Korean J Radiol.  2019 Apr;20(4):649-661. 10.3348/kjr.2018.0446.

Diffusion-weighted Magnetic Resonance Imaging for Predicting Response to Chemoradiation Therapy for Head and Neck Squamous Cell Carcinoma: A Systematic Review

• Chung SR
• Choi YJ
• Suh CH
• Lee JH
• Baek JH

• KMID: 2440488
• DOI: http://doi.org/10.3348/kjr.2018.0446

Abstract

OBJECTIVE
To systematically review the evaluation of the diagnostic accuracy of pre-treatment apparent diffusion coefficient (ADC) and change in ADC during the intra- or post-treatment period, for the prediction of locoregional failure in patients with head and neck squamous cell carcinoma (HNSCC).
MATERIALS AND METHODS
Ovid-MEDLINE and Embase databases were searched up to September 8, 2018, for studies on the use of diffusion-weighted magnetic resonance imaging for the prediction of locoregional treatment response in patients with HNSCC treated with chemoradiation or radiation therapy. Risk of bias was assessed by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2.
RESULTS
Twelve studies were included in the systematic review, and diagnostic accuracy assessment was performed using seven studies. High pre-treatment ADC showed inconsistent results with the tendency for locoregional failure, whereas all studies evaluating changes in ADC showed consistent results of a lower rise in ADC in patients with locoregional failure compared to those with locoregional control. The sensitivities and specificities of pre-treatment ADC and change in ADC for predicting locoregional failure were relatively high (range: 50-100% and 79-96%, 75-100% and 69-95%, respectively). Meta-analytic pooling was not performed due to the apparent heterogeneity in these values.
CONCLUSION
High pre-treatment ADC and low rise in early intra-treatment or post-treatment ADC with chemoradiation, could be indicators of locoregional failure in patients with HNSCC. However, as the studies are few, heterogeneous, and at high risk for bias, the sensitivity and specificity of these parameters for predicting the treatment response are yet to be determined.

Keyword

Head and neck; Squamous cell carcinoma; Cancer; DWI; Diffusion-weighted imaging; Apparent diffusion coefficient; Prediction; Treatment response; Response assessment; Systematic review; Meta-analysis

MeSH Terms

Bias (Epidemiology)
Carcinoma, Squamous Cell*
Diffusion
Epithelial Cells*
Head*
Humans
Magnetic Resonance Imaging*
Neck*
Population Characteristics
Sensitivity and Specificity

Figure

• 

  Fig. 1 Flow diagram of study selection process.ADC = apparent diffusion coefficient

• 

  Fig. 2 QUADAS-2 criteria for included studies.QUADAS-2 = Quality Assessment of Diagnostic Accuracy Studies-2

• 

  Fig. 3 Forest plots of sensitivity and specificity of pre-treatment ADC for prediction of locoregional recurrence.Horizontal lines indicate 95% CIs of individual studies. CI = confidence interval, Ref = reference

• 

  Fig. 4 Forest plots of sensitivity and specificity of change in ADC for prediction of locoregional recurrence.Horizontal lines indicate 95% CIs of individual studies.

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