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. 2022 Aug 31;29(9):6303-6313.
doi: 10.3390/curroncol29090495.

Changes in Apparent Diffusion Coefficient (ADC) in Serial Weekly MRI during Radiotherapy in Patients with Head and Neck Cancer: Results from the PREDICT-HN Study

Sweet Ping Ng  1   2   3 , Carlos E Cardenas  4 , Houda Bahig  5 , Baher Elgohari  1   6 , Jihong Wang  4 , Jason M Johnson  7 , Amy C Moreno  1 , Shalin J Shah  1 , Adam S Garden  1 , Jack Phan  1 , G Brandon Gunn  1 , Steven J Frank  1 , Yao Ding  4 , Lumine Na  8 , Ying Yuan  9 , Diana Urbauer  9 , Abdallah S R Mohamed  1 , David I Rosenthal  1 , William H Morrison  1 , Michael P MacManus  3 , Clifton D Fuller  1
Affiliations

Changes in Apparent Diffusion Coefficient (ADC) in Serial Weekly MRI during Radiotherapy in Patients with Head and Neck Cancer: Results from the PREDICT-HN Study

Sweet Ping Ng et al. Curr Oncol. .

Abstract

Background: The PREDICT-HN study aimed to systematically assess the kinetics of imaging MR biomarkers during head and neck radiotherapy. Methods: Patients with intact squamous cell carcinoma of the head and neck were enrolled. Pre-, during, and post-treatment MRI were obtained. Serial GTV and ADC measurements were recorded. The correlation between each feature and the GTV was calculated using Spearman’s correlation coefficient. The linear mixed model was used to evaluate the change in GTV over time. Results: A total of 41 patients completed the study. The majority (76%) had oropharyngeal cancer. A total of 36 patients had intact primary tumours that can be assessed on MRI, and 31 patients had nodal disease with 46 nodes assessed. Median primary GTV (GTVp) size was 14.1cc. The rate of GTVp shrinkage was highest between pre-treatment and week 4. Patients with T3-T4 tumours had a 3.8-fold decrease in GTVp compared to T1-T2 tumours. The ADC values correlated with residual GTVp. The median nodal volume (GTVn) was 12.4cc. No clinical features were found to correlate with GTVn reduction. The overall change in ADC for GTVn from pre-treatment was significant for 35th−95th percentiles in weeks 1−4 (p < 0.001). Conclusion: A discrepancy in the trajectory of ADC between primary and nodal sites suggested that they exhibit different treatment responses and should be analysed separately in future studies.

Keywords: apparent diffusion coefficient; gross tumour volume; head and neck; radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Mean change in primary tumour (A) and total nodal volume, (B) and from pre-treatment volume to each timepoint with 95% confidence interval. Abbreviation: GTV—gross tumour volume.
Figure 2
Figure 2
Factors associated with primary tumour volume reduction from pre-treatment to post-treatment. * Ratio of the geometric mean was calculated by log-linear regression models. The GTV reduction was log-transformed in a linear regression model.
Figure 3
Figure 3
Absolute Apparent Diffusion Coefficient (ADC) measurements, (A) and mean ADC change from pre-treatment, (B) for the primary tumour, with 95% confidence intervals.
Figure 4
Figure 4
Average change in apparent diffusion coefficient (ADC) values for primary tumour adjusted for pre-treatment ADC.
Figure 5
Figure 5
Absolute apparent diffusion coefficient (ADC) measurements (A) and mean ADC change from pre-treatment (B) for the involved nodes, with 95% confidence intervals.
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