利用扩散加权成像（DWI）和动态对比增强磁共振成像（DCE-MRI）预测头颈部鳞状细胞癌患者的远处转移
Prediction of distant metastases in patients with squamous cell carcinoma of head and neck using DWI and DCE-MRI.
作者信息
Chawla Sanjeev, Kim Sungheon G, Loevner Laurie A, Wang Sumei, Mohan Suyash, Lin Alexander, Poptani Harish
机构信息
Department of Radiology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
出版信息
Head Neck. 2020 Nov;42(11):3295-3306. doi: 10.1002/hed.26386. Epub 2020 Aug 1.
BACKGROUND
The primary purpose was to evaluate the prognostic potential of diffusion imaging (DWI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in predicting distant metastases in squamous cell carcinoma of head and neck (HNSCC) patients. The secondary aim was to examine differences in DWI and DCE-MRI-derived parameters on the basis of human papilloma virus (HPV) status, differentiation grade, and nodal stage of HNSCC.
METHODS
Fifty-six patients underwent pretreatment DWI and DCE-MRI. Patients were divided into groups who subsequently did (n = 12) or did not develop distant metastases (n = 44). Median values of apparent diffusion coefficient (ADC), volume transfer constant (K ), and mean intracellular water-lifetime (τ ) and volume were computed from metastatic lymph nodes and were compared between two groups. Prognostic utility of HPV status, differentiation grading, and nodal staging was also evaluated both in isolation or in combination with MRI parameters in distinguishing patients with and without distant metastases. Additionally, MRI parameters were compared between two groups based on dichotomous HPV status, differentiation grade, and nodal stage.
RESULTS
Lower but not significantly different K (0.51 ± 0.15 minute vs 0.60 ± 0.05 minute ) and not significantly different τ (0.13 ± 0.03 second vs 0.19 ± 0.02 second) were observed in patients who developed distant metastases than those who did not. Additionally, no significant differences in ADC or volume were found. τ was the best parameter in discriminating two groups with moderate sensitivity (67%) and specificity (61.4%). Multivariate logistic regression analyses did not improve the overall prognostic performance for combination of all variables. A trend toward higher τ was observed in HPV-positive patients than those with HPV-negative patients. Also, a trend toward higher K was observed in poorly differentiated HNSCCs than those with moderately differentiated HNSCCs.
CONCLUSION
Pretreatment DCE-MRI may be useful in predicting distant metastases in HNSCC.
背景
主要目的是评估扩散成像（DWI）和动态对比增强磁共振成像（DCE-MRI）在预测头颈部鳞状细胞癌（HNSCC）患者远处转移方面的预后潜力。次要目的是根据人乳头瘤病毒（HPV）状态、分化程度和HNSCC的淋巴结分期，研究DWI和DCE-MRI衍生参数的差异。
方法
56例患者在治疗前接受了DWI和DCE-MRI检查。患者被分为随后发生（n = 12）或未发生远处转移（n = 44）的组。计算转移淋巴结的表观扩散系数（ADC）、容积转运常数（K）、平均细胞内水半衰期（τ）和体积的中位数，并在两组之间进行比较。还单独或结合MRI参数评估了HPV状态、分化分级和淋巴结分期在区分有或无远处转移患者中的预后效用。此外，根据二分法的HPV状态、分化程度和淋巴结分期，比较两组之间的MRI参数。
结果
发生远处转移的患者与未发生远处转移的患者相比，K较低但差异无统计学意义（0.51±0.15分钟对0.60±0.05分钟），τ差异无统计学意义（0.13±0.03秒对0.19±0.02秒）。此外，ADC或体积未发现显著差异。τ是区分两组的最佳参数，敏感性为中等（67%），特异性为（61.4%）。多变量逻辑回归分析并未改善所有变量组合的总体预后性能。HPV阳性患者的τ有高于HPV阴性患者的趋势。同样，低分化HNSCC患者的K有高于中分化HNSCC患者的趋势。
结论
治疗前DCE-MRI可能有助于预测HNSCC患者的远处转移。
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