Diffusion‐weighted and dynamic contrast‐enhanced MRI to assess radiation therapy response for head and neck paragangliomas

Abstract

Background and Purpose The prediction of radiotherapy outcome in head and neck paragangliomas is clinically important. We investigated perfusion and diffusion markers for evaluation of response to radiotherapy of head and neck paragangliomas. Methods We retrospectively reviewed 330 consecutive patients from January 2016 to September 2019 with suspected head and neck paragangliomas, and enrolled 11 patients (2 males, 9 females; age: 55.2 ± 10.3 years) who had conventional MRI and dynamic contrast‐enhanced (DCE)‐MRI before and after radiation therapy. Radiation therapy, consisting of external beam radiotherapy or stereotactic radiotherapy, was conducted at the radiation oncology department in a single center. Mean apparent diffusion coefficient (ADC), normalized mean ADC, and parameters of DCE‐MRI were compared between pre‐ and post‐treatment status by paired t‐test. The Pearson correlation coefficient was used for the relationship between tumor volume ratio (post‐treatment status/pre‐treatment status) and pre‐treatment and post‐treatment values. Results Mean and normalized ADC values were statistically higher in post‐treatment status than pre‐treatment status (p = 0.005, p = 0.005, respectively), and Ktrans (volume transfer constant between extravascular, extracellular space [EES], and blood plasma per minute) and Kep (rate transfer constant between EES and blood plasma per minute) were significantly lower in post‐treatment status than pre‐treatment status (p = 0.007, p = 0.027, respectively). The correlation coefficient of the relationship between tumor volume ratio and pre‐treatment Ktrans (r = 0.70; p = 0.016) and between tumor volume ratio and post‐treatment Ktrans and Kep (r = 0.83; p = 0.002, r = 0.8; p = 0.003, respectively) was statistically significant. Conclusions Ktrans has predictive potential to predict the response to radiation therapy of head and neck paragangliomas.

Diagnostic Role of Diffusion-Weighted and Dynamic Contrast-Enhanced Perfusion MR Imaging in Paragangliomas and Schwannomas in the Head and Neck

“…Also, dynamic contrast-enhanced (DCE)-MR imaging can assess tumor microvasculature and permeability 8,9 and has been increasingly used to assess head and neck lesions. [10][11][12][13] However, DWI and DCE-MR imaging analysis for these tumors and for the mutation status of paragangliomas has not been fully explored. This study was designed to test the hypothesis that ADC values and DCE-MR imaging could help differentiate schwannomas from paragangliomas and distinguish nonhereditary and hereditary paragangliomas.…”

MR diffusion and dynamic‐contrast enhanced imaging to distinguish meningioma, paraganglioma, and schwannoma in the cerebellopontine angle and jugular foramen

“…DCE‐MRI can help to assess tumor microvasculature and permeability. This technique has been used for both characterization and differentiation of tumors and prediction of treatment effect in the head and neck 12,21–23 . ROIs were placed within the enhancing component of the tumors, avoiding the portions that mainly showed cystic/necrotic components, which could have lower the values of DCE‐MRI parameters.…”

“…This technique has been used for both characterization and differentiation of tumors and prediction of treatment effect in the Receiver operating characteristic curves of (A) meningioma versus paraganglioma, (B) meningioma versus schwannoma, and (C) paraganglioma versus schwannoma. Abbreviation: AUC, area under the curve head and neck 12,[21][22][23]. ROIs were placed within the enhancing component of the tumors, avoiding the portions that mainly showed cystic/ necrotic components, which could have lower the values of DCE-MRI parameters.…”

Neurofibromatosis type 2 versus sporadic vestibular schwannoma: The utility of MR diffusion and dynamic contrast‐enhanced imaging

“…The quantitative parameters of dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) include Vp (fractional plasma volume), Ve (fractional volume of extracellular space), Kep (reverse reflux rate constant), and Ktrans (forward volume transfer constant), and can assess a tumor's microcirculation 10 . Diffusion‐weighted imaging (DWI) and DCE‐MRI have been recently used for differentiation of head and neck tumors and treatment effect assessment 11–14 …”

“…10 Diffusion-weighted imaging (DWI) and DCE-MRI have been recently used for differentiation of head and neck tumors and treatment effect assessment. [11][12][13][14] Therefore, in this study we aimed to assess the utility of DWI and DCE-MRI as well as conventional MRI findings for differentiation between sporadic and NF2 VSs and to compare the diagnostic performances between DWI and DCE-MRI.…”