Feasibility of DW-MRI analysis of salivary glands during head and neck radiotherapy.

Abstract

With no effective treatment for xerostomia, there remains an unmet need to reduce radiation induced toxicity. Measuring physiological changes during RT in salivary glands using DW-MRI may predict which patients are most at risk of severe toxicity. This study evaluated the feasibility of measuring apparent diffusion coefficient (ADC) in the major salivary glands and describes the observed changes in volume and ADC during RT. Scans were acquired at baseline (MR_base) and after 10 fractions (MR_rpt). Sequences included T1 post contrast fat saturated (T1PCFS) and DW-MRI (5b values, 0-1000s/mm2). Ipsilateral and contralateral parotid (iPG/cPG), submandibular (iSMG/cSMG) and sublingual glands (iSLG/cSLG) were delineated on T1PCFS, modified on b0 and copied to the ADC map. 31 patients with intermediate/high risk squamous cell carcinoma (SCC) of the oropharynx were evaluated. On 124 scans, SMG and SLG delineations were successful on all; parotids were fully contoured in 90.7%. Baseline mean ADC were significantly different between each gland type (p<0.0001). IPG and cPG volume decreased during treatment by 6.7% and 11.2%. ISMG, cSMG, iSLG and cSLG volume increased by 6.9, 0.9, 60.8 and 60.3% respectively. All structures showed an increase in mean_ADC values. For each gland the increase in ADC was statistically significant p<0.0001. A smaller mean percentage increase in ADC was observed in the group experiencing a higher grade (2 or>) of toxicity. It is feasible to measure volume and ADC of the salivary glands prior to and during RT for HNC. Early data suggests a lower rise in ADC during treatment is associated with more severe late xerostomia.