• Ramesh Paudyal, Jung Hun Oh, Nadeem Riaz, Praveen Venigalla, Jingao Li, Vaios Hatzoglou, Jonathan Leeman, David Aramburu Nunez, Yonggang Lu, Joseph O Deasy, Nancy Lee, and Amita Shukla-Dave.
• Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
• J Magn Reson Imaging. 2017 Apr 1; 45 (4): 1013-1023.

PurposeCharacterize and monitor treatment response in human papillomavirus (HPV) head and neck squamous cell carcinoma (HNSCC) using intra-treatment (intra-TX) imaging metrics derived from intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (DW-MRI).Materials And MethodsThirty-four (30 HPV positive [+] and 4 HPV negative [-]) HNSCC patients underwent a total of 136 MRI including multi-b value DW-MRI (pretreatment [pre-TX] and intra-TX weeks 1, 2, and 3) at 3.0 Tesla. All patients were treated with chemo-radiation therapy. Monoexponential (yielding apparent diffusion coefficient [ADC]) and bi-exponential (yielding perfusion fraction [f], diffusion [D], and pseudo-diffusion [D*] coefficients) fits were performed on a region of interest and voxel-by-voxel basis, on metastatic neck nodes. Response was assessed using RECISTv1.1. The relative percentage change in D, f, and D* between the pre- and intra-TX weeks were used for hierarchical clustering. A Wilcoxon rank-sum test was performed to assess the difference in metrics within and between the complete response (CR) and non-CR groups.ResultsThe delta (Δ) change in volume (V)1wk-0wk for the CR group differed significantly (P = 0.016) from the non-CR group, while not for V2wk-0wk and V3wk-0wk (P > 0.05). The mean increase in ΔD3wk-0wk for the CR group was significantly higher (P = 0.017) than the non-CR group. ADC and D showed an increasing trend at each intra-TX week when compared with pre-TX in CR group (P < 0.003). Hierarchical clustering demonstrated the existence of clusters in HPV + patients.ConclusionAfter appropriate validation in a larger population, these IVIM imaging metrics may be useful for individualized treatment in HNSCC patients.Level Of Evidence2 J. Magn. Reson. Imaging 2017;45:1013-1023.© 2016 The Authors Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.

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