title: Tumor metabolism and perfusion in head and neck squamous cell carcinoma: pretreatment multimodality imaging with 1H magnetic resonance spectroscopy, dynamic contrast-enhanced MRI, and [18F]FDG-PET.
abstract: OBJECTIVE
  To correlate proton magnetic resonance spectroscopy ((1)H-MRS), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and (18)F-labeled fluorodeoxyglucose positron emission tomography ([(18)F]FDG PET) of nodal metastases in patients with head and neck squamous cell carcinoma (HNSCC) for assessment of tumor biology. Additionally, pretreatment multimodality imaging was evaluated for its efficacy in predicting short-term response to treatment.
  
  
  METHODS
  Metastatic neck nodes were imaged with (1)H-MRS, DCE-MRI, and [(18)F]FDG PET in 16 patients with newly diagnosed HNSCC, before treatment. Short-term patient radiological response was evaluated at 3 to 4 months. Correlations among (1)H-MRS (choline concentration relative to water [Cho/W]), DCE-MRI (volume transfer constant [K(trans)]; volume fraction of the extravascular extracellular space [v(e)]; and redistribution rate constant [k(ep)]), and [(18)F]FDG PET (standard uptake value [SUV] and total lesion glycolysis [TLG]) were calculated using nonparametric Spearman rank correlation. To predict short-term responses, logistic regression analysis was performed.
  
  
  RESULTS
  A significant positive correlation was found between Cho/W and TLG (ρ = 0.599; p = 0.031). Cho/W correlated negatively with heterogeneity measures of standard deviation std(v(e)) (ρ = -0.691; p = 0.004) and std(k(ep)) (ρ = -0.704; p = 0.003). Maximum SUV (SUVmax) values correlated strongly with MRI tumor volume (ρ = 0.643; p = 0.007). Logistic regression indicated that std(K(trans)) and SUVmean were significant predictors of short-term response (p < 0.07).
  
  
  CONCLUSIONS
  Pretreatment multimodality imaging using (1)H-MRS, DCE-MRI, and [(18)F]FDG PET is feasible in HNSCC patients with nodal metastases. Additionally, combined DCE-MRI and [(18)F]FDG PET parameters were predictive of short-term response to treatment.
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Jacobus F A
authors.initials: JF
authors.lastname: Jansen
authors.forename: Heiko
authors.initials: H
authors.lastname: Schöder
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
authors.forename: Hilda E
authors.initials: HE
authors.lastname: Stambuk
authors.forename: Ya
authors.initials: Y
authors.lastname: Wang
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Fury
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: David G
authors.initials: DG
authors.lastname: Pfister
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Jason A
authors.initials: JA
authors.lastname: Koutcher
authors.forename: Amita
authors.initials: A
authors.lastname: Shukla-Dave
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000068258:Bevacizumab; D002294:Carcinoma, Squamous Cell / Q000378:metabolism* / Q000556:secondary / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D002794:Choline / Q000378:metabolism; D002945:Cisplatin / Q000627:therapeutic use; D003287:Contrast Media; D003952:Diagnostic Imaging / Q000379:methods*; D005110:Extracellular Space / Q000378:metabolism; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D005472:Fluorouracil / Q000627:therapeutic use; D019786:Gadolinium DTPA; D005947:Glucose / Q000378:metabolism; D006019:Glycolysis; D006258:Head and Neck Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D014062:Tongue Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D014067:Tonsillar Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000068258:Bevacizumab; D005947:Glucose; D019786:Gadolinium DTPA; D002794:Choline; D002945:Cisplatin; D005472:Fluorouracil