Use of quantitative diffusion-weighted magnetic resonance imaging to predict human papilloma virus status in patients with oropharyngeal squamous cell carcinoma

Abstract

Although identification of human papilloma virus (HPV) status in oropharyngeal squamous cell carcinoma (OPSCC) is essential in predicting treatment response, no imaging modality can currently determine whether a tumor is HPV-related. In this retrospective study, 26 patients with OPSCC confined to the lateral wall or the base of tongue underwent neck magnetic resonance imaging, using T1-, T2- and diffusion-weighted imaging (DWI). Apparent diffusion coefficients (ADCs) in a region of interest covering the largest available primary tumor area of OPSCC on a single slice of the ADC map were calculated using two b values (0 and 1,000 s/mm(2)). Mean and minimum ADCs were compared with HPV status, using p16 immunohistochemistry as a surrogate marker for HPV infection. Mean and minimum ADCs for HPV(+) OPSCC were significantly lower than those for HPV(-) OPSCC. A cut-off value of mean ADC for HPV(+) OPSCC of 1.027 × 10(-3) mm(2)/s yielded sensitivity and specificity of 83.33 and 78.57%, respectively. In conclusion, the present study indicates that ADC could be used to predict HPV status in patients with OPSCC.

Quantitative Diffusion-Weighted MRI Parameters and Human Papillomavirus Status in Oropharyngeal Squamous Cell Carcinoma

“…Our data are in contrast to those of Nakahira et al, 16 who found significant lower pretreatment mean and minimum ADC values for HPVpositive than for HPV-negative OPSCCs. In their series of 26 patients, they used p16 protein overexpression as a surrogate marker for HPV infection.…”

“…Limited information is available on the relation between HPV involvement and ADC values. 16 In this study, we investigated the possible association between ADC values derived from DWI and the presence of biologically active HPV in patients with OPSCC.…”

Apparent Diffusion Coefficient Histograms of Human Papillomavirus–Positive and Human Papillomavirus–Negative Head and Neck Squamous Cell Carcinoma: Assessment of Tumor Heterogeneity and Comparison with Histopathology

“…Recent publications have attempted to determine whether mean ADC values calculated by monoexponential fitting could be used to determine the HPV status in HNSCC. 12,14,22 In contrast to the intravoxel incoherent motion biexponential model, the monoexponential model does not differentiate between molecular movement caused by microperfusion and true diffusion caused by Brownian movement. 23 To obtain a robust fitting, biexponential models require the acquisition of 6 -12 b-values, leading to increased examination time and a higher percentage of motion artifacts.…”

“…On DWI, HNSCC displays restricted diffusivity because of increased cellularity, and mean ADC values are in the range of 900 -1300 ϫ 10 Ϫ6 mm 2 /s. [9][10][11][12] These reported ADC values are based on a monoexponential fitting model with 2 b-values (b ϭ 0 and b ϭ 800 -1000 s/mm 2 ). [9][10][11]13 Mean ADC values are often calculated based on a single freehand ROI drawn over the largest axial tumor area, 14 or alternatively, they are based on elliptical…”

Diffusion-Weighted Imaging of Nasopharyngeal Carcinoma: Can Pretreatment DWI Predict Local Failure Based on Long-Term Outcome?

“…[17][18][19] It has been postulated that poor outcomes of some squamous cell carcinomas are due to tumor factors that are known to increase ADC values, such as micronecrosis, lower cellularity, and, more recently, negative human papillomavirus status and high stromal content. 3,[20][21] Of note, the ratio of stroma to tumor cells is recognized as an important determinant of outcome in head and neck squamous cell carcinoma. In regard to NPC, research now also shows that stroma-rich NPCs are associated with poor prognosis and an increased risk of relapse.…”