European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1301–1307 | Cite as

Arterial spin labeling perfusion-weighted MR imaging: correlation of tumor blood flow with pathological degree of tumor differentiation, clinical stage and nodal metastasis of head and neck squamous cell carcinoma

  • Ahmed Abdel Khalek Abdel Razek
  • Nadia Nada
Head and Neck



The prognostic parameters of head and neck squamous cell carcinoma (HNSCC) include the pathological degree of tumor differentiation, clinical staging, and presence of metastatic cervical lymph nodes. To correlate tumor blood flow (TBF) acquired from arterial spin labeling (ASL) perfusion-weighted MR imaging with pathological degree of tumor differentiation, clinical stage, and nodal metastasis of HNSCC.

Materials and methods

Retrospective analysis of 43 patients (31 male, 12 female with a mean age of 65 years) with HNSCC that underwent ASL of head and neck and TBF of HNSCC was calculated. Tumor staging and metastatic lymph nodes were determined. The stages of HNSCC were stage 1 (n = 7), stage II (n = 12), stage III (n = 11) and stage IV (n = 13). Metastatic cervical lymph nodes were seen in 24 patients. The degree of tumor differentiation was determined through pathological examination.


The mean TBF of poorly and undifferentiated HNSCC (157.4 ± 6.7 mL/100 g/min) was significantly different (P = 0.001) than that of well-to-moderately differentiated (142.5 ± 5.7 mL/100 g/min) HNSCC. The cut-off TBF used to differentiate well-moderately differentiated from poorly and undifferentiated HNSCC was 152 mL/100 g/min with an area under the curve of 0.658 and accuracy of 88.4%. The mean TBF of stages I, II (146.10 ± 9.1 mL/100 g/min) was significantly different (P = 0.014) than that of stages III, IV (153.33 ± 9.3 mL/100 g/min) HNSCC. The cut-off TBF used to differentiate stages I, II from stages III and IV was 148 mL/100 g/min with an area under the curve of 0.701 and accuracy of 69.8%. The TBF was higher in patients with metastatic cervical lymph nodes. The cut-off TBF suspect metastatic node was 147 mL/100 g/min with an area under the curve of 0.671 and accuracy of 67.4%.


TBF is a non-invasive imaging parameter that well correlated with pathological degree of tumor differentiation, clinical stage of tumor and nodal metastasis of HNSCC.


Arterial spin labeling Perfusion MR imaging Head and neck Carcinoma Prognosis 



Area under the curve


Arterial spin labeling


Field of view


Head and neck squamous cell carcinoma


Pseudo-continuous arterial spin labeling


Receiver operating characteristic


Tumor blood flow


Repetition time/echo time


Compliance with ethical standards

Informed consent

Informed consent waived because this is a retrospective study.

Institutional Review Board (IRB) approval

IRB approval was obtained.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

All authors declare they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Diagnostic RadiologyMansoura Faculty of MedicineMansouraEgypt
  2. 2.Department of PathologyMansoura Faculty of medicineMansouraEgypt

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