Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV

Eur J Nucl Med Mol Imaging. 2013 Jun;40(6):842-52. doi: 10.1007/s00259-013-2351-9. Epub 2013 Feb 22.


Purpose: Head and neck squamous cell carcinoma (HNSCC) may cause a decreased apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DW MRI) and an increased standardized uptake value (SUV) on fluorodeoxyglucose (FDG) positron emission tomography (PET/CT). We analysed the reproducibility of ADC and SUV measurements in HNSCC and evaluated whether these biomarkers are correlated or independent.

Methods: This retrospective analysis of DW MRI and FDG PET/CT data series included 34 HNSCC in 33 consecutive patients. Two experienced readers measured tumour ADC and SUV values independently. Statistical comparison and correlation with histopathology was done. Intra- and inter-observer agreement for ADC and SUV measurements was assessed.

Results: Intraclass correlation coefficient (ICC) analysis showed almost perfect reproducibility (>0.90) for ADCmean, ADCmin, SUVmax and SUVmean values for intra-observer and inter-observer agreement. Mean ADCmean and ADCmin in HNSCC were 1.05 ± 0.34 × 10(-3) mm(2)/s and 0.65 ± 0.29 × 10(-3) mm(2)/s, respectively. Mean SUVmean and mean SUVmax were 7.61 ± 3.87 and 12.8 ± 5.0, respectively. Although statistically not significant, a trend towards higher SUV and lower ADC was observed with increasing tumour dedifferentiation. Pearson's correlation analysis showed no significant correlation between ADC and SUV measurements (r -0.103, -0.051; p 0.552, 0.777).

Conclusion: Our data suggest that ADC and SUV values are reproducible and independent biomarkers in HNSCC.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biomarkers, Tumor / metabolism
  • Carcinoma, Squamous Cell / diagnosis*
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / pathology
  • Cell Differentiation
  • Diffusion Magnetic Resonance Imaging*
  • Female
  • Fluorodeoxyglucose F18 / pharmacology*
  • Head and Neck Neoplasms / diagnosis*
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / pathology
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Multimodal Imaging*
  • Observer Variation
  • Radionuclide Imaging
  • Recurrence
  • Reproducibility of Results
  • Retrospective Studies
  • Young Adult


  • Biomarkers, Tumor
  • Fluorodeoxyglucose F18