Abstract
BackgroundXerostomia caused by radiation-induced salivary glands injury has a considerable impact on patients’ quality of life. Nowadays, the existed different methods of evaluating xerostomia in clinical practice there are still some disadvantages and limitations. This study used diffusion-weighted magnetic resonance imaging (DW-MRI) with gustatory stimulation to assess salivary glands function after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).MethodsDW-MRI was performed in 30 NPC patients and swab method was used to calculate rest and stimulated salivary flow rates (SFR). DW sequence at rest and then repeated ten times during stimulation were obtained. Apparent diffusion coefficients (ADCs) maps of three glands were calculated. Patients before and after RT were recorded as xerostomia and non-xerostomia groups separately. Rest and stimulated ADCs, ADCs increase rates (IRs), time to maximum ADCs (Tmax), ADCs change rates (CRs), rest and stimulated SFR, SFR increase rates (IRs) and SFR change rates (CRs) before and after RT were assessed.ResultsThe rest and stimulated ADCs of three glands after RT were higher than those before RT (p < 0.001). The rest and stimulated SFR of all salivary glands after RT were lower than those before RT (p < 0.001). A correlation existed between rest ADCs of submandibular glands and rest SFR of submandibular mixed with sublingual glands and full three glands before RT (p = 0.019, p = 0.009), stimulated ADCs and stimulated SFR in parotid glands before RT (p = 0.047). The rest ADCs of parotid glands after RT correlated to XQ scores (p = 0.037).ConclusionsThe salivary glands’ ADCs increased after RT both in rest and stimulated state due to the radiation injury and the ADCs correlated with SFR and XQ scores of evaluating the xerostomia in clinical practice.
Highlights
Xerostomia caused by radiation-induced salivary glands injury has a considerable impact on patients’ quality of life
In our prospective study of 30 nasopharyngeal carcinoma (NPC) patients treated with intensitymodulated radiotherapy (IMRT), we evaluated the feasibility of dynamic diffusion-weighted magnetic resonance imaging (DW-MRI) used transient gustatory stimulation with lemon juice in evaluation of salivary glands function before and late after intensity-modulated radiotherapy (IMRT) by compared and correlated the changes in apparent diffusion coefficients (ADCs) with clinical methods, being the salivary flow rates (SFR) and the xerostomia questionnaire (XQ) scores, for evaluation of xerostomia
As a result of stimulation with lemon juice, an initial steady increase to peak during the first DWI scan (30 s) and subsequent decrease in ADCs was seen in all glands before and after RT
Summary
Xerostomia caused by radiation-induced salivary glands injury has a considerable impact on patients’ quality of life. For the evaluation of xerostomia induced by RT, DW-MRI has been used to assess the parotid glands [13, 15, 26] and submandibular glands [20, 27, 28] based on rest and stimulated ADCs, but the sublingual glands have not been assessed. Another concern is that the relationship between the ADCs and clinical methods used for evaluation of xerostomia, such as salivary flow rates (SFR) and xerostomia questionnaire (XQ) scores were remains unclear and have not been proven consistent previously [15]. The thresholds of ADCs and SFR suggesting xerostomia are still lacking
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