Dynamic Contrast-Enhanced Magnetic Resonance Imaging as a Predictor of Outcome in Head-and-Neck Squamous Cell Carcinoma Patients With Nodal Metastases

Abstract

Purpose Dynamic contrast-enhanced-MRI (DCE-MRI) can provide information regarding tumor perfusion and permeability and has shown prognostic value in certain tumors types. The goal of the present study was to assess the prognostic value of pretreatment DCE-MRI in head and neck squamous cell carcinoma (HNSCC) patients with nodal disease undergoing chemoradiation therapy or surgery. Methods and Materials Seventy-four patients with histologically proven squamous cell carcinoma and neck nodal metastases were eligible for the study. Pretreatment DCE-MRI was performed on a 1.5T MRI. Clinical follow-up was a minimum of 12 months. DCE-MRI data were analyzed using Tofts model. DCE-MRI parameters were related to treatment outcome (progression free survival [PFS] and overall survival [OS]). Patients were grouped as no evidence of disease (NED), alive with disease (AWD), dead with disease (DOD) or dead of other causes (DOC). Prognostic significance was assessed using the log rank test for single variables and Cox proportional hazards regression for combinations of variables. Results At last clinical follow-up, for stage III, all 12 pts were NED, for stage IV, 43 patients were NED, 4 were AWD, 11 were DOD, and 4 were DOC. Ktrans is volume transfer constant. In a stepwise Cox regression skewness of Ktrans was the strongest predictor for stage IV patients (PFS and OS: p<0.001). Conclusion Our study shows that skewness of Ktrans was the strongest predictor of PFS and OS in stage IV HNSCC patients with nodal disease. This study suggests an important role for pretreatment DCE-MRI parameter Ktrans as a predictor of outcome in these patients.

Texture analysis on parametric maps derived from dynamic contrast-enhanced magnetic resonance imaging in head and neck cancer

“…By applying pharmacokinetic modeling on sequential T1-weighted images acquired after administration of a contrast agent, one can yield relevant quantitative tumor biomarkers, such as volume transfer rate (K trans ) and volume fraction of the extravascular extracellular space (ve) [2,3] . For patients with advanced head and neck squamous cell carcinoma (HNSCC), DCE-MRI has shown potential for assessment of treatment response and outcome [4][5][6] . More specifically, measures derived from DCE-MRI, such as K trans and ve, were demonstrated to provide helpful additional information regarding characterization and prognosis of HNSCC with neck nodal metastases [7,8] .…”

Intravoxel incoherent motion diffusion-weighted imaging in head and neck squamous cell carcinoma: Assessment of perfusion-related parameters compared to dynamic contrast-enhanced MRI

“…Estimations of tumor perfusion have been performed mainly by the dynamic contrast-enhanced (DCE) technique [2,3]. This technique has been used widely for the assessment of tumor perfusion in HNSCC [4][5][6][7].…”

TumourMetrics: a comprehensive clinical solution for the standardization of DCE-MRI analysis in research and routine use

“…The rationale behind this extreme condition could be to provide a test that allows the estimate of uncertainty and quantitation limit, and to handle the occurrence of fitting failure, as K trans =0 min Clicking inside this area with the threshold tool [2] automatically created the ROI that contains all contiguous voxels with K trans equal or above the pointed cutoff value. The user confirmed the ROI and clicked the plot tool [3] to have a display of the measured kinetic curve, the model best fit and its parameters. The finding was then added to report [4] with the reference and orthogonal projection images [5].…”

“…The aim for this quantitative approach has been to overcome the unwanted dependences like the subject inter-and intra-variability, the inter observer variability, so that the derived parameters only reflect the local tissue properties. The added value of this quantitative method for tissue characterization has been shown in the prostate, liver, head and neck (1)(2)(3).…”