Utility of pretreatment mean apparent diffusion coefficient and apparent diffusion coefficient histograms in prediction of outcome to chemoradiation in head and neck squamous cell carcinoma

J Comput Assist Tomogr. Jan-Feb 2012;36(1):131-7. doi: 10.1097/RCT.0b013e3182405435.


Purpose: This study aimed to evaluate pretreatment whole-tumor mean apparent diffusion coefficient (ADC) and ADC histogram as predictors of outcome to chemoradiation in patients with head and neck squamous cell carcinoma (HNSCC).

Materials and methods: Patients with HNSCC underwent pretreatment 3-T diffusion-weighted magnetic resonance imaging with calculation of mean ADC and ADC histograms. Outcomes were determined 2 years after chemoradiation. Positive outcome was defined as no abnormal 18-fluoro deoxy glucose uptake on posttherapy computed tomography-positron emission tomography (or abnormal uptake that was proven benign), no locoregional recurrence or metastatic disease, and no requirement for salvage surgery. Negative outcome was defined as residual abnormal 18-fluoro deoxy glucose avidity that was proven malignant, salvage surgery requirement, locoregional recurrence or metastatic disease, death, or a combination of these. A 2-sample t test was used to compare the mean ADC between patients with positive and negative outcomes. The ADC cut point for dividing the groups was determined by looking at its distribution. A Kaplan-Meier plot was produced, and a log-rank test was conducted with calculation of sensitivity, specificity, and positive and negative predictive values.

Results: Nine patients showed positive and 8 showed negative outcomes. Significant difference (P = 0.03) was seen in mean ADC (in 10 mm/s) between patients showing positive and negative outcomes (1.18 and 1.43, respectively). According to the log-rank test, tumors with greater than 45% of their volume below the ADC threshold of 1.15 × 10 mm/s were more likely to have a positive outcome (accuracy, 77%).

Conclusions: Patients with HNSCC demonstrating lower pretreatment ADC and with greater than 45% of volume below ADC threshold of 1.15 × 10 mm/s may have better outcome to chemoradiation at 2 years.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Cell Count
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Chemoradiotherapy*
  • Contrast Media
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Image Interpretation, Computer-Assisted
  • Liver Function Tests
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Positron-Emission Tomography
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Contrast Media