Prediction of distant metastases in patients with squamous cell carcinoma of head and neck using DWI and DCE-MRI.

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.