Characterization and therapy monitoring of head and neck carcinomas using diffusion-imaging-based intravoxel incoherent motion parameters—preliminary results

• Published in: Neuroradiology Vol. 55; no. 5; pp. 527 - 536
• Main Authors: Hauser, Thomas, Essig, Marco, Jensen, Alexandra, Gerigk, Lars, Laun, Frederik Bernd, Münter, Marc, Simon, Dirk, Stieltjes, Bram
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.05.2013; Springer Nature B.V
• Subjects: Adult; Aged; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - pathology; Chemoradiotherapy - methods; Diffusion Magnetic Resonance Imaging - methods; Female; Head & neck cancer; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - pathology; Head and Neck Radiology; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Imaging; Imaging, Three-Dimensional - methods; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Motion; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Organ Sparing Treatments - methods; Pilot Projects; Prognosis; Radiology; Reproducibility of Results; Sensitivity and Specificity; Squamous Cell Carcinoma of Head and Neck; Therapy; Treatment Outcome; Tumor Burden - drug effects; Diffusion-weighted imaging; Head and neck squamous cell carcinoma; Intravoxel incoherent motion; Perfusion fraction; Therapy monitoring
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-013-1154-9

Introduction Using the intravoxel incoherent motion (IVIM) model, diffusion-related coefficient ( D ) and perfusion-related parameter ( f ) can be measured. Here, we used IVIM imaging to characterize squamous cell carcinomas of head and neck (HNSCC) and evaluated its application in follow-up after nonsurgical organ preserving therapy. Methods Twenty-two patients with locally advanced HNSCC (clinical stage III to IVb) were examined before treatment using eight different b values ( b  = 0, 50, 100, 150, 200, 250, 700, 800 s/mm 2 ). All patients were followed for at least 7.5 months after conclusion of therapy. In 16 of these patients, follow-up MRI was available. Using the IVIM approach, f and D were extracted using a bi-exponential fit. For comparison, ADC maps were calculated. Results The initial values of f before therapy were located between 5.9 % and 12.9 % (mean: 9.4 ± 2.4 %) except for two outliers ( f  = 17.9 % and 18.2 %). These two patients exclusively displayed poor initial treatment response. Overall, high initial f (13.1 ± 4.1 % vs. 9.1 ± 2.4 %) and ADC (1.17 ± 0.08 × 10 −3  mm 2 /s vs. 0.98 ± 0.19 × 10 −3  mm 2 /s) were associated with poor short term outcome ( n  = 6) after 7.5 months follow-up. D values before treatment were 0.98 × 10 −3  ± 0.18 mm 2 /s and ADC values were 1.03 × 10 −3  ± 0.18 mm 2 /s. At follow-up, in all primary responders, D (69 ± 52 %), f (65 ± 46 %), and ADC (68 ± 49%) increased. Conclusions Our preliminary evaluation indicates that an initial high f may predict poor prognosis in HNSCC. In responders, a significant increase of all IVIM parameters after therapy was demonstrated.