Relating pre-treatment non-Gaussian intravoxel incoherent motion diffusion-weighted imaging to human papillomavirus status and response in oropharyngeal carcinoma

Nienke D Sijtsema; Iris Lauwers; Gerda M Verduijn; Mischa S Hoogeman; Dirk H J Poot; Juan A Hernandez-Tamames; Aad van der Lugt; Marta E Capala; Steven F Petit

doi:10.1016/j.phro.2024.100574

Relating pre-treatment non-Gaussian intravoxel incoherent motion diffusion-weighted imaging to human papillomavirus status and response in oropharyngeal carcinoma

Phys Imaging Radiat Oncol. 2024 Apr 4:30:100574. doi: 10.1016/j.phro.2024.100574. eCollection 2024 Apr.

Authors

Affiliations

¹ Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
² Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
³ Department of Medical Physics and Informatics, HollandPTC, Delft, the Netherlands.

Abstract

Background and purpose: Diffusion-weighted imaging (DWI) is a promising technique for response assessment in head-and-neck cancer. Recently, we optimized Non-Gaussian Intravoxel Incoherent Motion Imaging (NG-IVIM), an extension of the conventional apparent diffusion coefficient (ADC) model, for the head and neck. In the current study, we describe the first application in a group of patients with human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma. The aim of this study was to relate ADC and NG-IVIM DWI parameters to HPV status and clinical treatment response.

Materials and methods: Thirty-six patients (18 HPV-positive, 18 HPV-negative) were prospectively included. Presence of progressive disease was scored within one year. The mean pre-treatment ADC and NG-IVIM parameters in the gross tumor volume were compared between HPV-positive and HPV-negative patients. In HPV-negative patients, ADC and NG-IVIM parameters were compared between patients with and without progressive disease.

Results: ADC, the NG-IVIM diffusion coefficient D, and perfusion fraction f were significantly higher, while pseudo-diffusion coefficient D* and kurtosis K were significantly lower in the HPV-negative compared to HPV-positive patients. In the HPV-negative group, a significantly lower D was found for patients with progressive disease compared to complete responders. No relation with ADC was observed.

Conclusion: The results of our single-center study suggest that ADC is related to HPV status, but not an independent response predictor. The NG-IVIM parameter D, however, was independently associated to response in the HPV-negative group. Noteworthy in the opposite direction as previously thought based on ADC.

Keywords: Diffusion-weighted imaging (DWI); Human papillomavirus (HPV); Intravoxel Incoherent Motion Diffusion Kurtosis Imaging (IVIM-DKI); Non-Gaussian Intravoxel Incoherent Motion Imaging (NG-IVIM); Oropharyngeal squamous cell carcinoma (OPSCC); Treatment response.