Prediction of the treatment outcome using intravoxel incoherent motion and diffusional kurtosis imaging in nasal or sinonasal squamous cell carcinoma patients.

Daisuke Yoshida,Kohsuke Kudo,Yukie Shimizu,Akihiro Homma,Khin Khin Tha,Noriyuki Fujima,Akiko Tsukahara,Hiroki Shirato,Tomohiro Sakashita

doi:10.1007/s00330-016-4440-1

Abstract

To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusional kurtosis imaging (DKI) parameters in nasal or sinonasal squamous cell carcinoma (SCC) patients to determine local control/failure. Twenty-eight patients were evaluated. MR acquisition used single-shot spin-echo EPI with 12 b-values. Quantitative parameters (mean value, 25th, 50th and 75th percentiles) of IVIM (perfusion fraction f, pseudo-diffusion coefficient D*, and true-diffusion coefficient D), DKI (kurtosis value K, kurtosis corrected diffusion coefficient Dk) and apparent diffusion coefficient (ADC) were calculated. Parameter values at both the pretreatment and early-treatment period, and the percentage change between these two periods were obtained. Multivariate logistic regression analysis: the percentage changes of D (mean, 25th, 50th, 75th), K (mean, 50th, 75th), Dk (mean, 25th, 50th), and ADC (mean, 25th, 50th) were predictors of local control. ROC curve analysis: the parameter with the highest accuracy = the percentage change of D value with the histogram 25th percentile (0.93 diagnostic accuracy). Multivariate Cox regression analyses: the percentage changes of D (mean, 25th, 50th), K (mean, 50th, 75th), Dk (mean, 25th, 50th) and ADC (mean, 25th, 50th) are predictors. IVIM and DKI parameters, especially the D-value's histogram 25th percentile, are useful for predicting local control. • Noninvasive assessment of treatment outcome in SCC patients was achieved using IVIM/DKI. • Several IVIM and DKI parameters can predict the local control. • Especially, the D-value's histogram 25th percentile has high diagnostic accuracy.

Highlights

Surgical resection, chemotherapy, radiotherapy, and their combinations are common treatments for head and neck squamous cell carcinoma (SCC), including nasal or sinonasal cavity SCC [1]
The Response Evaluation Criteria in Solid Tumors (RECIST) criteria provide a standard method [4], but it was reported that tumor size information is not very reliable for predicting treatment outcomes [5]
From September 2010 to June 2014, 31 consecutive patients who were referred to our hospital to undergo a super-selective arterial infusion of cisplatin with concomitant radiotherapy under a diagnosis of nasal or sinonasal cancer were prospectively enrolled with the following inclusion criteria: (1)

Summary

Introduction

Chemotherapy, radiotherapy, and their combinations are common treatments for head and neck squamous cell carcinoma (SCC), including nasal or sinonasal cavity SCC [1]. Super-selective arterial infusions of cisplatin with concomitant radiotherapy, in particular, have become popular for SCC because of its higher local control rate in advanced cases of nasal or sinonasal SCC [2, 3]. For such a nonsurgical therapy, it would be helpful to be able to predict — either before treatment or during the early treatment period — the treatment results of patients who may fail to respond to treatment at the primary site; doing so could optimize patient management. The apparent diffusion coefficient (ADC) obtained by diffusion-weighted imaging (DWI)

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Conclusion