From the Division of Radiology, Department of Imaging and Medical Informatics (T.d.P., V.L., M.D.A., M.B.).
Division of Head and Neck Surgery, Department of Clinical Neurosciences (N.D.).
AJNR Am J Neuroradiol. 2017 Nov;38(11):2153-2160. doi: 10.3174/ajnr.A5370. Epub 2017 Sep 14.
Head and neck squamous cell carcinoma associated with human papillomavirus infection represents a distinct tumor entity. We hypothesized that diffusion phenotypes based on the histogram analysis of ADC values reflect distinct degrees of tumor heterogeneity in human papillomavirus-positive and human papillomavirus-negative head and neck squamous cell carcinomas.
One hundred five consecutive patients (mean age, 64 years; range, 45-87 years) with primary oropharyngeal ( = 52) and oral cavity ( = 53) head and neck squamous cell carcinoma underwent MR imaging with anatomic and diffusion-weighted sequences ( = 0, = 1000 s/mm, monoexponential ADC calculation). The collected tumor voxels from the contoured ROIs provided histograms from which position, dispersion, and form parameters were computed. Histogram data were correlated with histopathology, p16-immunohistochemistry, and polymerase chain reaction for human papillomavirus DNA.
There were 21 human papillomavirus-positive and 84 human papillomavirus-negative head and neck squamous cell carcinomas. At histopathology, human papillomavirus-positive cancers were more often nonkeratinizing (13/21, 62%) than human papillomavirus-negative cancers (19/84, 23%; = .001), and their mitotic index was higher (71% versus 49%; = .005). ROI-based mean and median ADCs were significantly lower in human papillomavirus-positive (1014 ± 178 × 10 mm/s and 970 ± 187 × 10 mm/s, respectively) than in human papillomavirus-negative tumors (1184 ± 168 × 10 mm/s and 1161 ± 175 × 10 mm/s, respectively; < .001), whereas excess kurtosis and skewness were significantly higher in human papillomavirus-positive (1.934 ± 1.386 and 0.923 ± 0.510, respectively) than in human papillomavirus-negative tumors (0.643 ± 0.982 and 0.399 ± 0.516, respectively; < .001). Human papillomavirus-negative head and neck squamous cell carcinoma had symmetric normally distributed ADC histograms, which corresponded histologically to heterogeneous tumors with variable cellularity, high stromal component, keratin pearls, and necrosis. Human papillomavirus-positive head and neck squamous cell carcinomas had leptokurtic skewed right histograms, which corresponded to homogeneous tumors with back-to-back densely packed cells, scant stromal component, and scattered comedonecrosis.
Diffusion phenotypes of human papillomavirus-positive and human papillomavirus-negative head and neck squamous cell carcinomas show significant differences, which reflect their distinct degree of tumor heterogeneity.
与人乳头瘤病毒感染相关的头颈部鳞状细胞癌是一种独特的肿瘤实体。我们假设，基于 ADC 值直方图分析的扩散表现反映了人乳头瘤病毒阳性和人乳头瘤病毒阴性头颈部鳞状细胞癌中不同程度的肿瘤异质性。
105 例连续的原发性口咽（n = 52）和口腔（n = 53）头颈部鳞状细胞癌患者接受了 MRI 检查，包括解剖和扩散加权序列（b 值为 0、1000 s/mm2，单指数 ADC 计算）。从勾画的 ROI 中采集肿瘤体素，生成直方图，从中计算位置、分散度和形态参数。直方图数据与组织病理学、p16-免疫组织化学和人乳头瘤病毒 DNA 的聚合酶链反应相关联。
有 21 例人乳头瘤病毒阳性和 84 例人乳头瘤病毒阴性头颈部鳞状细胞癌。在组织病理学上，人乳头瘤病毒阳性的癌症更常为非角化型（13/21，62%），而非人乳头瘤病毒阴性的癌症为角化型（19/84，23%； =.001），且其有丝分裂指数更高（71%比 49%； =.005）。人乳头瘤病毒阳性肿瘤的基于 ROI 的平均 ADC 值（1014 ± 178×10mm/s）和中位数 ADC 值（970 ± 187×10mm/s）均显著低于人乳头瘤病毒阴性肿瘤（1184 ± 168×10mm/s 和 1161 ± 175×10mm/s； <.001），而人乳头瘤病毒阳性肿瘤的峰度和偏度值显著更高（1.934 ± 1.386 和 0.923 ± 0.510），而非人乳头瘤病毒阴性肿瘤的峰度和偏度值显著更低（0.643 ± 0.982 和 0.399 ± 0.516； <.001）。人乳头瘤病毒阴性的头颈部鳞状细胞癌的 ADC 直方图具有对称的正态分布，其对应于组织学上具有不同细胞密度、高基质成分、角化珠和坏死的异质性肿瘤。人乳头瘤病毒阳性的头颈部鳞状细胞癌的 ADC 直方图呈偏态右偏的尖峰分布，对应于具有细胞紧密堆积、间质成分稀少、散在的粉刺样坏死的均质性肿瘤。
人乳头瘤病毒阳性和人乳头瘤病毒阴性头颈部鳞状细胞癌的扩散表现存在显著差异，反映了其不同程度的肿瘤异质性。
