Abstract
Objective
To explore intravoxel incoherent motion (IVIM) characteristics of nasopharyngeal carcinoma (NPC) and relationships with different tumour stages.
Methods
We prospectively recruited 80 patients with newly diagnosed undifferentiated NPC. Diffusion-weighted MR imaging was performed and IVIM parameters (D, pure diffusion; f, perfusion fraction; D*, pseudodiffusion coefficient) were calculated. Patients were stratified into low and high tumour stage groups based on American Joint Committee on Cancer (AJCC) and TNM staging for determination of the predictive powers of IVIM parameters using t test, multiple logistic regression and ROC curve analyses.
Results
D, f and D* were all statistically significantly lower in high-stage groups in AJCC, T and N staging. D, f and D* were all independent predictors of AJCC staging, f and D* were independent predictors of T staging, and D was an independent predictor of N staging. D was most powerful for AJCC and N staging, whereas f was most powerful for T staging. Optimal cut-off values (area under the curve, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio) were as follows: AJCC stage, D = 0.782 × 10−3 mm2/s (0.915, 93.3 %, 76.2 %, 3.92, 0.09); T staging, f = 0.133 (0.905, 80.5 %, 92.5 %, 10.73, 0.21); N staging, D = 0.761 × 10−3 mm2/s (0.848, 87.5 %, 66.7 %, 2.62, 0.19). Multivariate analysis showed no diagnostic improvement.
Conclusion
Nasopharyngeal carcinoma has distinctive intravoxel incoherent motion characteristics parameters in different tumour staging, potentially helping pretreatment staging.
Key Points
• Magnetic resonance imaging is increasingly used to assess nasopharyngeal carcinoma (NPC).
• NPC has distinctive diffusion/perfusion characteristics at different stages.
• Non-invasive MR imaging may help pretreatment staging prediction.
• Diffusion properties of NPC best correlate with AJCC and N staging.
• Perfusion properties of NPC best correlate with T staging.
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Abbreviations
- AJCC:
-
American Joint Committee on Cancer
- AUC:
-
Area under the curve
- D :
-
Pure diffusion
- D* :
-
Pseudodiffusion coefficient
- DW:
-
Diffusion weighted
- f :
-
Perfusion fraction
- IVIM:
-
Intravoxel incoherent motion
- NPC:
-
Nasopharyngeal carcinoma
- ROC:
-
Receiver operating characteristic
- ROI:
-
Region of interest
- SD:
-
Standard deviation
- SNR:
-
Signal-to-noise ratio
- SPIR:
-
Spectral presaturation inversion recovery
- STIR:
-
Short T1 inversion recovery
- TFE:
-
Turbo-field-echo
- TR/TE:
-
Repetition time/echo time
- TSE:
-
Turbo-spin-echo
References
Lai V, Khong PL (2013) Updates on MR imaging and 18F-FDG PET/CT imaging in nasopharyngeal carcinoma. Oral Oncol. doi:10.1016/j.oraloncology.2013.05.005
Dzik-Jurasz A, Domenig C, George M et al (2002) Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet 360:307–308
Cui Y, Zhang XP, Sun YS, Tang L, Shen L (2008) Apparent diffusion coefficient: potential imaging biomarker for prediction and early detection of response to chemotherapy in hepatic metastases. Radiology 248:894–900
Park SH, Moon WK, Cho N et al (2010) Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. Radiology 257:56–63
Roth Y, Tichler T, Kostenich G et al (2004) High-b-value diffusion-weighted MR imaging for pretreatment prediction and early monitoring of tumor response to therapy in mice. Radiology 232:685–692
Fong D, Bhatia KSS, Yeung D, King AD (2010) Diagnostic accuracy of diffusion-weighted R imaging for nasopharyngeal carcinoma, head and neck lymphoma and squamous cell carcinoma at the primary site. Oral Oncol 46:603–606
Ichikawa Y, Sumi M, Sasaki M, Sumi T, Nakamura T (2012) Efficacy of diffusion-weighted imaging for the differentiation between lymphomas and carcinomas of the nasopharynx and oropharynx: correlations of apparent diffusion coefficients and histologic features. AJNR Am J Neuroradiol 33:761–766
Tshering Vogel DW, Zbaeren P, Geretschlaeger A, Vermathen P, De Keyzer F, Thoeny HC (2013) Diffusion-weighted MR imaging including bi-exponential fitting for the detection of recurrent or residual tumor after (chemo)radiotherapy for laryngeal and hypopharyngeal cancers. Eur Radiol 23:562–569
Sumi M, Van Cauteren M, Sumi T, Obara M, Ichikawa Y, Nakamura T (2012) Salivary gland tumors: use of intravoxel incoherent motion MR imaging for assessment of diffusion and perfusion for the differentiation of benign and malignant tumors. Radiology 263:770–771
Sumi M, Nakamura T (2013) Head and neck tumors: assessment of perfusion-related parameters and diffusion coefficients based on the intravoxel incoherent motion model. AJNR Am J Neuroradiol 34:410–416
Lai V, Li X, Lee VHF, Lam KO, Chan Q, Khong PL (2013) Intravoxel incoherent motion MR imaging: comparison of diffusion and perfusion characteristics between nasopharyngeal carcinoma and post-chemoradiation fibrosis. Eur Radiol. doi:10.1007/s00330-013-2889-8
Le Bihan D, Turner R, MacFall JR (1989) Effects of intravoxel incoherent motions (IVIM) in steady-state free precession (SSFP) imaging: application to molecular diffusion imaging. Magn Reson Med 10:324–337
Federau C, Maeder P, O’Brien K, Browaeys P, Meuli R, Hagmann P (2012) Quantitative measurement of brain perfusion with intravoxel incoherent motion MR imaging. Radiology 265:874–881
Pang Y, Turkbey B, Bernardo M et al (2013) Intravoxel incoherent motion MR imaging for prostate cancer: an evaluation of perfusion fraction and diffusion coefficient derived from different b-value combinations. Magn Reson Med 69:553–562
Luciani A, Vignaud A, Cavet M et al (2008) Liver cirrhosis: intravoxel incoherent motion MR imaging—pilot study. Radiology 249:891–899
Chong VFH, Zhou JY, Khoo JBK, Huang J, Lim TK (2004) Nasopharyngeal carcinoma tumor volume measurement. Radiology 231:914–921
Lee AWM, Lin JC, Ng WT (2012) Current management of nasopharyngeal cancer. Semin Radiat Oncol 22:233–244
Hauser T, Essig M, Jensen A et al (2013) Characterization and therapy monitoring of head and neck carcinomas using diffusion-based intravoxel incoherent motion parameters—preliminary results. Neuroradiology 55:527–536
Takahara T, Kwee TC (2012) Low b-value diffusion-weighted imaging: emerging applications in the body. J Magn Reson Imaging 35:1266–1273
Razek AA, Kamal E (2013) Nasopharyngeal carcinoma: correlation of apparent diffusion coefficient value with prognostic parameters. Radiol Med 118:534–539
Huang B, Wong CS, Whitcher B et al (2013) Dynamic contrast-enhanced magnetic resonance imaging for characterising nasopharyngeal carcinoma: comparison of semiquantitative and quantitative parameters and correlation with tumour stage. Eur Radiol 23:1495–1502
Andreou A, Koh DM, Collins DJ et al (2013) Measurement reproducibility of perfusion fraction and pseudodiffusion coefficient derived by intravoxel incoherent motion diffusion-weighted MR imaging in normal liver and metastases. Eur Radiol 23:428–434
Lemke A, Stieltjes B, Schad LR, Laun FB (2011) Toward an optimal distribution of b values for intravoxel incoherent motion imaging. Magn Reson Imaging 29:766–776
Orton MR, Collins DJ, Koh DM, Leach MO (2013) Improved intravoxel incoherent motion analysis of diffusion weighted imaging by data driven Bayesian modelling. Magn Reson Med. doi:10.1002/mrm.24649
Acknowledgments
Our study was supported by University Grants Council (UGC) seed funding from The University of Hong Kong, project no. 201112159010.
Dr. Q Chan is currently employed by Philips Medical Systems.
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A subset of our patients (55/80) from the present study was previously reported in our earlier paper “Intravoxel incoherent motion MR imaging: comparison of diffusion and perfusion characteristics between nasopharyngeal carcinoma and post-chemoradiation fibrosis” published in European Radiology (doi:10.1007/s00330-013-2889-8). In that paper we only focused on describing the diffusion and perfusion characteristics in differentiating between newly diagnosed nasopharyngeal carcinomas and post-chemoradiation fibrosis, but not their characteristics between different tumor stages.
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Lai, V., Li, X., Lee, V.H.F. et al. Nasopharyngeal carcinoma: comparison of diffusion and perfusion characteristics between different tumour stages using intravoxel incoherent motion MR imaging. Eur Radiol 24, 176–183 (2014). https://doi.org/10.1007/s00330-013-2995-7
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DOI: https://doi.org/10.1007/s00330-013-2995-7