title: Diffusion-weighted EPI- and HASTE-MRI and 18F-FDG-PET-CT early during chemoradiotherapy in advanced head and neck cancer.
abstract: OBJECTIVE
  Diffusion-weighted MRI (DW-MRI) has potential to predict chemoradiotherapy (CRT) response in head and neck squamous cell carcinoma (HNSCC) and is generally performed using echo-planar imaging (EPI). However, EPI-DWI is susceptible to geometric distortions. Half-fourier acquisition single-shot turbo spin-echo (HASTE)-DWI may be an alternative. This prospective pilot study evaluates the potential predictive value of EPI- and HASTE-DWI and 18F-fluorodeoxyglucose PET-CT (18F-FDG-PET-CT) early during CRT for locoregional outcome in HNSCC.
  
  
  METHODS
  Eight patients with advanced HNSCC (7 primary tumors and 25 nodal metastases) scheduled for CRT, underwent DW-MRI (using both EPI- and HASTE-DWI) and 18F-FDG-PET(-CT) pretreatment, early during treatment and three months after treatment. Median follow-up time was 38 months.
  
  
  RESULTS
  No local recurrences were detected during follow-up. Median Apparent Diffusion Coefficient (ADC)EPI-values in primary tumors increased from 77×10(-5) mm(2)/s pretreatment, to 113×10(-5) mm(2)/s during treatment (P=0.02), whereas ADCHASTE did not increase (74 and 74 mm(2)/s, respectively). Two regional recurrences were diagnosed. During treatment, ADCEPI tended to be higher for patients with regional control [(117.3±12.1)×10(-5) mm(2)/s] than for patients with a recurrence [(98.0±4.2)×10(-5) mm(2)/s]. This difference was not seen with ADCHASTE. No correlations between ΔADCEPI and ΔSUV (Standardized Uptake Value) were found in the primary tumor or nodal metastases.
  
  
  CONCLUSIONS
  HASTE-DWI seems to be inadequate in early CRT response prediction, compared to EPI-DWI which has potential to predict locoregional outcome. EPI-DWI and 18F-FDG-PET-CT potentially provide independent information in the early response to treatment, since no correlations were found between ΔADCEPI and ΔSUV.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Charlotte S
authors.initials: CS
authors.lastname: Schouten
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Lisa
authors.initials: L
authors.lastname: van der Putten
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Noij
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Emile F I
authors.initials: EF
authors.lastname: Comans
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Birgit I
authors.initials: BI
authors.lastname: Witte
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Doornaert
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, 2 Department of Radiology and Nuclear Medicine, 3 Department of Epidemiology and Biostatistics, 4 Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Castelijns
keywords: Chemoradiotherapy (CRT); diffusion-weighted magnetic resonance imaging (DW-MRI); head and neck squamous cell carcinoma (HNSCC); positron emission tomography (PET); treatment response