Background: This study aimed to explore the differences in quantitative diffusion-weighted (DW) MRI parameters in oropharyngeal squamous cell carcinoma (OPC) based on Human Papillomavirus (HPV) status before and during radiotherapy (RT). Methods: Echo planar DW sequences acquired before and during (chemo)radiotherapy (CRT) of 178 patients with histologically proven OPC were prospectively analyzed. The volumetric region of interest (ROI) was manually drawn on the apparent diffusion coefficient (ADC) map, and 105 DW-MRI radiomic parameters were extracted. Change in ADC values (Δ ADC) was calculated as the difference between baseline and during RT at week 4, normalized by the baseline values. Results: Pre-treatment first-order 10th percentile ADC and Gray Level co-occurrence matrix (GLCM)-correlation were significantly lower in HPV-positive compared with HPV-negative tumors (82.4 × 10−5mm2/s vs. 90.3 × 10−5mm2/s,p= 0.03 and 0.18 vs. 0.30,p< 0.01). In the fourth week of RT, all first-order ADC values were significantly higher in HPV-positive tumors (p< 0.01). Δ ADC mean was significantly higher for the HPV-positive compared with the HPV-negative OPC group (95% vs. 55%,p< 0.01). A predictive model for HPV status based on smoking status, alcohol consumption, GLCM correlation, and mean ADC and 10th percentile ADC values yielded an area under the curve of 0.77 (95% CI 0.70–0.84). Conclusions: Our results highlight the potential of DW-MR imaging as a non-invasive biomarker for the prediction of HPV status, although its current role remains supplementary to pathological confirmation.
背景：本研究旨在探讨基于人乳头瘤病毒（HPV）状态的差异，在放疗前及放疗期间口咽鳞状细胞癌（OPC）定量扩散加权（DW）磁共振成像参数的变化。方法：前瞻性分析了178例经组织学证实的OPC患者在（放）化疗前及化疗期间获得的平面回波DW序列。在表观扩散系数（ADC）图上手动勾画感兴趣体积区域（ROI），并提取了105个DW-MRI影像组学参数。ADC值变化（Δ ADC）计算为基线值与放疗第4周时数值的差值，并以基线值进行标准化。结果：与HPV阴性肿瘤相比，HPV阳性肿瘤治疗前的一阶ADC第10百分位数和灰度共生矩阵（GLCM）相关性显著较低（82.4 × 10⁻⁵mm²/s vs. 90.3 × 10⁻⁵mm²/s，p=0.03；0.18 vs. 0.30，p<0.01）。在放疗第4周，HPV阳性肿瘤的所有一阶ADC值均显著较高（p<0.01）。HPV阳性OPC组的Δ ADC平均值显著高于HPV阴性组（95% vs. 55%，p<0.01）。基于吸烟状况、饮酒情况、GLCM相关性、平均ADC值及ADC第10百分位数建立的HPV状态预测模型，其曲线下面积为0.77（95% CI 0.70–0.84）。结论：我们的研究结果凸显了DW-MR成像作为预测HPV状态的非侵入性生物标志物的潜力，尽管目前其作用仍作为病理学确认的补充。
Diffusion-Weighted MRI and Human Papillomavirus (HPV) Status in Oropharyngeal Cancer
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