• Identify a priori prognostic markers for head and neck cancer patients using DCE-MRI and 1H-MRS data, which may help in stratifying patients into "good risk" and "poor risk" categories to improve outcome and quality of life. [ Time Frame: February 2011 ] [ Designated as safety issue: No ]
  

• To determine if the a-priori DCE-MRI and 1H-MRS results provide independent markers of tumor response and/or long term disease-free survival compared to clinical prognosticators. [ Time Frame: February 2011 ] [ Designated as safety issue: No ]
  

Radiation: DCE-MRI, MRS
Patients will undergo DCE-MRI and 1H-MRS study prior to surgery or prior to beginning chemo-radiation therapy. Patients being treated with chemo-radiation therapy will undergo a second DCE-MRI and 1H-MRS study between 10-14 days after initiation of treatment.

Our aim is to perform pretreatment dynamic contrast enhanced - magnetic resonance imaging (DCE-MRI) and proton magnetic resonance spectroscopy (1H-MRS) on 200 patients with head and neck cancer eligible for surgery or chemo-radiation treatment. The pretreatment DCE-MRI and 1H-MRS exam will add about 20 minutes of scanning time to the routine MRI study with contrast agent performed at MSKCC. Patients undergoing chemo-radiation will also have an additional followup DCE-MRI and 1H-MRS exam between 10-14 days into the course of treatment. The followup DCE-MRI and 1H-MRS exam will be about 30-35 minutes (the DCEMRI images will take about 10 minutes, the 1H-MRS images about 10 minutes and setup on the MRI table will require 10-15 minutes).

The DCE-MRI data will provide insight into the tumor pathophysiology. With proper compartmental modelling, the data will yield results on tumor-vessel permeability, tumor perfusion, and extracellular-extravascular volume fraction, i.e. data relating to the tumor microenvironment. In addition, MR spectroscopy data show the metabolic signature of the tumor and an elevated choline level (resulting from the enhanced phospholipid cell membrane turnover associated with tumor proliferation, increased cellularity, and growth) which may serve as an indicator of active tumor and a decrease in choline may reflect tumor response. These results will determine the potential of DCE-MRI and 1H-MRS data as a priori or early markers of tumor response to chemo-radiation as well as long term disease-free survival after surgery or chemo-radiation therapy. The a priori DCE-MRI and 1H-MRS data may ultimately help physicians in selecting patient specific therapy.

Potential research subjects will be identified by a member of the patient's treatment team, the protocol investigator, or research team at Memorial Sloan-Kettering Cancer Center (MSKCC). If the investigator is a member of the treatment team, s/he will screen their patient's medical records for suitable research study participants and discuss the study and their potential for enrolling in the research study. Potential subjects contacted by their treating physician will be referred to the investigator/research staff of the study. The principal investigator may also screen the medical records of patients with whom they do not have a treatment relationship for the limited purpose of identifying patients who would be eligible to enroll in the study and to record appropriate contact information in order to approach these patients regarding the possibility of enrolling in the study.

Inclusion Criteria:

1. Histologically proven diagnosis of head and neck cancer
2. No prior treatment
3. Will undergo surgery or chemo-radiation treatment
4. Presence of evaluable primary tumor
5. Patients must be 18 years or older and have the ability to give informed consent

Exclusion Criteria:

1. Claustrophobia
2. Absence of evaluable primary tumor
3. Known reaction to Gd-DTPA
4. Pre-operative radiation to primary tumor site

5. Contraindication to MRI

   1. Pacemaker
   2. Aneurysmal clips
   3. Metal implants in field of view
   4. Pregnant or nursing women
   5. Age and mental status wherein he/she is unable to cooperate for MRI study