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van der Hulst HJ, Jansen RW, Vens C, Bos P, Schats W, de Jong MC, Martens RM, Bodalal Z, Beets-Tan RGH, van den Brekel MWM, de Graaf P, Castelijns JA. The Prediction of Biological Features Using Magnetic Resonance Imaging in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:5077. [PMID: 37894447 PMCID: PMC10605807 DOI: 10.3390/cancers15205077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Magnetic resonance imaging (MRI) is an indispensable, routine technique that provides morphological and functional imaging sequences. MRI can potentially capture tumor biology and allow for longitudinal evaluation of head and neck squamous cell carcinoma (HNSCC). This systematic review and meta-analysis evaluates the ability of MRI to predict tumor biology in primary HNSCC. Studies were screened, selected, and assessed for quality using appropriate tools according to the PRISMA criteria. Fifty-eight articles were analyzed, examining the relationship between (functional) MRI parameters and biological features and genetics. Most studies focused on HPV status associations, revealing that HPV-positive tumors consistently exhibited lower ADCmean (SMD: 0.82; p < 0.001) and ADCminimum (SMD: 0.56; p < 0.001) values. On average, lower ADCmean values are associated with high Ki-67 levels, linking this diffusion restriction to high cellularity. Several perfusion parameters of the vascular compartment were significantly associated with HIF-1α. Analysis of other biological factors (VEGF, EGFR, tumor cell count, p53, and MVD) yielded inconclusive results. Larger datasets with homogenous acquisition are required to develop and test radiomic-based prediction models capable of capturing different aspects of the underlying tumor biology. Overall, our study shows that rapid and non-invasive characterization of tumor biology via MRI is feasible and could enhance clinical outcome predictions and personalized patient management for HNSCC.
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Affiliation(s)
- Hedda J. van der Hulst
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, 6211 LK Maastricht, The Netherlands
| | - Robin W. Jansen
- Department of Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Conchita Vens
- Department of Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- School of Cancer Science, University of Glasgow, Glasgow G61 1QH, UK
| | - Paula Bos
- Department of Radiation Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Winnie Schats
- Scientific Information Service, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Marcus C. de Jong
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Roland M. Martens
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Zuhir Bodalal
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, 6211 LK Maastricht, The Netherlands
| | - Regina G. H. Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, 6211 LK Maastricht, The Netherlands
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Michiel W. M. van den Brekel
- Department of Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location University of Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Jonas A. Castelijns
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Mui AW, Lee AW, Ng WT, Lee VH, Vardhanabhuti V, Man SY, Chua DT, Guan XY. Optimal time for early therapeutic response prediction in nasopharyngeal carcinoma with functional magnetic resonance imaging. Phys Imaging Radiat Oncol 2023; 27:100458. [PMID: 37457666 PMCID: PMC10339040 DOI: 10.1016/j.phro.2023.100458] [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: 02/16/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background and Purpose Physiological changes in tumour occur much earlier than morphological changes. They can potentially be used as biomarkers for therapeutic response prediction. This study aimed to investigate the optimal time for early therapeutic response prediction with multi-parametric magnetic resonance imaging (MRI) in patients with nasopharyngeal carcinoma (NPC) receiving concurrent chemo-radiotherapy (CCRT). Material and Methods Twenty-seven NPC patients were divided into the responder (N = 23) and the poor-responder (N = 4) groups by their primary tumour post-treatment shrinkages. Single-voxel proton MR spectroscopy (1H-MRS), diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) MRI were scanned at baseline, weekly during CCRT and post-CCRT. The median choline peak in 1H-MRS, the median apparent diffusion coefficient (ADC) in DW-MRI, the median influx rate constant (Ktrans), reflux rate constant (Kep), volume of extravascular-extracellular space per unit volume (Ve), and initial area under the time-intensity curve for the first 60 s (iAUC60) in DCE-MRI were compared between the two groups with the Mann-Whitney tests for any significant difference at different time points. Results In DW-MRI, the percentage increase in ADC from baseline to week-1 for the responders (median = 11.39%, IQR = 18.13%) was higher than the poor-responders (median = 4.91%, IQR = 7.86%) (p = 0.027). In DCE-MRI, the iAUC60 on week-2 was found significantly higher in the poor-responders (median = 0.398, IQR = 0.051) than the responders (median = 0.192, IQR = 0.111) (p = 0.012). No significant difference was found in median choline peaks in 1H-MRS at all time points. Conclusion Early perfusion and diffusion changes occurred in primary tumours of NPC patients treated with CCRT. The DW-MRI on week-1 and the DCE-MRI on week-2 were the optimal time points for early therapeutic response prediction.
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Affiliation(s)
- Alan W.L. Mui
- Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Hong Kong, China
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Anne W.M. Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wai-Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Victor H.F. Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shei-Yee Man
- Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Daniel T.T. Chua
- Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Xin-Yuan Guan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Meyer HJ, Höhn AK, Surov A. Associations between dynamic-contrast enhanced MRI and tumor infiltrating lymphocytes and tumor-stroma ratio in head and neck squamous cell cancer. Cancer Imaging 2021; 21:60. [PMID: 34801089 PMCID: PMC8606096 DOI: 10.1186/s40644-021-00429-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/01/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives The present study used dynamic-contrast enhanced MRI (DCE-MRI) to elucidate possible associations with tumor-infiltrating lymphocytes (TIL), stroma ratio and vimentin expression in head and neck squamous cell cancer (HNSCC). Methods Overall, 26 patients with primary HNSCC of different localizations were involved in the study. DCE-MRI was obtained on a 3 T MRI and analyzed with a whole lesion measurement using a histogram approach. TIL- and vimentin-expression was calculated on bioptic samples before any form of treatment. P16 staining was used to define HPV-status. Results Tumor-stroma ratio correlated with entropy derived from Ktrans (r = − 0.52, p = 0.0071) and with kurtosis derived from Ve (r = − 0.53, p = 0.0058). Several Ve derived parameters correlated with expression of TIL within the stroma compartment. TIL within the tumor compartment correlated with entropy derived from Ktrans (r = 0.39, p = 0.047), p90 derived from Ve (r = 0.41, p = 0.036) and skewness derived from Ve (r = 0.41, p = 0.037). Furthermore, these associations were different between HPV positive and negative tumors. Conclusions DCE-MRI might be able to reflect tumor compartments and TIL expression in HNSCC. The most promising parameters were values derived from Ktrans and Ve.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | | | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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Tekiki N, Fujita M, Okui T, Kawai H, Oo MW, Kawazu T, Hisatomi M, Okada S, Takeshita Y, Barham M, Nagatsuka H, Yanagi Y, Asaumi JI. Dynamic contrast-enhanced MRI as a predictor of programmed death ligand-1 expression in patients with oral squamous cell carcinoma. Oncol Lett 2021; 22:778. [PMID: 34594419 PMCID: PMC8456498 DOI: 10.3892/ol.2021.13039] [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] [Received: 04/23/2021] [Accepted: 08/11/2021] [Indexed: 12/29/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) targeting programmed death ligand-1 (PD-L1) are highly promising therapies for oral squamous cell carcinoma (OSCC). The assessment of PD-L1 expression may help predicting the therapeutic effect of ICIs and, thus, benefit patient selection. Contrast index (CI) parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) have been proven as efficient to assess microvessel density (MVD) in OSCC. The present study aimed to determine the correlation between DCE-MRI parameters and MVD and between DCE-MRI parameters and PD-L1 expression to determine whether DCE-MRI could be used non-invasively to evaluate PD-L1 expression in patients with OSCC. A total of 21 patients with primary OSCC who had undergone a 3T MRI scan, including DCE-MRI, were included in the present study, and CI curve-derived parameters were examined. The MVD and PD-L1 expression in the surgically resected specimens were analyzed using immunohistochemistry (IHC) staining for CD31 and IHC staining for PD-L1, respectively. The results demonstrated that the expression levels of these markers were correlated with DCE-MRI parameters. PD-L1 expression levels were found to be significantly correlated with the maximum CI (CI-max; P=0.007), peak CI (CI-peak; P=0.007), maximum CI gain (CI-gain; P=0.006) and MVD (P=0.001) values. The mean CI-max, CI-peak, CI-gain and MVD values were significantly higher in tumors with high PD-L1 expression (P<0.05). MVD levels were also significantly correlated with the time of CI-max (T-max; P=0.003) and CI-gain (P=0.037). The mean CI-gain was significantly increased, and the mean T-max was significantly shorter in high MVD tumors (P<0.05 and P<0.01, respectively). In summary, the findings from the present study confirmed the correlation between CI parameters, derived from DCE-MRI, and MVD, and suggested that these parameters may be correlated with PD-L1 expression in OSCC tumor cells.
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Affiliation(s)
- Nouha Tekiki
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Mariko Fujita
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.,Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - May Wathone Oo
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Toshiyuki Kawazu
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Miki Hisatomi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Shunsuke Okada
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Majd Barham
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yoshinobu Yanagi
- Department of Dental Informatics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Jun-Ichi Asaumi
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.,Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
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Mui AWL, Lee AWM, Lee VHF, Ng WT, Vardhanabhuti V, Man SSY, Chua DTT, Law SCK, Guan XY. Prognostic and therapeutic evaluation of nasopharyngeal carcinoma by dynamic contrast-enhanced (DCE), diffusion-weighted (DW) magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Magn Reson Imaging 2021; 83:50-56. [PMID: 34246785 DOI: 10.1016/j.mri.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/11/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is an aggressive head and neck malignancy, and radiotherapy (with or without chemotherapy) is the primary treatment modality. Reliable tumour assessment during the treatment phase, which can portend the efficacy of radiotherapy and early identification of potential treatment failure in radioresistant disease, has been implicit for better cancer management. Technological advancement in the last decade has fostered the development of functional magnetic resonance imaging (fMRI) techniques into a promising tool for diagnostic and therapeutic assessments in head and neck cancer. Apart from conventional morphological assessment, early detection of the physiological environment by fMRI allows a more thorough investigation in monitoring tumour response. This article discusses the relevant fMRI utilities in NPC as an early prognostic and monitoring tool for treatment. Challenges and future developments of fMRI in radiation oncology are also discussed.
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Affiliation(s)
- Alan W L Mui
- Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Hong Kong; Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Anne W M Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Victor H F Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - W T Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Shei S Y Man
- Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Daniel T T Chua
- Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Stephen C K Law
- Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong
| | - X Y Guan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Zhang Y, Li Z, Gao C, Shen J, Chen M, Liu Y, Cao Z, Pang P, Cui F, Xu M. Preoperative histogram parameters of dynamic contrast-enhanced MRI as a potential imaging biomarker for assessing the expression of Ki-67 in prostate cancer. Cancer Med 2021; 10:4240-4249. [PMID: 34117733 PMCID: PMC8267123 DOI: 10.1002/cam4.3912] [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: 11/17/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To investigate whether preoperative histogram parameters of dynamic contrast‐enhanced MRI (DCE‐MRI) can assess the expression of Ki‐67 in prostate cancer (PCa). Materials and methods A consecutive series of 76 patients with pathology‐proven PCa who underwent routine DCE‐MRI scans were retrospectively recruited. Quantitative parameters including the volume transfer constant (Ktrans), rate contrast (Kep), extracellular‐extravascular volume fraction (Ve), and plasma volume (Vp) by outlining the three‐dimensional volume of interest (VOI) of all lesions were processed. Then, the histogram analyses of these quantitative parameters were performed. The Spearman rank correlation analysis was used to evaluate the correlation of these parameters and Ki‐67 expression of PCa. Receiver operating characteristic (ROC) curve analysis was adopted to evaluate the efficacy of these quantitative histogram parameters in identifying high Ki‐67 expression from low Ki‐67 expression of PCa. Results Eighty‐eight PCa lesions were enrolled in this study, including 31 lesions with high Ki‐67 expression and 57 lesions with low Ki‐67 expression. The median, mean, 75th percentile, and 90th percentile derived from Ktrans and Kep had a moderately positive correlation with Ki‐67 expression (r = 0.361–0.450, p < 0.05), in which both the median and mean of Ktrans had the highest positive correlation (r = 0.450, p < 0.05). The diagnostic efficacy of the Ktrans median, mean, 75th percentile, and 90th percentile, along with the Kep‐based median and mean was assessed by the ROC curve. The area under the curve (AUC) of the mean for Ktrans was the highest (0.826). When the cut‐off of the mean for Ktrans was ≥0.47/min, its Youden index, sensitivity, and specificity were 0.625, 0.871, and 0.754, respectively. The AUC of the median of Kep was the lowest (0.772). Conclusion The histogram of DCE‐MRI quantitative parameters is correlated with Ki‐67 expression, which has the potential to noninvasively assess the expression of Ki‐67 with patients of PCa.
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Affiliation(s)
- Yongsheng Zhang
- Department of Radiology, The Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiping Li
- Department of Radiology, The Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Chen Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianliang Shen
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Mingtao Chen
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yufeng Liu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhijian Cao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Peipei Pang
- GE Healthcare Life Sciences, Hangzhou, China
| | - Feng Cui
- Department of Radiology, The Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Maosheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,The First Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
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Meyer HJ, Höhn AK, Surov A. Associations between histogram analysis parameters derived from dynamic-contrast enhanced MRI and PD L1-expression in head and neck squamous cell carcinomas. A preliminary study. Magn Reson Imaging 2020; 72:117-121. [PMID: 32663619 DOI: 10.1016/j.mri.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/04/2020] [Accepted: 07/05/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Programmed death 1 ligand (PD-L 1) plays an essential role in oncology. It might be crucial to predict its expression non-invasively by imaging. Dynamic-contrast enhanced MRI (DCE MRI) is one of the important imaging modalities in head and neck squamous cell cancer (HNSCC). The aim of the present study was to analyze possible associations between histogram analysis parameters of DCE MRI and PD-L 1 expression in HNSCC METHODS: Overall, 26 patients with primary HNSCC of different localizations were involved in the study. DCE MRI was obtained on a 3 T MRI and analyzed with a whole lesion measurement using a histogram approach. PD-L 1 expression was estimated on bioptic samples before any form of treatment using 3 scores (Tumor positive score (TPS), Immune cell score (ICS) and Combined positive score (CPS)). RESULTS CPS correlated with mode derived from Ktrans (r = 0.40, p = .04). Also CPS correlated with P90 derived from Kep (r = 0.40, p = .04). ICS correlated with the maximum derived from Kep (r = 0.41, p = .03) and entropy derived from Kep (r = 0.43, p = .02). There were no associations between DCE MRI parameters and TPS. CONCLUSION Ktrans and Kep related histogram analysis parameters derived from DCE MRI correlated moderately with PD-L 1 expression of immune cells in HNSCC.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | | | - Alexey Surov
- Department of Radiology and Nuclear medicine, University of Magdeburg, Magdeburg, Germany
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Meyer HJ, Hamerla G, Leifels L, Höhn AK, Surov A. Histogram analysis parameters derived from DCE-MRI in head and neck squamous cell cancer – Associations with microvessel density. Eur J Radiol 2019; 120:108669. [DOI: 10.1016/j.ejrad.2019.108669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 01/21/2023]
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Texture Analysis of Multi-Shot Echo-planar Diffusion-Weighted Imaging in Head and Neck Squamous Cell Carcinoma: The Diagnostic Value for Nodal Metastasis. J Clin Med 2019; 8:jcm8111767. [PMID: 31652840 PMCID: PMC6912832 DOI: 10.3390/jcm8111767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/13/2019] [Accepted: 10/22/2019] [Indexed: 12/28/2022] Open
Abstract
Accurate assessment of nodal metastasis in head and neck squamous cell carcinoma (SCC) is important, and diffusion-weighted imaging (DWI) has emerged as a potential technique in differentiating benign from malignant lymph nodes (LNs). This study aims to evaluate the diagnostic performance of texture analysis using apparent diffusion coefficient (ADC) data of multi-shot echo-planar imaging-based DWI (msEPI-DWI) in predicting metastatic LNs of head and neck SCC. 36 patients with pathologically proven head and neck SCC were included in this study. A total of 204 MRI-detected LNs, including 176 subcentimeter-sized LNs, were assigned to metastatic or benign groups. Texture features of LNs were compared using independent t-test. Hierarchical cluster analysis was performed to exclude redundant features. Multivariate logistic regression and receiver operating characteristic analysis were performed to assess the diagnostic performance. The discriminative texture features for predicting metastatic LNs were complexity, energy and roundness. Areas under the curves (AUCs) for diagnosing metastasis in all/subcentimeter-sized LNs were 0.829/0.767 using complexity, 0.699/0.685 using energy and 0.671/0.638 using roundness, respectively. The combination of three features resulted in higher AUC values of 0.836/0.781. In conclusion, texture analysis of ADC data using msEPI-DWI could be a useful tool for nodal staging in head and neck SCC.
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Abstract
BACKGROUND FDG-PET might be able to reflect histopathology features of tumors. Ki 67 in head and neck carcinomas (HNSCC). The present study sought to elucidate the association between Ki 67 index and SUVmax based upon a large patient sample. METHODS PubMed database was screened for studies analyzed the relationship between Ki 67 and SUV in HNSCC. Nine studies comprising 211 patients were suitable for analysis. RESULTS SUVmax increased with tumor grade and was statistically significant different between G1, G2, and G3 tumors. The ROC analysis for discrimination between G1/G2 and G3 tumors revealed an area under curve of 0.71. In the overall patient sample, SUVmax correlated statistically significant with Ki 67 index (r = 0.154, P = .032). CONCLUSION The present study identified a weak correlation between SUV values and proliferation index Ki 67 index in HNSCC in a large patient sample. Therefore, SUVmax cannot be used as surrogate parameter for proliferation activity in HNSCC.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig
| | - Peter Gundermann
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig
- Department of Diagnostic and Interventional Radiology, University of Ulm, Ulm, Germany, Germany
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Application of dynamic magnetic resonance imaging information technology in adjuvant chemotherapy for breast cancer. J Infect Public Health 2019; 13:2062-2066. [PMID: 31296481 DOI: 10.1016/j.jiph.2019.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/16/2019] [Accepted: 06/21/2019] [Indexed: 11/22/2022] Open
Abstract
In order to study the application of dynamic magnetic resonance imaging information technology in breast cancer adjuvant chemotherapy, female patients diagnosed with breast cancer in The People's Hospital of Shanxi Province are selected as research objects. Dynamic enhanced magnetic resonance imaging scans are performed to compare pathological changes by hematoxylin and eosin staining. The dynamic NMR morphological changes are used to evaluate the efficacy of neoadjuvant chemotherapy. Semi-quantitative analysis is used to compare the TIC types of lesions, and the changes in quantitative analysis parameters are used to evaluate the efficacy. The results show that in the dynamic magnetic resonance imaging technique, the effective group (RECIST standard is CR and PR) has statistically significant changes in the quantitative analysis parameters Ktrans and Kep before and after neoadjuvant chemotherapy. Ktrans and Kep are used in neoadjuvant chemotherapy for breast cancer. The assessment is consistent with the morphological RECIST criteria assessment and can be used for qualitative diagnosis of breast tumors.
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Surov A, Meyer HJ, Höhn AK, Schob S, Winter K, Sabri O, Purz S. Metabolo-volumetric parameters of 18F-FDG-PET can predict expression of EGFR and HIF 1alpha in uterine cervical cancer. Cancer Biomark 2019; 24:135-140. [PMID: 30530968 DOI: 10.3233/cbm-182019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of our study was to investigate possible relationships between 18F-FDG-PET parameters and clinically relevant histopathological findings in patients with cervical cancer (CC). METHODS Eighteen female patients (mean age 55.4 years) with histologically confirmed squamous cell CC were involved into the study. In all cases, 18F-FDG-PET CT was performed. Mean and maximum standardized uptake values (SUVmean and SUVmax), total lesion glycolysis (TLG) and metabolic tumor volume (MTV) were determined on PET-images. For every tumor the following specimen stainings were performed: epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), tumor suppressor protein p53, hypoxia-inducible factor (HIF)-1α, and histone 3. All stained specimens were digitalized and analyzed by using the ImageJ software 1.48v. Spearman's correlation coefficient (p) was used to analyze associations between investigated parameters. p-values < 0.05 were taken to indicate statistical significance. RESULTS TLG and MTV correlated well with expression of EGFR (p= 0.601, P= 0.008 and p= 0.586, P= 0.011, respectively). SUVmedian correlated inversely with expression of HIF 1alpha (p=-0.509, P= 0.031). SUVmean tended to correlate with expression of EGFR and HIF 1alpha. None of the PET parameters correlated with expression of Histone 3, p53 and VEGF. CONCLUSION TLG and MTV can reflect expression of EGFR and SUVmedian correlated significantly with expression of HIF-1α. None of the PET parameters can predict expression of Histone 3, p53 and VEGF.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital of Leipzig, Leipzig 04103, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany
| | - Stefan Schob
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Leipzig 04103, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig 04103, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig 04103, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig 04103, Germany
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Garbajs M, Strojan P, Surlan-Popovic K. Prognostic role of diffusion weighted and dynamic contrast-enhanced MRI in loco-regionally advanced head and neck cancer treated with concomitant chemoradiotherapy. Radiol Oncol 2019; 53:39-48. [PMID: 30840595 PMCID: PMC6411028 DOI: 10.2478/raon-2019-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/04/2019] [Indexed: 02/08/2023] Open
Abstract
Background In the study, the value of pre-treatment dynamic contrast-enhanced (DCE) and diffusion weighted (DW) MRI-derived parameters as well as their changes early during treatment was evaluated for predicting disease-free survival (DFS) and overall survival (OS) in patients with locoregionally advanced head and neck squamous carcinoma (HNSCC) treated with concomitant chemoradiotherapy (cCRT) with cisplatin. Patients and methods MRI scans were performed in 20 patients with locoregionally advanced HNSCC at baseline and after 10 Grays (Gy) of cCRT. Tumour apparent diffusion coefficient (ADC) and DCE parameters (volume transfer constant [Ktrans], extracellular extravascular volume fraction [ve], and plasma volume fraction [Vp]) were measured. Relative changes in parameters from baseline to 10 Gy were calculated. Univariate and multivariate Cox regression analysis were conducted. Receiver operating characteristic (ROC) curve analysis was employed to identify parameters with the best diagnostic performance. Results None of the parameters was identified to predict for DFS. On univariate analysis of OS, lower pre-treatment ADC (p = 0.012), higher pre-treatment Ktrans (p = 0.026), and higher reduction in Ktrans (p = 0.014) from baseline to 10 Gy were identified as significant predictors. Multivariate analysis identified only higher pre-treatment Ktrans (p = 0.026; 95% CI: 0.000-0.132) as an independent predictor of OS. At ROC curve analysis, pre-treatment Ktrans yielded an excellent diagnostic accuracy (area under curve [AUC] = 0.95, sensitivity 93.3%; specificity 80 %). Conclusions In our group of HNSCC patients treated with cisplatin-based cCRT, pre-treatment Ktrans was found to be a good predictor of OS.
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Affiliation(s)
- Manca Garbajs
- Institute of Clinical Radiology, University Medical CentreLjubljana, Slovenia
- Manca Garbajs, M.D., Institute of Clinical Radiology, University Medical Centre, Zaloška c. 7, SI-1000 Ljubljana, Slovenia.
Phone: + 386 40 212 226
| | - Primoz Strojan
- Division of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
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Associations between Histogram Analysis Parameters Derived from DCE-MRI and Histopathological Features including Expression of EGFR, p16, VEGF, Hif1-alpha, and p53 in HNSCC. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:5081909. [PMID: 30718984 PMCID: PMC6334376 DOI: 10.1155/2019/5081909] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022]
Abstract
Background Our purpose was to elucidate possible correlations between histogram parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) with several histopathological features in head and neck squamous cell carcinomas (HNSCC). Methods Thirty patients with primary HNSCC were prospectively acquired. Histogram analysis was derived from the DCE-MRI parameters: Ktrans, Kep, and Ve. Additionally, in all cases, expression of human papilloma virus (p16) hypoxia-inducible factor-1-alpha (Hif1-alpha), vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), and tumor suppressor protein p53 were estimated. Results Kep kurtosis was significantly higher in p16 tumors, and Ve min was significantly lower in p16 tumors compared to the p16 negative tumors. In the overall sample, Kep entropy correlated well with EGFR expression (p=0.38, P=0.04). In p16 positive carcinomas, Ktrans max correlated with VEGF expression (p=0.46, P=0.04), Ktrans kurtosis correlated with Hif1-alpha expression (p=0.46, P=0.04), and Ktrans entropy correlated with EGFR expression (p=0.50, P=0.03). Regarding Kep parameters, mode correlated with VEGF expression (p=0.51, P=0.02), and entropy correlated with Hif1-alpha expression (p=0.47, P=0.04). In p16 negative carcinomas, Kep mode correlated with Her2 expression (p=−0.72, P=0.03), Ve max correlated with p53 expression (p=−0.80, P=0.009), and Ve p10 correlated with EGFR expression (p=0.68, P=0.04). Conclusion DCE-MRI can reflect several histopathological features in HNSCC. Associations between DCE-MRI and histopathology in HNSCC depend on p16 status. Kep kurtosis and Ve min can differentiate p16 positive and p16 negative carcinomas.
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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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