Clinical Research Papers:
Multiparametric imaging using 18F-FDG PET/CT heterogeneity parameters and functional MRI techniques: prognostic significance in patients with primary advanced oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiotherapy
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Sheng-Chieh Chan1,2,*, Nai-Ming Cheng2,3,*, Chia-Hsun Hsieh4, Shu-Hang Ng5,6, Chien-Yu Lin7, Tzu-Chen Yen2,3, Cheng-Lung Hsu4, Hung-Ming Wan4, Chun-Ta Liao8, Kai-Ping Chang8 and Jiun-Jie Wang6
1 Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
2 Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
3 Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
4 Department of Internal Medicine, Division of Medical Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
5 Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
6 Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
7 Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
8 Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
* These authors have contributed equally to this work
Shu-Hang Ng, email:
Jiun-Jie Wang, email:
Keywords: PET, heterogeneity, DCE-MRI, DWI, head and neck cancer
Received: July 22, 2016 Accepted: February 20, 2017 Published: March 04, 2017
Background: In this study, PET heterogeneity was combined with functional MRI techniques to refine the prediction of prognosis in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC). Methods: A total of 124 patients with primary advanced OHSCC who underwent pretreatment 18F-FDG PET/CT, dynamic contrast-enhanced MR imaging (DCE-MRI), and diffusion-weighted MR imaging (DWI) were enrolled. Conventional and heterogeneity parameters from 18F-FDG PET as well as perfusion parameters from DCE-MRI and diffusion parameter from DWI of primary tumors were analyzed in relation to recurrence-free survival (RFS) and overall survival (OS). Results: Multivariate analysis identified hypopharyngeal tumors (P = 0.038), alcohol drinking (P = 0.006), Ktrans ≤ 0.5512 (P = 0.017), and Kep ≤ 0.8872 (P = 0.005) as adverse prognostic factors for RFS. Smoking (p = 0.009), Ktrans ≤ 0.5512 (P = 0.0002), Kep ≤ 0.8872 (P = 0.004), and the PET heterogeneity parameter uniformity ≤ 0.00381 (P = 0.028) were independent predictors of poor OS. The combination of PET uniformity with DCE-MRI parameters and smoking allowed distinguishing four prognostic groups, with 3-year OS rates of 100%, 76.6%, 57.4%, and 7.1%, respectively (P < 0.0001). This prognostic system appeared superior to both the TNM staging system (P = 0.186) and the combination of conventional PET parameters with DCE-MRI (P = 0.004). Conclusions: Multiparametric imaging based on PET heterogeneity and DCE-MRI parameters combined with clinical risk factors is superior to the concomitant use of functional MRI coupled with conventional PET parameters. This approach may improve the prognostic stratification of OHSCC patients.
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