title: Head and neck squamous cell carcinoma: diagnostic performance of diffusion-weighted MR imaging for the prediction of treatment response.
abstract: OBJECTIVE
  To determine the diagnostic performance of diffusion-weighted (DW) imaging for the prediction of treatment failure in primary head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  The study was approved by the local institutional ethics committee and conducted with informed written consent in patients with primary HNSCC treated with radiation therapy and chemotherapy. DW imaging of the primary tumor was performed before treatment in 37 patients and was repeated within 2 weeks of treatment in 30 patients. Histograms of apparent diffusion coefficients (ADCs) were analyzed, and mean ADC, kurtosis, skewness, and their respective percentage change were correlated for local failure and local control at 2 years by using the Student t test. Univariate and multivariate analyses of the ADC parameters, T stage, and tumor volume were performed by using logistic regression for prediction of local failure.
  
  
  RESULTS
  Local failure occurred in 16 of 37 (43%) patients and local control occurred in 21 of 37 (57%) patients. Pretreatment ADC parameters showed no correlation with local failure. There was significant intratreatment increase in mean ADC and a decrease in skewness and kurtosis (P < .001, P < .001, P = .024, respectively) for the whole group of patients when compared with those before treatment. During treatment, primary tumors showed a significantly lower increase in percentage change of mean ADC, higher skewness, and higher kurtosis for local failure than for local control (P = .016, .015, and .040, respectively). These ADC parameters also were significant for predicting local failure with use of univariate but not multivariate analysis.
  
  
  CONCLUSIONS
  Early intratreatment DW imaging has the potential to allow prediction of treatment response at the primary site in patients with HNSCC.
authors.affiliation: Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngai Shing Street, Shatin, New Territories, Hong Kong SAR, China. king2015@cuhk.edu.hk
authors.forename: Ann D
authors.initials: AD
authors.lastname: King
authors.forename: Kwok-Keung
authors.initials: KK
authors.lastname: Chow
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Yu
authors.forename: Frankie Kwok Fai
authors.initials: FK
authors.lastname: Mo
authors.forename: David K W
authors.initials: DK
authors.lastname: Yeung
authors.forename: Jing
authors.initials: J
authors.lastname: Yuan
authors.forename: Kunwar S
authors.initials: KS
authors.lastname: Bhatia
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Vlantis
authors.forename: Anil T
authors.initials: AT
authors.lastname: Ahuja
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D016896:Treatment Outcome