (4.09 ± 1.57 vs 6.34 ± 2.59, P = 0.03), MTV (9.50 ± 7.92 vs 20.36 ± 13.30, P = 0.02), TGU (55.97 ± 39.09 vs 212.3 ± 186.3, P = 0.002). Conclusion This study showed that entropy derived from ADC maps is strongly associated with MTV and TLG in HNSCC. Entropy, SUVmax, SUVmean, TLG and MTV were statistically significant higher in T3/4 tumors in comparison to T1/2 carcinomas.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Sandra Purz
- Department of Nuclear Medicine, University of Leizig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leizig, Leipzig, Germany
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
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Correlation of the apparent diffusion coefficient and the standardized uptake value in neoplastic lesions: a meta-analysis. Nucl Med Commun 2018; 38:1076-1084. [PMID: 28885542 DOI: 10.1097/mnm.0000000000000746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Diffusion-weighted imaging and fluorine-18-fluorodeoxyglucose PET are increasingly being recognized as feasible oncological techniques. The apparent diffusion coefficient (ADC) measured by diffusion-weighted imaging and the standardized uptake value (SUV) from fluorine-18-fluorodeoxyglucose PET have similar clinical applications. The aim of this study was to assess the correlation between these two parameters in various cancers. MATERIALS AND METHODS Several major databases were searched for eligible studies. The correlation coefficient (ρ) values were pooled in a random-effects model. Begg's test was used to analyze the existence of publication bias and the sources of heterogeneity were explored in subgroup analyses on the basis of study design, diagnostic method, scanning modality, and tumor type. RESULTS Thirty-five articles were accepted. The pooled ρ value of all of the accepted studies was -0.30 (95% confidence interval: -0.33 to -0.27), and notable heterogeneity was present (I=69.4%, P<0.001), which indicated a relatively weak negative correlation. The pooled ρ values were -0.26, -0.33, -0.32, and -0.33 for the SUVmax/ADCmean, SUVmax/ADCmin, SUVmean/ADCmean, and SUVmean/ADCmin relationships, respectively. The study design and diagnostic method were potential sources of heterogeneity. Lung cancer showed a stronger correlation (ρ=-0.42) than head and neck cancer (ρ=-0.27), cervical cancer (ρ=-0.21), and breast cancer (ρ=-0.23). A Begg's test indicated no significant publication bias among the accepted studies (P>0.05). CONCLUSION The two functional parameters of ADC and SUV showed a very weak inverse correlation, which may contribute toward a sophisticated characterization of tumor biology. However, the findings require further validation with trials with large samples and different tumor types.
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Zhou W, Wen J, Hua F, Xu W, Lu X, Yin B, Geng D, Guan Y. 18F-FDG PET/CT in immunocompetent patients with primary central nervous system lymphoma: Differentiation from glioblastoma and correlation with DWI. Eur J Radiol 2018; 104:26-32. [PMID: 29857862 DOI: 10.1016/j.ejrad.2018.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/17/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is useful for the detection of cancerous lesions, and FDG uptake is related to the apparent diffusion coefficient (ADC) derived from diffusion-weighted imaging (DWI) of extracranial tumors. The purpose of our study was to investigate the ability of FDG PET/CT in distinguishing primary central nervous system lymphoma (PCNSL) from glioblastoma multiforme (GBM) and to explore the relationship between 18F-FDG uptake and the ADC in patients with PCNSL. METHODS We reviewed 92 patients (40 with PCNSL and 52 with GBM) who underwent FDG PET/CT scans at disease onset. The maximum standardized uptake value (SUVmax), tumor to normal contralateral cortex activity (T/N) ratio, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of tumor lesions were calculated. Receiver operating characteristic (ROC) curves were generated to determine the diagnostic performance for FDG PET-related parameters to differentiate PCNSL from GBM. Twenty-eight patients with PCNSL (with 34 lesions) also underwent diffusion-weighted imaging. Pearson's correlation analysis was used to assess the relation between SUV- and ADC-derived parameters. RESULTS The SUVmax, T/N ratio, SUVmean, and TLG values were significantly higher in PCNSL than in GBM. Comparative ROC analysis indicated that the SUVmax had a greater area under the curve (AUC) of 0.910 than the T/N ratio (0.905, P = .85), SUVmean (0.836, P = .0006), or TLG (0.641, P < 0.0001). The T/N ratio had the highest specificity (94.23%) for differentiating PCNSL from GBM, while the SUVmax had the most optimal sensitivity (92.31%). Further combined analysis of the indices did not significantly improve the AUC. Moderate inverse correlations between the SUVmax, SUVmean, TLG, and the ADC ratio (rADC) were found in PCNSLs (r = -0.526, P = .002; r = -0.504, P = .004; and r = -0.483, P = .006; respectively). CONCLUSIONS The SUVmax and T/N ratio may be reliable measures for differentiating PCNSLs from GBMs. Additionally, FDG metabolism indices were inversely proportional to the rADCs of PCNSL lesions.
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Affiliation(s)
- Weiyan Zhou
- PET Center, Huashan Hospital, Fudan University, No. 518, East Wuzhong Road, Xuhui District, Shanghai 200235, China
| | - Jianbo Wen
- Department of Radiology, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai 200040, China
| | - Fengchun Hua
- PET Center, Huashan Hospital, Fudan University, No. 518, East Wuzhong Road, Xuhui District, Shanghai 200235, China
| | - Weixingzi Xu
- Department of Radiology, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai 200040, China
| | - Xiuhong Lu
- PET Center, Huashan Hospital, Fudan University, No. 518, East Wuzhong Road, Xuhui District, Shanghai 200235, China
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai 200040, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Jing'an District, Shanghai 200040, China
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, No. 518, East Wuzhong Road, Xuhui District, Shanghai 200235, China.
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Zwirner K, Thorwarth D, Winter RM, Welz S, Weiss J, Schwenzer NF, Schmidt H, la Fougère C, Nikolaou K, Zips D, Gatidis S. Voxel-wise correlation of functional imaging parameters in HNSCC patients receiving PET/MRI in an irradiation setup. Strahlenther Onkol 2018; 194:719-726. [PMID: 29564483 DOI: 10.1007/s00066-018-1292-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/05/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to demonstrate the feasibility of voxel-wise multiparametric characterization of head and neck squamous cell carcinomas (HNSCC) using hybrid multiparametric magnetic resonance imaging and positron emission tomography with [18F]-fluorodesoxyglucose (FDG-PET/MRI) in a radiation treatment planning setup. METHODS Ten patients with locally advanced HNSCC were examined with a combined FDG-PET/MRI in an irradiation planning setup. The multiparametric imaging protocol consisted of FDG-PET, T2-weighted transverse short tau inversion recovery sequence (STIR) and diffusion-weighted MRI (DWI). Primary tumours were manually segmented and quantitative imaging parameters were extracted. PET standardized uptake values (SUV) and DWI apparent diffusion coefficients (ADC) were correlated on a voxel-wise level. RESULTS Images acquired in this specialised radiotherapy planning setup achieved good diagnostic quality. Median tumour volume was 4.9 [1.1-42.1] ml. Mean PET SUV and ADC of the primary tumours were 5 ± 2.5 and 1.2 ± 0.3 10-3 mm2/s, respectively. In voxel-wise correlation between ADC values and corresponding FDG SUV of the tumours, a significant negative correlation was observed (r = -0.31 ± 0.27, p < 0.05). CONCLUSION Multiparametric voxel-wise characterization of HNSCC is feasible using combined PET/MRI in a radiation planning setup. This technique may provide novel insights into tumour biology with regard to radiation therapy in the future.
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Affiliation(s)
- Kerstin Zwirner
- Department of Radiation Oncology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,German Cancer Research Center (DKFZ) partner site Tübingen, German Cancer Consortium (DKTK), Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - René M Winter
- Section for Biomedical Physics, Department of Radiation Oncology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Stefan Welz
- Department of Radiation Oncology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,German Cancer Research Center (DKFZ) partner site Tübingen, German Cancer Consortium (DKTK), Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Nina F Schwenzer
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Holger Schmidt
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Christian la Fougère
- German Cancer Research Center (DKFZ) partner site Tübingen, German Cancer Consortium (DKTK), Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Otfried-Müller-Straße 14, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- German Cancer Research Center (DKFZ) partner site Tübingen, German Cancer Consortium (DKTK), Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,German Cancer Research Center (DKFZ) partner site Tübingen, German Cancer Consortium (DKTK), Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Kim YI, Cheon GJ, Kang SY, Paeng JC, Kang KW, Lee DS, Chung JK. Prognostic value of simultaneous 18F-FDG PET/MRI using a combination of metabolo-volumetric parameters and apparent diffusion coefficient in treated head and neck cancer. EJNMMI Res 2018; 8:2. [PMID: 29322269 PMCID: PMC5762617 DOI: 10.1186/s13550-018-0357-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/04/2018] [Indexed: 01/16/2023] Open
Abstract
Background The aim of this study was to determine the usefulness of combined positron emission tomography (PET)/magnetic resonance imaging (MRI) parameters provided by simultaneous 18F-fluorodeoxyglucose (FDG) PET/MRI for the prediction of treatment failure in surgically resected head and neck cancer. We hypothesized that PET parameters corrected by tumor cellularity (combined PET/MRI parameters) could predict the prognosis. On regional PET, maximum standardized uptake value (SUVmax) was measured as metabolic parameters. In addition, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were checked as metabolo-volumetric parameters. Mean apparent diffusion coefficient (ADCmean) of tumor was evaluated as the MRI parameter on the ADC map. Ratios between metabolic/metabolo-volumetric parameters and ADC were calculated as combined PET/MRI parameters. PET, MRI, and combined PET/MRI parameters were compared with clinicopathologic parameters in terms of treatment failure. Results Seventy-two patients (mean age = 55.9 ± 14.6 year, M: F = 45: 27) who underwent simultaneous 18F-FDG PET/MRI before head and neck cancer surgery were retrospectively enrolled. Twenty-two patients (30.6%) showed tumor treatment failure after head and neck cancer surgery (mean treatment failure = 13.0 ± 7.0 months). In the univariate analysis, MTV (P = 0.044) and ratios between metabolo-volumetric parameters and ADC (MTV/ADCmean, P = 0.022; TLG/ADCmean, P = 0.044) demonstrated significance among 18F-FDG PET/MRI parameters. Lymphatic invasion (P = 0.044) and perineural invasion (P = 0.046) revealed significance among clinicopathologic parameters. In the multivariate analysis, MTV (P = 0.026), MTV/ADCmean (P = 0.011), and TLG/ADCmean (P = 0.002) with lymphatic invasion (P = 0.026, 0.026, and 0.044, respectively) showed significance. Conclusions Combined PET/MRI parameters (PET metabolo-volumetric parameters corrected by tumor cellularity) could be effective predictors of tumor treatment failure after head and neck cancer surgery in addition to MTV and clinicopathologic parameter. Electronic supplementary material The online version of this article (10.1186/s13550-018-0357-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yong-Il Kim
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.,Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea.
| | - Seo Young Kang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Zhou Q, Zeng F, Ding Y, Fuller CD, Wang J. Meta-analysis of diffusion-weighted imaging for predicting locoregional failure of chemoradiotherapy in patients with head and neck squamous cell carcinoma. Mol Clin Oncol 2017; 8:197-203. [PMID: 29423223 DOI: 10.3892/mco.2017.1504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to evaluate the accuracy of diffusion-weighted imaging (DWI) for predicting locoregional failure of chemoradiotherapy in patients with head and neck squamous cell carcinoma (HNSCC). A comprehensive search was conducted through the EMBASE, PubMed and Cochrane Library databases for relevant publications. Stata software was used to calculate the pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratios, and to construct a summary receiver operating characteristics (sROC) curve for DWI. A total of 9 studies comprising 421 patients were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.82 [95% confidence interval (CI): 0.72-0.88], 0.70 (95% CI: 0.62-0.77), 2.7 (95% CI: 2.1-3.6), 0.26 (95% CI: 0.17-0.41), and 10.48 (95% CI: 5.35-20.53), respectively. The area under the sROC curve was 0.84 (95% CI: 0.81-0.87). Therefore, DWI appears to be a promising imaging modality for predicting local failure of chemoradiotherapy in patients with HNSCC.
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Affiliation(s)
- Qiming Zhou
- Department of Oncology, The Sixth People's Hospital, Shenzhen, Guangdong 518052, P.R. China.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Fangfang Zeng
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yao Ding
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Associations between 18F-FDG-PET, DWI, and DCE Parameters in Patients with Head and Neck Squamous Cell Carcinoma Depend on Tumor Grading. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:5369625. [PMID: 29114177 PMCID: PMC5671689 DOI: 10.1155/2017/5369625] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/31/2017] [Accepted: 09/12/2017] [Indexed: 02/02/2023]
Abstract
Our purpose was to analyze associations between positron emission tomography (PET), diffusion weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging in patients with head and neck squamous cell carcinoma (HNSCC). The study involved 34 patients (9 women, 25 men, mean age: 56.7 ± 10.2 years). In all patients a simultaneous 18F-FDG-PET/MR was performed. DWI was obtained by using of an axial EPI sequence. Minimal ADC values (ADCmin), mean ADC values (ADCmean), and maximal ADC values (ADCmax) were estimated. DCE MRI was performed by using dynamic T1w DCE sequence. The following parameters were estimated: Ktrans, Ve, and Kep. Spearman's correlation coefficient was used to analyze associations between investigated parameters. In overall sample, ADCmean correlated significantly with Ve and Ktrans, ADCmin correlated with Ve, and ADCmax correlated with Ktrans and Ve. SUVmean tended to correlate slightly with Ktrans. In G1/2 tumors, only Ktrans correlated well with ADCmax and SUVmean. In G3 tumors, Ktrans correlated well with Kep and Ve. Ve showed significant correlations with ADCmean and ADCmax. Ktrans correlated with ADCmax. Kep was higher in cancers with N2/3 stages. Tumor metabolism, water diffusion, and tumor perfusion have complex relationships in HNSCC. Furthermore, these associations depend on tumor grading. Kep may predict lymphonodal metastasizing.
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Abstract
BACKGROUND The (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG-PET/CT) procedure is a cornerstone in the diagnostics of head and neck cancers. Several years ago PET-magnetic resonance imaging (PET/MRI) also became available as an alternative hybrid multimodal imaging method. OBJECTIVE Does PET/MRI have advantages over PET/CT in the diagnostics of head and neck cancers? MATERIAL AND METHODS The diagnostic accuracy of the standard imaging methods CT, MRI and PET/CT is depicted according to currently available meta-analyses and studies concerning the use of PET/MRI for these indications are summarized. RESULTS In all studies published up to now PET/MRI did not show superiority regarding the diagnostic accuracy in head and neck cancers; however, there is some evidence that in the future PET/MRI can contribute to tumor characterization and possibly be used to predict tumor response to therapy with the use of multiparametric imaging. CONCLUSION Currently, (18)F-FDG-PET/CT is not outperformed by PET/MRI in the diagnostics of head and neck cancers. The additive value of PET/MRI due to the use of multiparametric imaging needs to be investigated in future research.
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Noij DP, Jagesar VA, de Graaf P, de Jong MC, Hoekstra OS, de Bree R, Castelijns JA. Detection of residual head and neck squamous cell carcinoma after (chemo)radiotherapy: a pilot study assessing the value of diffusion-weighted magnetic resonance imaging as an adjunct to PET-CT using 18 F-FDG. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:296-305.e2. [DOI: 10.1016/j.oooo.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/08/2017] [Accepted: 04/15/2017] [Indexed: 02/06/2023]
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Wong KH, Panek R, Bhide SA, Nutting CM, Harrington KJ, Newbold KL. The emerging potential of magnetic resonance imaging in personalizing radiotherapy for head and neck cancer: an oncologist's perspective. Br J Radiol 2017; 90:20160768. [PMID: 28256151 DOI: 10.1259/bjr.20160768] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Head and neck cancer (HNC) is a challenging tumour site for radiotherapy delivery owing to its complex anatomy and proximity to organs at risk (OARs) such as the spinal cord and optic apparatus. Despite significant advances in radiotherapy planning techniques, radiation-induced morbidities remain substantial. Further improvement would require high-quality imaging and tailored radiotherapy based on intratreatment response. For these reasons, the use of MRI in radiotherapy planning for HNC is rapidly gaining popularity. MRI provides superior soft-tissue contrast in comparison with CT, allowing better definition of the tumour and OARs. The lack of additional radiation exposure is another attractive feature for intratreatment monitoring. In addition, advanced MRI techniques such as diffusion-weighted, dynamic contrast-enhanced and intrinsic susceptibility-weighted MRI techniques are capable of characterizing tumour biology further by providing quantitative functional parameters such as tissue cellularity, vascular permeability/perfusion and hypoxia. These functional parameters are known to have radiobiological relevance, which potentially could guide treatment adaptation based on their changes prior to or during radiotherapy. In this article, we first present an overview of the applications of anatomical MRI sequences in head and neck radiotherapy, followed by the potentials and limitations of functional MRI sequences in personalizing therapy.
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Affiliation(s)
- Kee H Wong
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Rafal Panek
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Shreerang A Bhide
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Christopher M Nutting
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Kevin J Harrington
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Katie L Newbold
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
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Meta-Analysis of the Correlation between Apparent Diffusion Coefficient and Standardized Uptake Value in Malignant Disease. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:4729547. [PMID: 29097924 PMCID: PMC5612674 DOI: 10.1155/2017/4729547] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/15/2017] [Indexed: 12/19/2022]
Abstract
The objective of this meta-analysis is to explore the correlation between the apparent diffusion coefficient (ADC) on diffusion-weighted MR and the standard uptake value (SUV) of 18F-FDG on PET/CT in patients with cancer. Databases such as PubMed (MEDLINE included), EMBASE, and Cochrane Database of Systematic Review were searched for relevant original articles that explored the correlation between SUV and ADC in English. After applying Fisher's r-to-z transformation, correlation coefficient (r) values were extracted from each study and 95% confidence intervals (CIs) were calculated. Sensitivity and subgroup analyses based on tumor type were performed to investigate the potential heterogeneity. Forty-nine studies were eligible for the meta-analysis, comprising 1927 patients. Pooled r for all studies was −0.35 (95% CI: −0.42–0.28) and exhibited a notable heterogeneity (I2 = 78.4%; P < 0.01). In terms of the cancer type subgroup analysis, combined correlation coefficients of ADC/SUV range from −0.12 (lymphoma, n = 5) to −0.59 (pancreatic cancer, n = 2). We concluded that there is an average negative correlation between ADC and SUV in patients with cancer. Higher correlations were found in the brain tumor, cervix carcinoma, and pancreas cancer. However, a larger, prospective study is warranted to validate these findings in different cancer types.
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Aramburu Núñez D, Lopez Medina A, Mera Iglesias M, Salvador Gomez F, Dave A, Hatzoglou V, Paudyal R, Calzado A, Deasy JO, Shukla-Dave A, Muñoz VM. Multimodality functional imaging using DW-MRI and 18F-FDG-PET/CT during radiation therapy for human papillomavirus negative head and neck squamous cell carcinoma: Meixoeiro Hospital of Vigo Experience. World J Radiol 2017; 9:17-26. [PMID: 28144403 PMCID: PMC5241537 DOI: 10.4329/wjr.v9.i1.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/29/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To noninvasively investigate tumor cellularity measured using diffusion-weighted magnetic resonance imaging (DW-MRI) and glucose metabolism measured by 18F-labeled fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) during radiation therapy (RT) for human papillomavirus negative (HPV-) head and neck squamous cell carcinoma (HNSCC).
METHODS In this prospective study, 6 HPV- HNSCC patients underwent a total of 34 multimodality imaging examinations (DW-MRI at 1.5 T Philips MRI scanner [(n = 24) pre-, during- (2-3 wk), and post-treatment (Tx), and 18F-FDG PET/CT pre- and post-Tx (n = 10)]. All patients received RT. Monoexponential modeling of the DW-MRI data yielded the imaging metric apparent diffusion coefficient (ADC) and the mean of standardized uptake value (SUV) was measured from 18F-FDG PET uptake. All patients had a clinical follow-up as the standard of care and survival status was documented at 1 year.
RESULTS There was a strong negative correlation between the mean of pretreatment ADC (ρ = -0.67, P = 0.01) and the pretreatment 18F-FDG PET SUV. The percentage (%) change in delta (∆) ADC for primary tumors and neck nodal metastases between pre- and Wk2-3 Tx were as follows: 75.4% and 61.6%, respectively, for the patient with no evidence of disease, 27.5% and 32.7%, respectively, for those patients who were alive with disease, and 26.9% and 7.31%, respectively, for those who were dead with disease.
CONCLUSION These results are preliminary in nature and are indicative, and not definitive, trends rendered by the imaging metrics due to the small sample size of HPV- HNSCC patients in a Meixoeiro Hospital of Vigo Experience.
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Park JJ, Kim CK, Park BK. Prognostic value of diffusion-weighted magnetic resonance imaging and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography after concurrent chemoradiotherapy in uterine cervical cancer. Radiother Oncol 2016; 120:507-511. [DOI: 10.1016/j.radonc.2016.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 11/25/2022]
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40
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King AD, Thoeny HC. Functional MRI for the prediction of treatment response in head and neck squamous cell carcinoma: potential and limitations. Cancer Imaging 2016; 16:23. [PMID: 27542718 PMCID: PMC4992206 DOI: 10.1186/s40644-016-0080-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/02/2016] [Indexed: 12/27/2022] Open
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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Affiliation(s)
- Ann D King
- 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.
| | - Harriet C Thoeny
- Department of Radiology, Neuroradiology and Nuclear Medicine, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
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Cammaroto G, Quartuccio N, Sindoni A, Di Mauro F, Caobelli F. The role of PET/CT in the management of patients affected by head and neck tumors: a review of the literature. Eur Arch Otorhinolaryngol 2016; 273:1961-73. [PMID: 25971995 DOI: 10.1007/s00405-015-3651-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/06/2015] [Indexed: 02/07/2023]
Abstract
The management of head and neck tumor (HNSCC) has been changing over the years, especially due to the aid of imaging techniques that help physicians to attain a correct diagnosis. These techniques represent a valuable tool to help tailor treatment and during follow-up of patients affected by malignancies. The aim of this review is to summarize the results of the most recent and relevant studies about the use of PET imaging in HNSCCs. This review is divided into six chapters: (1) The role of PET/CT in the pre-treatment phase; (2) PET/CT and radiotherapy planning; (3) PET/CT in the post-treatment setting; (4) PET/CT and SUVmax for prediction of prognosis; (5) miscellanea on the utility of PET in specific HNSCCs; (6) non-FDG PET tracers used in HNSCC. Promising results have been obtained so far. Despite the encouraging outcomes, more investigations are needed to warrant the value of this technique, especially in the pre-treatment setting.
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Affiliation(s)
- Giovanni Cammaroto
- Department of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Natale Quartuccio
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Alessandro Sindoni
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Francesca Di Mauro
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
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Min M, Lin P, Liney G, Lee M, Forstner D, Fowler A, Holloway L. A review of the predictive role of functional imaging in patients with mucosal primary head and neck cancer treated with radiation therapy. J Med Imaging Radiat Oncol 2016; 61:99-123. [DOI: 10.1111/1754-9485.12496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 06/11/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Myo Min
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool New South Wales Australia
| | - Peter Lin
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Department of Nuclear Medicine and Positron Emission Tomography; Liverpool Hospital; Liverpool New South Wales Australia
- University of Western Sydney; Sydney New South Wales Australia
| | - Gary Liney
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool New South Wales Australia
- Centre for Medical Radiation Physics; University of Wollongong; Wollongong New South Wales Australia
| | - Mark Lee
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Dion Forstner
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool New South Wales Australia
| | - Allan Fowler
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
| | - Lois Holloway
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool New South Wales Australia
- Centre for Medical Radiation Physics; University of Wollongong; Wollongong New South Wales Australia
- Institute of Medical Physics; School of Physics; University of Sydney; Sydney New South Wales Australia
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Atkinson W, Catana C, Abramson JS, Arabasz G, McDermott S, Catalano O, Muse V, Blake MA, Barnes J, Shelly M, Hochberg E, Rosen BR, Guimaraes AR. Hybrid FDG-PET/MR compared to FDG-PET/CT in adult lymphoma patients. Abdom Radiol (NY) 2016; 41:1338-48. [PMID: 27315095 DOI: 10.1007/s00261-016-0638-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The goal of this study is to evaluate the diagnostic performance of simultaneous FDG-PET/MR including diffusion compared to FDG-PET/CT in patients with lymphoma. METHODS Eighteen patients with a confirmed diagnosis of non-Hodgkin's (NHL) or Hodgkin's lymphoma (HL) underwent an IRB-approved, single-injection/dual-imaging protocol consisting of a clinical FDG-PET/CT and subsequent FDG-PET/MR scan. PET images from both modalities were reconstructed iteratively. Attenuation correction was performed using low-dose CT data for PET/CT and Dixon-MR sequences for PET/MR. Diffusion-weighted imaging was performed. SUVmax was measured and compared between modalities and the apparent diffusion coefficient (ADC) using ROI analysis by an experienced radiologist using OsiriX. Strength of correlation between variables was measured using the Pearson correlation coefficient (r p). RESULTS Of the 18 patients included in this study, 5 had HL and 13 had NHL. The median age was 51 ± 14.8 years. Sixty-five FDG-avid lesions were identified. All FDG-avid lesions were visible with comparable contrast, and therefore initial and follow-up staging was identical between both examinations. SUVmax from FDG-PET/MR [(mean ± sem) (21.3 ± 2.07)] vs. FDG-PET/CT (mean 23.2 ± 2.8) demonstrated a strongly positive correlation [r s = 0.95 (0.94, 0.99); p < 0.0001]. There was no correlation found between ADCmin and SUVmax from FDG-PET/MR [r = 0.17(-0.07, 0.66); p = 0.09]. CONCLUSION FDG-PET/MR offers an equivalent whole-body staging examination as compared with PET/CT with an improved radiation safety profile in lymphoma patients. Correlation of ADC to SUVmax was weak, understating their lack of equivalence, but not undermining their potential synergy and differing importance.
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Affiliation(s)
- Wendy Atkinson
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Ciprian Catana
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Jeremy S Abramson
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Grae Arabasz
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Shanaugh McDermott
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Onofrio Catalano
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Victorine Muse
- Division of Thoracic Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Michael A Blake
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jeffrey Barnes
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Martin Shelly
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ephraim Hochberg
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Bruce R Rosen
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Alexander R Guimaraes
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA.
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Division of Body Imaging, Department of Diagnostic Radiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd., Mail Code L340, Portland, OR, 97239, USA.
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Surov A, Stumpp P, Meyer HJ, Gawlitza M, Höhn AK, Boehm A, Sabri O, Kahn T, Purz S. Simultaneous (18)F-FDG-PET/MRI: Associations between diffusion, glucose metabolism and histopathological parameters in patients with head and neck squamous cell carcinoma. Oral Oncol 2016; 58:14-20. [PMID: 27311397 DOI: 10.1016/j.oraloncology.2016.04.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/03/2016] [Accepted: 04/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze possible associations between functional simultaneous (18)F-FDG-PET/MR imaging parameters and histopathological parameters in head and neck squamous cell carcinoma (HNSCC). MATERIAL AND METHODS 11 patients (2 female, 9 male; mean age 56.0years) with biopsy-proven primary HNSCC underwent simultaneous (18)F-FDG-PET/MRI with a dedicated head and neck protocol including diffusion weighted imaging. For each tumor, glucose metabolism was estimated with standardized uptake values (SUV) and diffusion restriction was calculated using apparent diffusion coefficients (ADC). The tumor proliferation index was estimated on Ki 67 antigen stained specimens. Cell count, total nucleic area, and average nucleic area were estimated in each case. Pearson's correlation coefficient was used to analyze possible associations between the estimated parameters. RESULTS The mean SUVmax value was 24.41±6.51, and SUVmean value 15.01±4.07. Mean values (×10(-3)mm(2)s(-1)) of ADC parameters were as follows: ADCmin: 0.65±0.20; ADCmean: 1.28±0.18; and ADCmax: 2.16±0.35. Histopathological analysis identified the following results: cell count 1069.82±388.66, total nucleic area 150771.09±61177.12μm(2), average nucleic area 142.90±57.27μm(2) and proliferation index 49.09±22.67%. ADCmean correlated with Ki 67 level (r=-0.728, p=0.011) and total nucleic area (r=-0.691, p=0.019) and tended to correlate with average nucleic area (r=-0.527, p=0.096). ADCmax correlated with Ki 67 level (r=-0.633, p=0.036). SUVmax also tended to correlate with average nucleic area (r=0.573, p=0.066). Combined parameter SUVmax/ADCmin correlated with average nucleic area (r=0.627, p=0.039). CONCLUSION ADC and SUV values showed significant correlations with different histopathological parameters and can be used as biological markers in HNSCC.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Hans Jonas Meyer
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097 Halle, Germany
| | - Matthias Gawlitza
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Boehm
- ENT Department, University Hospital of Leipzig, Liebigstrasse 10-14, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
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Preda L, Conte G, Bonello L, Giannitto C, Travaini LL, Raimondi S, Summers PE, Mohssen A, Alterio D, Cossu Rocca M, Grana C, Ruju F, Bellomi M. Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma. Eur Radiol 2016; 26:4432-4441. [PMID: 26965504 DOI: 10.1007/s00330-016-4284-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/30/2015] [Accepted: 02/16/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the independent prognostic value of standardized uptake value (SUV) and apparent diffusion coefficient (ADC), separately and combined, in order to evaluate if the combination of these two variables allows further prognostic stratification of patients with head and neck squamous cell carcinomas (HNSCC). METHODS Pretreatment SUV and ADC were calculated in 57 patients with HNSCC. Mean follow-up was 21.3 months. Semiquantitative analysis of primary tumours was performed using SUVmaxT/B, ADCmean, ADCmin and ADCmax. The prognostic value of SUVmaxT/B, ADCmean, ADCmin and ADCmax in predicting disease-free survival (DFS) was evaluated with log-rank test and Cox regression models. RESULTS Patients with SUVmaxT/B ≥5.75 had an overall worse prognosis (p = 0.003). After adjusting for lymph node status and diameter, SUVmaxT/B and ADCmin were both significant predictors of DFS with hazard ratio (HR) = 10.37 (95 % CI 1.22-87.95) and 3.26 (95 % CI 1.20-8.85) for SUVmaxT/B ≥5.75 and ADCmin ≥0.58 × 10-3 mm2/s, respectively. When the analysis was restricted to subjects with SUVmaxT/B ≥5.75, high ADCmin significantly predicted a worse prognosis, with adjusted HR = 3.11 (95 % CI 1.13-8.55). CONCLUSIONS The combination of SUVmaxT/B and ADCmin improves the prognostic role of the two separate parameters; patients with high SUVmaxT/B and high ADCmin are associated with a poor prognosis. KEY POINTS • High SUV maxT/B is a poor prognostic factor in HNSCC • High ADC min is a poor prognostic factor in HNSCC • In patients with high SUV maxT/B , high ADC min identified those with worse prognosis.
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Affiliation(s)
- Lorenzo Preda
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Giorgio Conte
- Specialisation School of Radiology, University of Milan, Milan, Italy.
| | - Luke Bonello
- Specialisation School of Radiology, University of Milan, Milan, Italy
| | | | - Laura L Travaini
- Department of Nuclear Medicine, European Institute of Oncology, Milan, Italy
| | - Sara Raimondi
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Paul E Summers
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Ansarin Mohssen
- Department of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - Daniela Alterio
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Maria Cossu Rocca
- Department of Urogenital Cancer Medical Treatment, European Institute of Oncology, Milan, Italy
| | - Chiara Grana
- Department of Nuclear Medicine, European Institute of Oncology, Milan, Italy
| | - Francesca Ruju
- Specialisation School of Radiology, University of Milan, Milan, Italy
| | - Massimo Bellomi
- Department of Radiology, European Institute of Oncology, Milan, Italy.,Department of Oncology and Haematology-Oncology, University of Milan, Milan, Italy
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Ng SH, Liao CT, Lin CY, Chan SC, Lin YC, Yen TC, Chang JTC, Ko SF, Fan KH, Wang HM, Yang LY, Wang JJ. Dynamic contrast-enhanced MRI, diffusion-weighted MRI and 18F-FDG PET/CT for the prediction of survival in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation. Eur Radiol 2016; 26:4162-4172. [PMID: 26911889 DOI: 10.1007/s00330-016-4276-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We prospectively investigated the roles of pretreatment dynamic contrast-enhanced MR imaging (DCE-MRI), diffusion-weighted MR imaging (DWI) and 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT for predicting survival of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) patients treated with chemoradiation. METHODS Patients with histologically proven OHSCC and neck nodal metastases scheduled for chemoradiation were eligible. Clinical variables as well as DCE-MRI-, DWI- and 18F-FDG PET/CT-derived parameters of the primary tumours and metastatic neck nodes were analysed in relation to 3-year progression-free survival (PFS) and overall survival (OS) rates. RESULTS Eighty-six patients were available for analysis. Multivariate analysis identified the efflux rate constant (K ep)-tumour < 3.79 min-1 (P = 0.001), relative volume of extracellular extravascular space (V e)-node < 0.23 (P = 0.004) and SUVmax-tumour > 19.44 (P = 0.025) as independent risk factors for both PFS and OS. A scoring system based upon the sum of each of the three imaging parameters allowed stratification of our patients into three groups (patients with 0/1 factor, patients with 2 factors and patients with 3 factors, respectively) with distinct PFS (3-year rates = 72 %, 38 % and 0 %, P < 0.0001) and OS (3-year rates = 81 %, 46 % and 20 %, P < 0.0001). CONCLUSIONS K ep-tumour, V e-node and SUVmax-tumour were independent prognosticators for OHSCC treated with chemoradiation. Their combination helped survival stratification. KEY POINTS • K ep -tumour, V e -node and SUV max -tumour are independent predictors of survival rates. • The combination of these three prognosticators may help stratification of survival. • MRI and FDG-PET/CT play complementary roles in prognostication of head and neck cancer.
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Affiliation(s)
- Shu-Hang Ng
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Sheng-Chieh Chan
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Yu-Chun Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan
| | - Tzu-Chen Yen
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Sheung-Fat Ko
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics and Informatics Unit, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan.
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan.
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University / Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
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Langner S. Optimized imaging of the midface and orbits. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 14:Doc05. [PMID: 26770279 PMCID: PMC4702054 DOI: 10.3205/cto000120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A variety of imaging techniques are available for imaging the midface and orbits. This review article describes the different imaging techniques based on the recent literature and discusses their impact on clinical routine imaging. Imaging protocols are presented for different diseases and the different imaging modalities.
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Affiliation(s)
- Sönke Langner
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
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Divine MR, Katiyar P, Kohlhofer U, Quintanilla-Martinez L, Pichler BJ, Disselhorst JA. A Population-Based Gaussian Mixture Model Incorporating 18F-FDG PET and Diffusion-Weighted MRI Quantifies Tumor Tissue Classes. J Nucl Med 2015; 57:473-9. [PMID: 26659350 DOI: 10.2967/jnumed.115.163972] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/17/2015] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED The aim of our study was to create a novel Gaussian mixture modeling (GMM) pipeline to model the complementary information derived from(18)F-FDG PET and diffusion-weighted MRI (DW-MRI) to separate the tumor microenvironment into relevant tissue compartments and follow the development of these compartments longitudinally. METHODS Serial (18)F-FDG PET and apparent diffusion coefficient (ADC) maps derived from DW-MR images of NCI-H460 xenograft tumors were coregistered, and a population-based GMM was implemented on the complementary imaging data. The tumor microenvironment was segmented into 3 distinct regions and correlated with histology. ANCOVA was applied to gauge how well the total tumor volume was a predictor for the ADC and (18)F-FDG, or if ADC was a good predictor of (18)F-FDG for average values in the whole tumor or average necrotic and viable tissues. RESULTS The coregistered PET/MR images were in excellent agreement with histology, both visually and quantitatively, and allowed for validation of the last-time-point measurements. Strong correlations were found for the necrotic (r = 0.88) and viable fractions (r = 0.87) between histology and clustering. The GMM provided probabilities for each compartment with uncertainties expressed as a mixture of tissues in which the resolution of scans was inadequate to accurately separate tissues. The ANCOVA suggested that both ADC and (18)F-FDG in the whole tumor (P = 0.0009, P = 0.02) as well as necrotic (P = 0.008, P = 0.02) and viable (P = 0.003, P = 0.01) tissues were a positive, linear function of total tumor volume. ADC proved to be a positive predictor of (18)F-FDG in the whole tumor (P = 0.001) and necrotic (P = 0.02) and viable (P = 0.0001) tissues. CONCLUSION The complementary information of (18)F-FDG and ADC longitudinal measurements in xenograft tumors allows for segmentation into distinct tissues when using the novel GMM pipeline. Leveraging the power of multiparametric PET/MRI in this manner has the potential to take the assessment of disease outcome beyond RECIST and could provide an important impact to the field of precision medicine.
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Affiliation(s)
- Mathew R Divine
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Prateek Katiyar
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany Max Planck Institute for Intelligent Systems, Tuebingen, Germany; and
| | - Ursula Kohlhofer
- Institute of Pathology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | | | - Bernd J Pichler
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Jonathan A Disselhorst
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Brandmaier P, Purz S, Bremicker K, Höckel M, Barthel H, Kluge R, Kahn T, Sabri O, Stumpp P. Simultaneous [18F]FDG-PET/MRI: Correlation of Apparent Diffusion Coefficient (ADC) and Standardized Uptake Value (SUV) in Primary and Recurrent Cervical Cancer. PLoS One 2015; 10:e0141684. [PMID: 26551527 PMCID: PMC4638340 DOI: 10.1371/journal.pone.0141684] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/12/2015] [Indexed: 01/18/2023] Open
Abstract
Objectives Previous non–simultaneous PET/MR studies have shown heterogeneous results about the correlation between standardized uptake values (SUVs) and apparent diffusion coefficients (ADCs). The aim of this study was to investigate correlations in patients with primary and recurrent tumors using a simultaneous PET/MRI system which could lead to a better understanding of tumor biology and might play a role in early response assessment. Methods We included 31 patients with histologically confirmed primary (n = 14) or recurrent cervical cancer (n = 17) who underwent simultaneous whole-body 18F-FDG-PET/MRI comprising DWI. Image analysis was performed by a radiologist and a nuclear physician who identified tumor margins and quantified ADC and SUV. Pearson correlations were calculated to investigate the association between ADC and SUV. Results 92 lesions were detected. We found a significant inverse correlation between SUVmax and ADCmin (r = -0.532, p = 0.05) in primary tumors as well as in primary metastases (r = -0.362, p = 0.05) and between SUVmean and ADCmin (r = -0.403, p = 0.03). In recurrent local tumors we found correlations for SUVmax and ADCmin (r = -0.747, p = 0.002) and SUVmean and ADCmin (r = -0.773, p = 0.001). Associations for recurrent metastases were not significant (p>0.05). Conclusions Our study demonstrates the feasibility of fast and reliable measurement of SUV and ADC with simultaneous PET/MRI. In patients with cervical cancer we found significant inverse correlations for SUV and ADC which could play a major role for further tumor characterization and therapy decisions.
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Affiliation(s)
- P. Brandmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - S. Purz
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - K. Bremicker
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - M. Höckel
- Department of Gynecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - H. Barthel
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - R. Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - T. Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - O. Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - P. Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
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Gawlitza M, Purz S, Kubiessa K, Boehm A, Barthel H, Kluge R, Kahn T, Sabri O, Stumpp P. In Vivo Correlation of Glucose Metabolism, Cell Density and Microcirculatory Parameters in Patients with Head and Neck Cancer: Initial Results Using Simultaneous PET/MRI. PLoS One 2015; 10:e0134749. [PMID: 26270054 PMCID: PMC4536035 DOI: 10.1371/journal.pone.0134749] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/30/2015] [Indexed: 12/20/2022] Open
Abstract
Objective To demonstrate the feasibility of simultaneous acquisition of 18F-FDG-PET, diffusion-weighted imaging (DWI) and T1-weighted dynamic contrast-enhanced MRI (T1w-DCE) in an integrated simultaneous PET/MRI in patients with head and neck squamous cell cancer (HNSCC) and to investigate possible correlations between these parameters. Methods 17 patients that had given informed consent (15 male, 2 female) with biopsy-proven HNSCC underwent simultaneous 18F-FDG-PET/MRI including DWI and T1w-DCE. SUVmax, SUVmean, ADCmean, ADCmin and Ktrans, kep and ve were measured for each tumour and correlated using Spearman’s ρ. Results Significant correlations were observed between SUVmean and Ktrans (ρ = 0.43; p ≤ 0.05); SUVmean and kep (ρ = 0.44; p ≤ 0.05); Ktrans and kep (ρ = 0.53; p ≤ 0.05); and between kep and ve (ρ = -0.74; p ≤ 0.01). There was a trend towards statistical significance when correlating SUVmax and ADCmin (ρ = -0.35; p = 0.08); SUVmax and Ktrans (ρ = 0.37; p = 0.07); SUVmax and kep (ρ = 0.39; p = 0.06); and ADCmean and ve (ρ = 0.4; p = 0.06). Conclusion Simultaneous 18F-FDG-PET/MRI including DWI and T1w-DCE in patients with HNSCC is feasible and allows depiction of complex interactions between glucose metabolism, microcirculatory parameters and cellular density.
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Affiliation(s)
- Matthias Gawlitza
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- * E-mail:
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Klaus Kubiessa
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Andreas Boehm
- ENT-Department, University Hospital of Leipzig, Liebigstraße 10–14, 04103 Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
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