Prognostic Value of Apparent Diffusion Coefficient in Oropharyngeal Carcinoma

Imaging Findings of Human Papillomavirus-Positive and Human Papillomavirus-Negative Oropharyngeal Squamous Cell Carcinoma Associated with Recurrence

Objectives: This study aimed to compare the imaging findings associated with the recurrence of HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC). Methods: In total, 68 patients (51 men; mean age, 64.4 years; age range, 41-86 years; 48 HPV-positive patients and 20 HPV-negative patients) with histopathologically proven OPSCC who underwent CT, MRI, and 18F-FDG-PET/CT before treatment between October 2014 and July 2022 were enrolled in this study. The imaging findings were retrospectively evaluated and statistically compared. Results: HPV-positive OPSCC had a significantly lower recurrence rate compared with that of HPV-negative OPSCC (p < 0.01). Among HPV-positive OPSCCs, patients with recurrence were considerably older than those without recurrence (p < 0.05); however, the T and N categories did not differ between the two groups. Meanwhile, among HPV-negative OPSCCs, the T and N categories were associated with recurrence (p < 0.05). Furthermore, the attenuation on contrast-enhanced CT (p < 0.05) and signal intensity on contrast-enhanced T1-weighted images (p < 0.05) of nodal metastases were significantly lower in recurrence patients compared to those in nonrecurrence patients. Cystic change in nodal metastases in HPV-positive and HPV-negative OPSCCs were similar in patients with and without recurrence. Conclusions: The T and N categories were associated with recurrence in HPV-negative OPSCC but not in HPV-positive OPSCC. Prognostic factors differed significantly between HPV-positive and HPV-negative OPSCC.

Can initial apparent diffusion coefficient and tumour volume predict future metastases in treatment-naive patients with laryngeal squamous cell carcinoma

Purpose

To evaluate the predictive capability of the apparent diffusion coefficient (ADC) at initial diagnosis in treatment-naive patients with laryngeal squamous cell carcinoma (LSCC) for the development of future metastases.

Material and methods

Magnetic resonance images of patients with pathologically proven non-metastatic, treatmentnaive LSCC were retrospectively evaluated. Follow-up positron emission tomography scans were assessed for the scanning of metastases.

Results

A total of 37 patients (32 males and 5 females) with a mean age of 62.8 ± 8.9 years were enrolled. Mean tumour volume and ADC were 4.8 ± 62 cm3 and 0.72 ± 0.51 × 10-3 mm2/s, respectively. Six local and 8 distant metastases were detected in a mean follow-up period of 17.5 ± 10.2 months. A significant association between ADC and the presence distant metastases (p = 0.046) and local metastases (p = 0.042) was found. The difference in mean ADC values between future metastatic and non-metastatic initial tumours was significant (p = 0.017).

Conclusions

Pre-treatment ADC values and volume of the initial tumour might provide early information about the development of future metastases in patients with LSCC in this series.

Relating pre-treatment non-Gaussian intravoxel incoherent motion diffusion-weighted imaging to human papillomavirus status and response in oropharyngeal carcinoma

Background and purpose

Diffusion-weighted imaging (DWI) is a promising technique for response assessment in head-and-neck cancer. Recently, we optimized Non-Gaussian Intravoxel Incoherent Motion Imaging (NG-IVIM), an extension of the conventional apparent diffusion coefficient (ADC) model, for the head and neck. In the current study, we describe the first application in a group of patients with human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma. The aim of this study was to relate ADC and NG-IVIM DWI parameters to HPV status and clinical treatment response.

Materials and methods

Thirty-six patients (18 HPV-positive, 18 HPV-negative) were prospectively included. Presence of progressive disease was scored within one year. The mean pre-treatment ADC and NG-IVIM parameters in the gross tumor volume were compared between HPV-positive and HPV-negative patients. In HPV-negative patients, ADC and NG-IVIM parameters were compared between patients with and without progressive disease.

Results

ADC, the NG-IVIM diffusion coefficient D, and perfusion fraction f were significantly higher, while pseudo-diffusion coefficient D* and kurtosis K were significantly lower in the HPV-negative compared to HPV-positive patients. In the HPV-negative group, a significantly lower D was found for patients with progressive disease compared to complete responders. No relation with ADC was observed.

Conclusion

The results of our single-center study suggest that ADC is related to HPV status, but not an independent response predictor. The NG-IVIM parameter D, however, was independently associated to response in the HPV-negative group. Noteworthy in the opposite direction as previously thought based on ADC.

Usefulness of apparent diffusion coefficient values for distinguishing between squamous cell carcinoma and malignant salivary gland tumor of the head and neck

PURPOSE

The aim of the study was to assess the usefulness of apparent diffusion coefficient (ADC) values for differentiating between SCC and malignant salivary gland tumors of the head and neck.

MATERIALS AND METHODS

This retrospective cross-sectional study was conducted on 29 patients with SCCs and 10 patients with malignant salivary gland tumors who underwent pretreatment MRI of the head and neck. The minimum and average ADC values of the tumors were measured, with normalized tumor to spinal cord ADC ratios generated. Comparisons of ADC values and normalized ADC ratios between the two tumor types were performed using the unpaired t-test.

RESULTS

The minimum and average ADC values and normalized average ADC ratios of SCCs (753.17 ± 214.47 × 10-6 mm2/s, 848.79 ± 250.13 × 10-6 mm2/s, and 0.92 ± 0.25, respectively) were significantly lower than those of malignant salivary gland tumors (1084.90 ± 242.60 × 10-6 mm2/s, 1305.90 ± 270.99 × 10-6 mm2/s, and 1.58 ± 0.31, respectively; all p < 0.001). A cutoff value of 1.31 for the normalized average ADC ratio was used to distinguish between SCCs and malignant salivary gland tumors and achieved an area under the curve of 0.93, sensitivity of 96.6%, specificity of 90%, and accuracy of 94.6%.

CONCLUSION

ADC value measurement could help differentiate between SCCs and malignant salivary gland tumors.

A Prognostic Model Generated from an Apparent Diffusion Coefficient Ratio Reliably Predicts the Outcomes of Oral Tongue Squamous Cell Carcinoma

This study aimed to develop an apparent diffusion coefficient (ADC) ratio-based prognostic model to predict the recurrence and disease-free survival (DFS) of oral tongue squamous cell carcinoma (OTSCC). A total of 188 patients with cT1-2 oral tongue squamous cell carcinoma were enrolled retrospectively. Clinical and laboratory data were extracted from medical records. The ADC values were measured at the regions of interest of the tumor and non-tumor tissues of the MRI images, and the ADC ratio was used for comparison between the patient with recurrence (n = 83 case, 44%) and patients without recurrence (n = 105 cases, 56%). Cox proportional hazards models were generated to analyze the risk factors of cancer recurrence. A nomogram was developed based on significant risk factors to predict 1-, 5- and 10-year DFS. The receiver operator characteristic (ROC) curves of predictors in the multivariable Cox proportional hazards prognostic model were generated to predict the recurrence and DFS. The integrated areas under the ROC curve were calculated to evaluate discrimination of the models. The ADC ratio, tumor thickness and lymph node ratio were reliable predictors in the final prognostic model. The final model had a 71.1% sensitivity and an 81.0% specificity. ADC ratio was the strongest predictor of cancer recurrence in prognostic performance. Discrimination and calibration statistics were satisfactory with C-index above 0.7 for both model development and internal validation. The calibration curve showed that the 5- and 10-year DFS predicted by the nomogram agreed with actual observations.

Imaging of human papilloma virus associated oropharyngeal squamous cell carcinoma and its impact on diagnosis, prognostication, and response assessment

The clinical behaviour and outcomes of patients with oropharyngeal cancer (OPC) may be dichotomised according to their association with human papilloma virus (HPV) infection. Patients with HPV-associated disease (HPV+OPC) have a distinct demographic profile, clinical phenotype and demonstrate considerably better responses to chemoradiotherapy. This has led to a reappraisal of staging and treatment strategies for HPV+OPC, which are underpinned by radiological data. Structural modalities, such as CT and MRI can provide accurate staging information. These can be combined with ultrasound-guided tissue sampling and functional techniques (such as diffusion-weighted MRI and 18F-fludeoxyglucose positron emission tomography-CT) to monitor response to treatment, derive prognostic information, and to identify individuals who might benefit from intensification or deintensification strategies. Furthermore, advanced MRI techniques, such as intravoxel incoherent motion and perfusion MRI as well as application of artificial intelligence and radiomic techniques, have shown promise in treatment response monitoring and prognostication. The following review will consider the contemporary role and knowledge on imaging in HPV+OPC.

Role of diffusion-weighted imaging in differentiating angiomatous meningioma from atypical meningioma

BACKGROUND

Conventional magnetic resonance imaging (MRI) characteristics of angiomatous meningioma (AM) and atypical meningioma (ATM) sometimes overlap. However, there are significant differences in the treatment and prognosis of the two tumors. The aim of the study was to assess the role of diffusion-weighted imaging (DWI) in differentiating AM from ATM.

METHODS

Clinical, MRI, and pathological data of 25 patients with AM and 30 patients with ATM were retrospectively analyzed. Main clinical indexes, conventional MRI characteristics, and apparent diffusion coefficient (ADC) values were compared between the two groups, and receiver operating characteristic (ROC) curves were drawn to determine the diagnostic performance of ADC values in distinguishing AM from ATM.

RESULTS

The minimum ADC value (ADCmin), average ADC value (ADCmean), and relative ADC value (rADC) for AM (908.00 ± 117.00 × 10^-6 mm²/s, 921.04 ± 67.09 × 10^-6 mm²/s, and 1.15 ± 0.09, respectively) were significantly higher than those for ATM (710.50 ± 79.80 × 10^-6 mm²/s, 748.50 ± 67.27 × 10^-6 mm²/s, and 0.96 ± 0.09, respectively; all P < 0.05). ROC analysis showed that ADCmin had the best diagnostic performance in distinguishing AM from ATM, with an area under the curve value of 0.977. When using 759.00 × 10^-6 mm²/s as the optimal threshold, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.00 %, 96.00 %, 92.72 %, 96.40 %, and 88.90 %, respectively.

CONCLUSIONS

DWI plays an important role in differentiating AM from ATM, and ADCmin is the most promising potential parameter that can improve the preoperative diagnostic accuracy of both tumors.