Article Figures & Data
Figures
- Fig 1.
Box plots for mean ADC, median ADC, excess kurtosis, and skewness from ROIs obtained in 105 tumors (84 HPV− HNSCC and 21 HPV+ HNSCC). Horizontal lines indicate median values (black lines). The bottom and the top of the box are the first and third quartiles whereas whiskers indicate maximum and minimum values. Outliers are indicated by circles.
- Fig 2.
A 59-year-old womam with HPV− HNSCC (T2N0M0). A, T2-weighted image reveals a left tonsillar tumor (arrow) with intermediate signal intensity. B, B1000 and C, gray-scale ADC map show restricted tumor diffusion (arrows). The freehand ROI contoured on the ADC map is visible as a blue line. D, On the color-coded ADC map (same level as C), tumor heterogeneity (purple and various shades of blue-green areas within the tumor) is more easily appreciated than in C. E, Histology (hematoxylin-eosin; original magnification, 200X) shows heterogeneous tumor matrix with areas of densely packed and loosely packed squamous cells of variable size. Variable amounts of keratin pearls (asterisk) and necrosis were present in this tumor. F, Immunohistochemistry for p16 (original magnification, 200X) is negative (ie, most cells show no brownish coloration).
- Fig 3.
A 60-year-old man with HPV+ HNSCC (T3N2M0). A, T2-weighted image reveals a left tonsillar tumor (long arrow) with intermediate signal intensity, parapharyngeal space invasion, and bilateral retropharyngeal lymph node metastases (short arrows). B, B1000 and C, gray-scale ADC map show restricted diffusion within the tonsillar tumor (long arrows) and within the lymph node metastases (short arrows). The freehand ROI contoured on the gray-scale ADC map is visible as a blue line. D, Color-coded ADC map (same level as C). Note that this tumor is less heterogeneous (mainly blue areas) than the tumor in Fig 1. E, Histology (hematoxylin-eosin; original magnification, 200×) shows homogeneous tumor consisting of clusters of densely packed, basaloid cells with scant cytoplasm, and without keratinization. Focal necrosis in the center of the tumor cell clusters (comedonecrosis) is present (asterisk). F, Immunohistochemistry for p16 is positive; more than 70% of tumor cells show strong cytoplasmic and nuclear staining indicating HPV positivity (original magnification, 200×). Polymerase chain reaction for HPV DNA further confirmed HPV positivity.
- Fig 4.
Characteristic histograms obtained in 2 different patients with HNSCC of the base of the tongue. Patient A (T4N2M0) has an HPV+ HNSCC (gray histogram) and patient B (T4N2M0) has an HPV− cancer (blue histogram). Red lines correspond to the median value of each histogram. Yellow lines correspond to the mean value of each histogram. Note that the histogram in the HPV− cancer (blue histogram) is symmetric with widely distributed ADC values around the central line (Gaussian distribution), whereas the histogram in the HPV+ HNSCC (gray histogram) shows asymmetric distribution of ADC values with a right thicker tail (right skew) and an elongated aspect (leptokurtic shape) because a larger proportion of voxel values are located in a narrow band. The mean ADC in HPV+ HNSCC is farther away from the median ADC value (distribution skewed to the right) than in the HPV− histogram.
Tables
Characteristics HPV− HNSCC (n = 84) HPV+ HNSCC (n = 21) P Valueb Average age (range), yr 65 (45–87) 61 (45–73) .15c Sex, no. (%) Women 23 (27) 7 (33) Men 61 (73) 14 (67) .79d Tumor location, no. (%) Oral cavity 50 (60) 3 (14) Oropharynx 34 (40) 18 (86) <.001d T classification according to AJCC 2017, no. (%)f T1 5 (6) 1 (5) T2 22 (26) 6 (29) T3 15 (18) 3 (14) T4 42 (50) 11 (52) 1e N classification according to AJCC 2017, no. (%) N0 36 (43) 4 (19) N1 13 (15) 6 (29) N2 35 (42) 9 (43) N3 0 (0) 2 (9) .012e M classification according to AJCC 2017, no. (%) M0 77 (92) 18 (86) M1 1 (1) 1 (5) Mx 6 (7) 2 (9) .47e Tumor keratinization, no. (%) Present 65 (77) 8 (38) Absent 19 (23) 13 (62) .001d Degree of keratinization, no. (%) Keratinizing 48 (57) 3 (14) Focally keratinizing 17 (20) 5 (24) <.001e Nonkeratinizing, no. (%) 19 (23) 13 (62) Histologic differentiation, no. (%) Well differentiated 15 (18) Not assessablef Moderately differentiated 48 (57) Poorly differentiated 21 (25) Semiquantitative histologic score, no. (%)g Score 1 (most heterogeneous) 14 (17) 0 (0) Score 2 8 (9) 0 (0) Score 3 41 (49) 7 (33) .002e Score 4 12 (14) 5 (24) Score 5 (most homogeneous) 9 (11) 9 (43) Mean proliferation index, MIB-1 (%)h 49 71 .005c Range in % 8–90 30–95 Note:—AJCC indicates American Joint Committee on Cancer.
↵a Total patients, 105.
↵b P values are indicated for the comparisons between HPV+ and HPV− HNSCCs.
↵c Wilcoxon rank sum test.
↵d Pearson χ2 test.
↵e Fisher test.
↵f HPV+ HNSCC was not graded according to AJCC 2017 guidelines.3
↵g The semiquantitative histologic score is described in On-line Table 1.
↵h Available in 95 histologic samples.
- Table 2:
Quantitative ADC parameters from histogram analysis of tumors in the oropharynx and oral cavity at 1.5T and 3T and for all tumors together irrespective of field strength (pooled data)
Histogram-Based ADC Parameters 1.5T (n = 45) 3T (n = 60) Pooled Data (n = 105) HPV− (n = 33) (mean ± SD) HPV+ (n = 12) (mean ± SD) P Valuea HPV− (n = 51) (mean ± SD) HPV+ (n = 9) (mean ± SD) P Valuea HPV− (n = 84) (mean ± SD) HPV+ (n = 21) (mean ± SD) P Valuea Mean ADC (× 10−6 mm2/s) 1158 ± 183 989 ± 188 .004 1201 ± 157 1046 ± 167 .02 1184 ± 168 1014 ± 178 <.001 Median ADC (×10−6 mm2/s) 1135 ± 193 936 ± 198 .003 1177 ± 162 1016 ± 170 .03 1161 ± 175 970 ± 187 <.001 Minimum ADC (× 10−6 mm2/s) 422 ± 251 379 ± 172 .36 441 ± 238 286 ± 207 .10 433 ± 242 339 ± 188 .09 25 Quartile (× 10−6 mm2/s) 977 ± 162 813 ± 172 .008 1004 ± 151 900 ± 165 .13 993 ± 155 850 ± 171 <.001 75 Quartile (× 10−6 mm2/s) 1318 ± 216 1115 ± 219 .003 1374 ± 183 1163 ± 180 .005 1352 ± 197 1136 ± 200 <.001 Interquartile range (× 10−6 mm2/s) 341 ± 111 302 ± 79 .33 371 ± 114 263 ± 68 .003 359 ± 113 285 ± 75 .003 Skewness 0.362 ± 0.647 1.012 ± 0.546 .004 0.424 ± 0.416 0.804 ± 0.461 .02 0.399 ± 0.516 0.923 ± 0.510 <.001 Excess kurtosis 0.841 ± 0.116 1.728 ± 1.250 .03 0.514 ± 0.872 2.207 ± 1.583 .001 0.643 ± 0.982 1.934 ± 1.386 <.001 ↵a P values (Wilcoxon rank sum test) are indicated for the comparisons between HPV+ and HPV− HNSCCs.
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