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Prognostic role of diffusion weighted and dynamic contrast-enhanced MRI in loco-regionally advanced head and neck cancer treated with concomitant chemoradiotherapy

Manca Garbajs
Manca Garbajs
, 
Primoz Strojan
Primoz Strojan
 and 
Katarina Surlan-Popovic
Katarina Surlan-Popovic
   | Mar 03, 2019
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Article Category: Research Article
Published Online: Mar 03, 2019
Page range: 39 - 48
Received: Jan 23, 2019
Accepted: Feb 04, 2019
DOI: https://doi.org/10.2478/raon-2019-0010
© 2019 Manca Garbajs, Primoz Strojan, Katarina Surlan-Popovic, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

58 year old patient with oropharyngeal squamous cell carcinoma (T4a N2b) who was alive at the end of follow up with overall survival of 41.1 months. Axial post-contrast T1 images, co-registred and corresponding apparent diffusion coefficient (ADC) maps and color-coded dynamic contrast-enhanced MRI derived volume transfer constant (Ktrans), extracellular extravascular fraction (Ve) and plasma volume fraction (Vp) maps in the area of the tumour (arrows) are shown. Top: before treatment; bottom: after 10 Gray of chemo-radiotherapy.
58 year old patient with oropharyngeal squamous cell carcinoma (T4a N2b) who was alive at the end of follow up with overall survival of 41.1 months. Axial post-contrast T1 images, co-registred and corresponding apparent diffusion coefficient (ADC) maps and color-coded dynamic contrast-enhanced MRI derived volume transfer constant (Ktrans), extracellular extravascular fraction (Ve) and plasma volume fraction (Vp) maps in the area of the tumour (arrows) are shown. Top: before treatment; bottom: after 10 Gray of chemo-radiotherapy.

Figure 2

65 year old patient with hypopharyngeal squamous cell carcinoma (T2 N2) who died 14 months of starting of chemo-radiotherapy due to disease relaps into the lungs. Axial post-contrast T1 images, co-registred and corresponding apparent diffusion coefficient (ADC) maps and color-coded dynamic contrast-enhanced MRI derived volume transfer constant (Ktrans), extracellular extravascular fraction (Ve) and plasma volume fraction (Vp) maps in the area of the tumour (arrows) are shown. Top: before treatment; bottom: after 10 Gray of chemo-radiotherapy.
65 year old patient with hypopharyngeal squamous cell carcinoma (T2 N2) who died 14 months of starting of chemo-radiotherapy due to disease relaps into the lungs. Axial post-contrast T1 images, co-registred and corresponding apparent diffusion coefficient (ADC) maps and color-coded dynamic contrast-enhanced MRI derived volume transfer constant (Ktrans), extracellular extravascular fraction (Ve) and plasma volume fraction (Vp) maps in the area of the tumour (arrows) are shown. Top: before treatment; bottom: after 10 Gray of chemo-radiotherapy.

Figure 3

Receiver operating characteristic (ROC) curves for dynamic contrast-enhanced MRI (DCE-MRI) derived parameter Ktrans (volume transfer constant) exhibiting area under ROC curve (AUC) of 0.95 with sensitivity 93.3% and specificity 80%. (p = 0.003).
Receiver operating characteristic (ROC) curves for dynamic contrast-enhanced MRI (DCE-MRI) derived parameter Ktrans (volume transfer constant) exhibiting area under ROC curve (AUC) of 0.95 with sensitivity 93.3% and specificity 80%. (p = 0.003).

Figure 4

Kaplan-Meier estimates of overall survival in HNSCC patients (20) stratified according to pre-treatement DCE-MRI derived parameter Ktrans (cutt-off value of ≥ 0.29 min-1, determined at ROC curve analysis).DCE-MRI = dynamic contrast-enhanced MRI; Ktrans = volume transfer constant; ROC = receiver operating curve
Kaplan-Meier estimates of overall survival in HNSCC patients (20) stratified according to pre-treatement DCE-MRI derived parameter Ktrans (cutt-off value of ≥ 0.29 min-1, determined at ROC curve analysis).DCE-MRI = dynamic contrast-enhanced MRI; Ktrans = volume transfer constant; ROC = receiver operating curve

Absolute values of DWI and DCE-MRI derived parameters and tumour volumes before treatment and their relative changes after 10 Gy (expressed as median and range) for the entire cohort of the patients and separately for alive and deceased patients at the end of follow-up

Parameters The entire cohort of patients (n = 20, 100%) Patients still alive at the end of follow-up (n = 15; 75%) Deceased patients at the end of follow-up (n = 5; 25%)
Pre-treatment values
ADC (x 10-3 mm2/s) 0.81 (0.62–1.07) 0.76 (0.62–0.91) 0.96 (0.76–1.07)
Ktrans (min-1) 0.48 (0.13–0.79) 0.57 (0.23–0.79) 0.22 (0.13–0.35)
Ve 0.32 (0.15–0.64) 0.32 (0.17–0.64) 0.22 (0.15–0.37)
Vp 0.17 (0.06–0.43) 0.15 (0.07–0.43) 0.35 (0.06–0.41)
Tumour volume (ml) 10.5 (2.6–54.9 ). 8.8 (2.6–44.55) 18.21 (6.6–54.9)
Relative changes after 10 Gy
ΔADC 22.5% (1.7 to 52.4%) 25.0 (4.7 to 51.4) 9.2 (1.7 to 52.4)
ΔKtrans -50.3% (-93.4 to 179.2%) -60.0 (-93.0 to -43.2) 4.2 (-37.1 to 179.2)
ΔVe -35.2% (-88.9 to 126.8%) -40.0 (-88.9 to 65.4) -14.7 (-40. to 126.8)
ΔVp 70% (73.2 to 357.14%) 92.9 (-18.6 to 357.2) 10.0 (-73.2 to 100)
ΔTumour volume (-15.0%; -76.3 to 254.6%); -14.0 (-76.3 to 254.6) -19.6 (-37.7 to 114.72)

The baseline clinical characteristics of all the patients

Patient Sex Age (yrs) Tumour location TNM Stage
1 M 53 Oropharynx T4aN1 IVA
2 M 67 Hypopharynx T3N1 III
3 M 66 Hypopharynx T3N2b IVA
4 M 56 Oropharynx T3N2b IVA
5 M 49 Oropharynx T2N2b IVA
6 M 57 Oropharynx T4aN2c IVA
7 M 59 Hypopharynx T4aN2b IVA
8 M 60 Oropharynx T3N2b IVA
9 M 58 Oropharynx T4aN2b IVA
10 M 53 Oropharynx T4aN2c IVA
11 M 64 Oropharynx T3N2c IVA
12 M 56 Hypopharynx T3N2b IVA
13 M 65 Oropharynx T2N2b IVA
14 M 53 Hypopharynx T4aN2c IVA
15 M 66 Oropharynx T3N2b IVA
16 M 65 Oropharynx T3N2a IVA
17 M 46 Oropharynx T3N3 IVB
18 M 67 Hypopharynx T3N1 III
19 F 58 Oropharynx T3N1 III
20 M 48 Hypopharynx T3N1 III

Univariate analysis of risk factors associated with disease-free survival and overall survival rates (n = 20)

Parameters Disease-free survival (p value) Overall survival (p value)
Clinical parameters
Age 0.338 0.556
Tumour location 0.396 0.752
Stage 1.000 0.198
Pre-treatment values of functional parameters and tumour volume
ADC (x 10-3 mm2/s) 0.856 0.012*
Ktrans (min-1) 0.116 0.026*
Ve 0.754 0.293
Vp 0.165 0.342
Tumour volume 0.959 0.048*
Relative changes after 10 Gy of functional parameters and tumour volume
ΔADC (%) 0.740 0.061
ΔKtrans 0.688 0.014*
ΔVe 0.957 0.405
ΔVp 0.672 0.077
ΔTumour volume (ml) 0.495 0.486
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