Abstract
ObjectivesTo compare accuracy and assess agreement between intravoxel incoherent motion (IVIM) magnetic resonance (MR) perfusion-related parameters and quantitative dynamic contrast-enhanced (DCE) MR parameters in nasopharyngeal carcinoma (NPC).ResultsD, f, D*, Ktrans, Kep and Vp were significantly lower in the high stage group while Ve was significantly higher in the high stage group. Optimal cut-off values were: D=0.749 × 10−3 mm2/s; f=0.145; D*=100.401 × 10−3 mm2/s; Ktrans=0.571/min; Kep=0.8196/min; Ve=0.6556 %; Vp=0.0757 %. D* (p=0.001), Ktrans (p<0.001), Ve (p=0.014) were all reliable independent predictors for AJCC staging. IVIM-MR perfusion-related (f, D*) and DCE-MR (Ktrans, Kep, Ve, Vp) parameters were significantly correlated (p<0.001).Materials and Methods75 patients with newly diagnosed NPC were prospectively recruited. Diffusion-weighted MR and DCE-MR imaging were performed with respective IVIM (D, f, D*) and DCE (Ktrans, Kep, Ve, Vp) MR parameters calculated. Patients were stratified into low and high tumor stage groups according to American Joint Committee on Cancer (AJCC) staging for determination of the predictive powers of IVIM-MR and DCE-MR parameters using t–test, ROC curve analyses and multiple logistic regression analysis. Correlation between IVIM-MR perfusion-related and DCE-MR parameters was assessed using Spearman's rank correlation.ConclusionIVIM-MR perfusion-related and quantitative DCE-MR parameters were significantly correlated in the assessment of NPC and were both reliable independent predictors in the prediction of AJCC staging. IVIM-MR perfusion imaging can be a potential useful non-invasive perfusion imaging tool for clinical use in the assessment of NPC.
Highlights
Noninvasive diagnostic imaging and staging in nasopharyngeal carcinoma (NPC) is crucial in the early diagnosis and treatment planning, especially for patients with high stage disease requiring adjuvant therapy
Patients were stratified into low and high tumor stage groups according to American Joint Committee on Cancer (AJCC) staging for determination of the predictive powers of Intravoxel incoherent motion (IVIM)-Magnetic resonance (MR) and dynamic contrast enhanced (DCE)-MR parameters using t–test, Receiver operating characteristic (ROC) curve analyses and multiple logistic regression analysis
IVIM-MR perfusion-related and quantitative DCE-MR parameters were significantly correlated in the assessment of NPC and were both reliable independent predictors in the prediction of AJCC staging
Summary
Noninvasive diagnostic imaging and staging in nasopharyngeal carcinoma (NPC) is crucial in the early diagnosis and treatment planning, especially for patients with high stage disease requiring adjuvant therapy. Diffusion-weighted (DW) MR imaging allows additional information on the functional assessment and characterization of the tumor, showing promising results with successful differentiation between different tumor grading, rendering it an imaging biomarker. We have previously demonstrated that it is feasible in the differentiation between NPC and post-chemoradiation fibrosis [5], as well as in the pre-treatment staging prediction [6], showing high diagnostic accuracy. While the precision of the derived pure diffusion parameter, D (reflecting tissue cellularity) has been proven to be consistent with high diagnostic confidence, concern has been raised regarding the accuracy of the derived perfusion related parameters (perfusion fraction, f reflecting normal angiogenesis with intact vascular permeability; and pseudodiffusion coefficient, D* reflecting tumoral vascularity) given the limited signalto-noise ratio (SNR). The relationship between IVIM-MR perfusion-related parameters and semi-quantitative DCEMR parameters had initially been tested in NPC, showing promising result [15]. The relationship between IVIM-MR perfusion-related parameters and quantitative DCE-MR parameters remains unexplored
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