Department of Radiology and Nuclear Medicine, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands.
Eur Radiol. 2021 Feb;31(2):616-628. doi: 10.1007/s00330-020-07163-3. Epub 2020 Aug 26.
To assess (I) correlations between diffusion-weighted (DWI), intravoxel incoherent motion (IVIM), dynamic contrast-enhanced (DCE) MRI, and F-FDG-PET/CT imaging parameters capturing tumor characteristics and (II) their predictive value of locoregional recurrence-free survival (LRFS) and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC) treated with (chemo)radiotherapy.
Between 2014 and 2018, patients with histopathologically proven HNSCC, planned for curative (chemo) radiotherapy, were prospectively included. Pretreatment clinical, anatomical, and functional imaging parameters (obtained by DWI/IVIM, DCE-MRI, and F-FDG-PET/CT) were extracted for primary tumors (PT) and lymph node metastases. Correlations and differences between parameters were assessed. The predictive value of LRFS and OS was assessed, performing univariable, multivariable Cox and CoxBoost regression analyses.
In total, 70 patients were included. Significant correlations between F-FDG-PET parameters and DWI-/DCE volume parameters were found (r > 0.442, p < 0.002). The combination of HPV (HR = 0.903), intoxications (HR = 1.065), PT ADC (HR = 1.252), K (HR = 1.223), and V (HR = 1.215) was predictive for LRFS (C-index = 0.546; p = 0.023). N-stage (HR = 1.058), HPV positivity (HR = 0.886), hypopharyngeal tumor location (HR = 1.111), ADC (HR = 1.102), ADC (HR = 1.137), D* (HR = 0.862), K (HR = 1.106), V (HR = 1.195), SUV (HR = 1.094), and TLG (HR = 1.433) were predictive for OS (C-index = 0.664; p = 0.046).
Functional imaging parameters, performing DWI/IVIM, DCE-MRI, and F-FDG-PET/CT, yielded complementary value in capturing tumor characteristics. More specific, intoxications, HPV-negative status, large tumor volume-related parameters, high permeability (K), and high extravascular extracellular space (V) parameters were predictive for adverse locoregional recurrence-free survival and adverse overall survival. Low cellularity (high ADC) and high metabolism (high SUV) were additionally predictive for decreased overall survival. These different predictive factors added to estimated locoregional and overall survival.
• Parameters of DWI/IVIM, DCE-MRI, and 18F-FDG-PET/CT were able to capture complementary tumor characteristics. • Multivariable analysis revealed that intoxications, HPV negativity, large tumor volume and high vascular permeability (K), and extravascular extracellular space (Ve) were complementary predictive for locoregional recurrence. • In addition to predictive parameters for locoregional recurrence, also high cellularity (low ADC) and high metabolism (high SUV) were complementary predictive for overall survival.
评估（I）扩散加权（DWI）、体素内不相干运动（IVIM）、动态对比增强（DCE）MRI 和 F-FDG-PET/CT 成像参数与肿瘤特征之间的相关性，以及（II）这些参数对接受（放）化疗的头颈部鳞状细胞癌（HNSCC）患者局部区域无复发生存率（LRFS）和总生存率（OS）的预测价值。
在 2014 年至 2018 年间，前瞻性纳入了经组织病理学证实的 HNSCC 患者，计划进行根治性（放）化疗。为原发肿瘤（PT）和淋巴结转移提取预处理的临床、解剖和功能成像参数（通过 DWI/IVIM、DCE-MRI 和 F-FDG-PET/CT 获得）。评估参数之间的相关性和差异。通过单变量、多变量 Cox 和 CoxBoost 回归分析评估 LRFS 和 OS 的预测价值。
共纳入 70 例患者。发现 F-FDG-PET 参数与 DWI-/DCE 体积参数之间存在显著相关性（r＞0.442，p＜0.002）。HPV（HR=0.903）、中毒（HR=1.065）、PT ADC（HR=1.252）、K（HR=1.223）和 V（HR=1.215）的组合对 LRFS 具有预测价值（C 指数=0.546；p=0.023）。N 分期（HR=1.058）、HPV 阳性（HR=0.886）、咽下部肿瘤位置（HR=1.111）、ADC（HR=1.102）、ADC（HR=1.137）、D*（HR=0.862）、K（HR=1.106）、V（HR=1.195）、SUV（HR=1.094）和 TLG（HR=1.433）对 OS 具有预测价值（C 指数=0.664；p=0.046）。
进行 DWI/IVIM、DCE-MRI 和 F-FDG-PET/CT 的功能成像参数在捕获肿瘤特征方面具有互补价值。更具体地说，中毒、HPV 阴性状态、与大肿瘤体积相关的参数、高通透性（K）和高细胞外间隙（V）参数与不良局部区域无复发生存和不良总生存相关。低细胞密度（高 ADC）和高代谢（高 SUV）还与降低总生存率相关。这些不同的预测因素增加了对局部区域和总体生存率的估计。
DWI/IVIM、DCE-MRI 和 18F-FDG-PET/CT 的参数能够捕捉互补的肿瘤特征。
多变量分析显示，中毒、HPV 阴性、大肿瘤体积和高血管通透性（K）和细胞外间隙（Ve）是局部区域复发的互补预测因素。
除了局部区域复发的预测因素外，高细胞密度（低 ADC）和高代谢（高 SUV）也是总生存率的互补预测因素。
