Using diffusion-relaxation correlation spectroscopic imaging to assess the heterogeneity of head and neck tumors and identify occult lymph node metastasis

doi:10.3969/j.issn.1674-8115.2025.09.012

Abstract

Abstract:

Objective ·To evaluate the feasibility and diagnostic performance of diffusion-relaxation correlation spectroscopic imaging (DR-CSI) in assessing the heterogeneity of benign and malignant head and neck tumors, as well as in identifying occult lymph node metastasis (OLNM). Methods ·A prospective study was conducted from January to December 2024 at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, enrolling patients with suspected head and neck tumors who were scheduled for surgery and had a confirmed pathological diagnosis. All patients underwent preoperative routine head and neck plain and contrast-enhanced magnetic resonance imaging (MRI) examinations, including DR-CSI sequence. Conventional imaging parameters, including maximal diameter (MD), depth of invasion (DOI) for tumors, and MD and short diameter (SD) for lymph nodes, were obtained. Post-processing was performed to obtain apparent diffusion coefficient (ADC), T2 value, and D-T2 spectra for all lesions. The compartment segmentation strategy was optimized based on the spectral peak distribution characteristics of different diseases, and the volume fraction (V _i ) of each compartment was obtained. Independent sample t-tests, Mann-Whitney U tests, chi-square tests, or Fisher's exact tests were used to compare intergroup differences in clinical data and imaging metrics. Principal component analysis (PCA) and Adonis analysis were employed to evaluate the discriminative ability of imaging metrics among different subtypes of benign tumors. Receiver operating characteristic (ROC) analysis was used to evaluate the ability of univariate and multivariable models to characterize the malignancy of head and neck squamous cell carcinoma (HNSCC) and identify OLNM. Results ·A total of 97 cases were collected, including 28 benign tumors and 69 HNSCCs. Fifteen pathologically confirmed OLNMs and 20 benign lymph nodes (BLNs) were also enrolled. Among the 28 benign tumors, there were 6 cases of pleomorphic adenoma stroma-rich (PA stroma-rich), 9 cases of pleomorphic adenoma stroma-poor (PA stroma-poor), 9 cases of Warthin's tumor (WT), and 4 cases of basal cell adenoma (BCA). Statistically significant differences were observed in certain imaging parameters (ADC, T2, and DR-CSI V _i ) among benign tumor subtypes. PCA analysis demonstrated a strong discriminative ability of imaging parameters in distinguishing pathological subtypes of benign tumors (R²=0.64, P<0.001). Among the 69 HNSCCs, 47 were classified as Grade 1 (well/moderately well-differentiated) and 22 as Grade 2 (moderately/poorly differentiated). Compared to Grade 1, Grade 2 showed lower ADC and higher T2 values, though differences were not statistically significant. As HNSCC malignancy increased, V_A4 decreased and V_B4^{increased significantly. OLNM showed a significant increase in SD and V_A4 compared to BLNs. The combination of SD and V_A4 for preoperative OLNM identification achieved a diagnostic efficiency of 0.843. Conclusion ·DR-CSI can analyze diffusion and relaxation characteristics at the sub-voxel level, offering valuable insights for characterizing benign head and neck tumor subtypes, assessing HNSCC malignancy, and identifying OLNMs. Compared to traditional parameters like ADC or T2, DR-CSI provides enhanced tissue microstructure analysis.}

Key words: diffusion-relaxation correlation spectroscopic imaging, pleomorphic adenoma, Warthin's tumor, basal cell adenoma, head and neck squamous cell carcinoma, occult lymph node metastasis

CLC Number:

R455.2

LI Siyu, CHEN Ya, HU Wentao, DAI Yongming, WU Yingwei. Using diffusion-relaxation correlation spectroscopic imaging to assess the heterogeneity of head and neck tumors and identify occult lymph node metastasis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(9): 1202-1213.

Figures/Tables 12

TrendMD

References 27

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Item	PA stroma-poor (n=9)	PA stroma-rich (n=6)	WT (n=9)	BCA (n=4)	P value
Age/year	45.4±13.9	40.8±11.0	51.7±10.1	41.8±9.0	0.101
Sex/n (%)					0.423
Male	5 (55.6)	2 (33.3)	7 (77.8)	2(50.0)
Female	4 (44.4)	4 (66.7)	2 (22.2)	2 (50.0)
MD/cm	2.56±1.04	2.00±0.88	3.33±0.97	1.98±0.64	0.040
ADC/(μm²·ms^-1)	1.35±0.13	2.04±0.10	0.87±0.21	1.72±0.18	<0.001
T2/ms	80.32±19.89	155.85±23.84	67.12±5.56	124.29±19.16	<0.001

Item	PA stroma-poor (n=9)	PA stroma-rich (n=6)	WT (n=9)	BCA (n=4)	P value
Age/year	45.4±13.9	40.8±11.0	51.7±10.1	41.8±9.0	0.101
Sex/n (%)					0.423
Male	5 (55.6)	2 (33.3)	7 (77.8)	2(50.0)
Female	4 (44.4)	4 (66.7)	2 (22.2)	2 (50.0)
MD/cm	2.56±1.04	2.00±0.88	3.33±0.97	1.98±0.64	0.040
ADC/(μm²·ms^-1)	1.35±0.13	2.04±0.10	0.87±0.21	1.72±0.18	<0.001
T2/ms	80.32±19.89	155.85±23.84	67.12±5.56	124.29±19.16	<0.001

Item	Grade 1 (n=47)	Grade 2 (n=22)	P value
Age/year	51.8±14.6	59.6±10.1	0.043
Sex/n (%)			0.715
Male	32 (68.1)	14 (63.6)
Female	14 (31.9)	8 (36.4)
Subsite/n (%)			0.599
Oral tongue	39 (83.0)	18 (81.8)
Oral floor	1 (2.1)	1 (4.5)
Gingiva	5 (10.6)	1 (4.5)
Oropharynx	2 (4.3)	2 (9.1)
MD/cm	2.85 (1.98, 3.75)	3.00 (2.05, 3.73)	0.605
DOI/cm	1.30 (0.90, 1.68)	1.30 (1.00, 2.00)	0.506
cT stage/n (%)			0.973
T1‒2	13 (27.7)	6 (27.3)
T3‒4	34 (72.3)	16 (72.7)
LNM/n (%)			0.044
Negative	25 (53.2)	6 (27.3)
Positive	22 (46.8)	16 (72.1)
ADC/(μm²·ms^-1)	0.98 (0.92, 1.12)	0.92 (0.87, 1.04)	0.053
T2/ms	65.46 (52.28, 70.40)	62.75 (56.91, 69.13)	0.827
DR-CSI V_A4/%	40.2 (25.7, 54.1)	22.9 (17.9, 33.5)	0.002
DR-CSI V_B4/%	41.3 (28.6, 58.4)	59.3 (52.8, 67.8)	0.002
DR-CSI V_C4/%	14.9 (12.1, 20.6)	14.2 (12.7, 19.4)	0.718

Item	Grade 1 (n=47)	Grade 2 (n=22)	P value
Age/year	51.8±14.6	59.6±10.1	0.043
Sex/n (%)			0.715
Male	32 (68.1)	14 (63.6)
Female	14 (31.9)	8 (36.4)
Subsite/n (%)			0.599
Oral tongue	39 (83.0)	18 (81.8)
Oral floor	1 (2.1)	1 (4.5)
Gingiva	5 (10.6)	1 (4.5)
Oropharynx	2 (4.3)	2 (9.1)
MD/cm	2.85 (1.98, 3.75)	3.00 (2.05, 3.73)	0.605
DOI/cm	1.30 (0.90, 1.68)	1.30 (1.00, 2.00)	0.506
cT stage/n (%)			0.973
T1‒2	13 (27.7)	6 (27.3)
T3‒4	34 (72.3)	16 (72.7)
LNM/n (%)			0.044
Negative	25 (53.2)	6 (27.3)
Positive	22 (46.8)	16 (72.1)
ADC/(μm²·ms^-1)	0.98 (0.92, 1.12)	0.92 (0.87, 1.04)	0.053
T2/ms	65.46 (52.28, 70.40)	62.75 (56.91, 69.13)	0.827
DR-CSI V_A4/%	40.2 (25.7, 54.1)	22.9 (17.9, 33.5)	0.002
DR-CSI V_B4/%	41.3 (28.6, 58.4)	59.3 (52.8, 67.8)	0.002
DR-CSI V_C4/%	14.9 (12.1, 20.6)	14.2 (12.7, 19.4)	0.718

Item	PA stroma-poor (n=9)	PA stroma-rich (n=6)	P value
ADC/(μm²·ms^-1)	1.35±0.13	2.04±0.10	<0.001
T2/ms	80.32±19.89	155.85±23.84	<0.001
DR-CSI V_A1+2+3/%	87.0±6.1	46.4±19.8	0.003
DR-CSI V_B1+2+3/%	3.9±3.6	39.9±17.6	0.004
DR-CSI V_C/%	9.1±4.4	13.7±3.8	0.060
Item	PA stroma-poor (n=9)	WT (n=9)	P value
ADC/(μm²·ms^-1)	1.35±0.13	0.87±0.21	<0.001
T2/ms	80.32±19.89	67.12±5.56	0.086
DR-CSI V_A1B1/%	25.3±4.5	53.9±9.5	<0.001
DR-CSI V_A2+3B2+3/%	67.3 (60.3, 70.5)	16.9 (2.0, 19.2)	<0.001
DR-CSI V_C/%	9.1±4.4	34.5±12.5	<0.001
Item	WT (n=9)	BCA (n=4)	P value
ADC/(μm²·ms^-1)	0.87±0.21	1.72±0.18	<0.001
T2/ms	67.12±5.56	124.29±19.16	0.008
DR-CSI V_A1+2/%	53.1±9.3	15.4±7.0	<0.001
DR-CSI V_A3/%	15.7 (2.0, 19.1)	38.5 (33.0, 40.9)	0.005
DR-CSI V_B1+2+3/%	1.1±0.9	29.0±11.7	0.017
DR-CSI V_C/%	34.5±12.5	18.1±2.7	0.004
Item	PA stroma-rich (n=6)	BCA (n=4)	P value
ADC/(μm²·ms^-1)	2.04±0.10	1.72±0.18	0.006
T2/ms	155.85±23.84	124.29±19.16	0.059
DR-CSI V_A1+2B1+2/%	40.7±3.7	63.0±7.0	0.004
DR-CSI V_A3B3/%	45.6±3.9	18.9±7.6	0.003
DR-CSI V_C/%	13.7±3.8	18.1±2.7	0.080