Tumor Metabolism and Perfusion in Head and Neck Squamous Cell Carcinoma: Pretreatment Multimodality Imaging With 1H Magnetic Resonance Spectroscopy, Dynamic Contrast-Enhanced MRI, and [ 18F]FDG-PET

To correlate proton magnetic resonance spectroscopy ( 1H-MRS), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and 18F-labeled fluorodeoxyglucose positron emission tomography ([ 18F]FDG PET) of nodal metastases in patients with head and neck squamous cell carcinoma (HNSCC) for assessment of tumor biology. Additionally, pretreatment multimodality imaging was evaluated for its efficacy in predicting short-term response to treatment. Metastatic neck nodes were imaged with 1H-MRS, DCE-MRI, and [ 18F]FDG PET in 16 patients with newly diagnosed HNSCC, before treatment. Short-term patient radiological response was evaluated at 3 to 4 months. Correlations among 1H-MRS (choline concentration relative to water [Cho/W]), DCE-MRI (volume transfer constant [ K trans]; volume fraction of the extravascular extracellular space [ v e]; and redistribution rate constant [ k ep]), and [ 18F]FDG PET (standard uptake value [SUV] and total lesion glycolysis [TLG]) were calculated using nonparametric Spearman rank correlation. To predict short-term responses, logistic regression analysis was performed. A significant positive correlation was found between Cho/W and TLG (ρ = 0.599; p = 0.031). Cho/W correlated negatively with heterogeneity measures of standard deviation std( v e) (ρ = −0.691; p = 0.004) and std( k ep) (ρ = −0.704; p = 0.003). Maximum SUV (SUVmax) values correlated strongly with MRI tumor volume (ρ = 0.643; p = 0.007). Logistic regression indicated that std( K trans) and SUVmean were significant predictors of short-term response ( p < 0.07). Pretreatment multimodality imaging using 1H-MRS, DCE-MRI, and [ 18F]FDG PET is feasible in HNSCC patients with nodal metastases. Additionally, combined DCE-MRI and [ 18F]FDG PET parameters were predictive of short-term response to treatment.