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. 2011 Oct;18(10):1225-32.
doi: 10.1016/j.acra.2011.06.009. Epub 2011 Aug 10.

Diffusion weighted imaging in predicting progression free survival in patients with squamous cell carcinomas of the head and neck treated with induction chemotherapy

Su Berrak  1 , Sanjeev Chawla, Sungheon Kim, Harry Quon, Eric Sherman, Laurie A Loevner, Harish Poptani
Affiliations

Diffusion weighted imaging in predicting progression free survival in patients with squamous cell carcinomas of the head and neck treated with induction chemotherapy

Su Berrak et al. Acad Radiol. 2011 Oct.

Abstract

Rationale and objectives: The aim of this study was to assess the role of diffusion-weighted imaging in predicting progression-free survival in patients with head and neck squamous cell carcinoma (HNSCC) treated with induction chemotherapy.

Materials and methods: Eighteen patients with HNSCC underwent diffusion-weighted imaging studies prior to treatment and within 3 weeks after completion of induction chemotherapy. Median apparent diffusion coefficient (ADC) values were computed from the largest cervical metastatic lymph node. Percentage changes in ADC values from pretreatment to posttreatment time points were compared between alive and dead patients using the Mann-Whitney U test. P values < .05 were considered statistically significant.

Results: A 22% increase in ADC was observed after induction chemotherapy in alive patients (n = 15), while patients who died from HNSCC (n = 3) demonstrated a 33% decrease in ADC. The difference in percentage change in ADC between alive and dead patients was significant (P = .039).

Conclusions: ADC may be a useful marker in predicting progression-free survival in patients with HNSCC undergoing induction chemotherapy.

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Figures

Figure 1
Figure 1
Representative images of a patient who presented ≥50% nodal volume reduction after the end of induction chemotherapy and showed positive response at 6 months follow-up period as well as at the at last date of clinical follow-up. Axial T2 weighted image (a) demonstrating a hyper-intense metastatic cervical lymph node at level IIa of left neck which was studied (arrow). This mass exhibits heterogeneous contrast enhancement on post contrast T1weighted image (b) and low ADC on corresponding ADC map (c) at pretreatment time point. Axial T2 weighted (d) and post-contrast T1 weighted images (e) demonstrate reduction in the nodal volume (arrow) following induction chemotherapy and ADC map (f) demonstrates an increase in ADC compared to pretreatment time point from this node.
Figure 2
Figure 2
Box and whisker plots demonstrating variations in % change in ADC (a), T2 (b), and volume (c), from metastatic cervical lymph node of alive and dead patients. Significantly increased % change in ADC values from alive patients was observed compared to dead patients (p=0.039). * indicates significant change (p<0.05). Boxes represent the median, the 25th and the 75th percentiles, while bars indicate the range of data distribution.
Figure 2
Figure 2
Box and whisker plots demonstrating variations in % change in ADC (a), T2 (b), and volume (c), from metastatic cervical lymph node of alive and dead patients. Significantly increased % change in ADC values from alive patients was observed compared to dead patients (p=0.039). * indicates significant change (p<0.05). Boxes represent the median, the 25th and the 75th percentiles, while bars indicate the range of data distribution.
Figure 2
Figure 2
Box and whisker plots demonstrating variations in % change in ADC (a), T2 (b), and volume (c), from metastatic cervical lymph node of alive and dead patients. Significantly increased % change in ADC values from alive patients was observed compared to dead patients (p=0.039). * indicates significant change (p<0.05). Boxes represent the median, the 25th and the 75th percentiles, while bars indicate the range of data distribution.
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