Multimodality functional imaging using DW-MRI and 18F-FDG-PET/CT during radiation therapy for human papillomavirus negative head and neck squamous cell carcinoma: Meixoeiro Hospital of Vigo Experience

Figure 1 Workflow representing the study design performed in all the patients. ¹⁸F-FDG: Fluorine-18 Fludeoxyglucose; PET/CT: Positron emission tomography/computed tomography; DW-MRI: Diffusion-weighted magnetic resonance imaging.

Figure 2 Relationship between pre-Tx mean standardized uptake value and pre-Tx mean apparent diffusion coefficient showing a significant strong negative inverse correlation. SUV: Standardized uptake value; ADC: Apparent diffusion coefficient.

Figure 3 Representative no evidence of disease patient. A and G: Pre-Tx PET/CT of the primary tumor and a neck nodal metastasis; B and H: Primary tumor and representative neck nodal metastasis contoured over a T2-W MRI; C and I: Pre-Tx ADC map overlaid on T2-W MRI; D and J: Wk2-Tx ADC map overlaid on T2-W; E and K: Wk3-Tx ADC map overlaid on T2-W; F and L: T2-W MRI post-Tx with no evidence of primary tumor and neck nodal metastases. PET/CT: Positron emission tomography/computed tomography; MRI: Magnetic resonance imaging; ADC: Apparent diffusion coefficient; IMRT: Intensity modulated radiation therapy.

Figure 4 Representative alive with disease patient. A and G: pre-Tx PET/CT of the primary tumor and two neck nodal metastases; B and H: Primary tumor and representative neck nodal metastasis contoured over a T2-W MRI; C and I: Pre-Tx ADC map overlaid on T2-W MRI; D and J: Wk2-Tx ADC map overlaid on T2-W; E and K: Wk3-Tx ADC map overlaid on T2-W; F and L: T2-W MRI post-Tx with no evidence of primary tumor but with presence of neck nodal metastasis. PET/CT: Positron emission tomography/computed tomography; MRI: Magnetic resonance imaging; ADC: Apparent diffusion coefficient; IMRT: Intensity modulated radiation therapy.

Figure 5 Representative dead of disease patient. A and G: Pre-Tx PET/CT of the primary tumor and three neck nodal metastases; B and H: Primary tumor and representative neck nodal metastasis contoured over a T2-W MRI; C and I: Pre-Tx ADC map overlaid on T2-W MRI; D and J: Wk2-Tx ADC map overlaid on T2-W; E and K: Wk3-Tx ADC map overlaid on T2-W; F and L: T2-W MRI post-Tx with no evidence of primary tumor but with presence of neck nodal metastasis. PET/CT: Positron emission tomography/computed tomography; MRI: Magnetic resonance imaging; ADC: Apparent diffusion coefficient; IMRT: Intensity modulated radiation therapy.