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The Quantification of Radiation Fibrosis Using Clinically Indicated Magnetic Resonance Imaging for Head and Neck Cancer Patients

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Abstract

Currently, no objective method exists to measure the extent of fibrosis in swallowing musculature in head and neck cancer (HNC) patients. We developed and psychometrically tested a method of quantifying fibrosis volume using magnetic resonance imaging (MRI). The overall aim of this study was to determine if clinical MRI is a reliable tool to measure fibrosis of the pharyngeal musculature in patients with HNC managed with RT and to assess its potential to capture changes in fibrosis over time. Eligible participants were adults with HNC treated with radiation therapy (RT) who received minimally two MRIs and videofluoroscopic swallow (VFS) studies from baseline (pre-RT) up to 1-year post-RT. Two neuroradiologists independently contoured fibrosis volume in batches from MRIs using Vitrea™. Sufficient inter-rater reliability was set at Intraclass Correlation Coefficient (ICC) > 0.75. Two speech-language pathologists independently rated VFSs for swallowing impairment using standardized scales, with discrepancies resolved by consensus. MRI and VFS scores were correlated using Spearman’s rank coefficient. Participants included 42 adults (male = 33); mean age 59 (SD = 8.8). ICC (95% Confidence Interval) for fibrosis volume was 0.34 (0, 0.76) for batch one and 0.43 (0, 0.82) for batch two. Consensus meetings were held after each batch. Sufficient reliability was reached by batch three (ICC = 0.95 (0.79, 0.99)). Fibrosis volume increased significantly from 3 to 12 months (mean change = 1.28 mL (SD = 5.21), p = 0.006), as did pharyngeal impairment from baseline to 12 months (mean score change = 3.05 (SD = 3.02), p = 0.003). Fibrosis volume moderately correlated with pharyngeal impairment at 3 and 12 months (0.49, p = 0.004 and 0.59, p = 0.005, respectively). We demonstrated a reliable measure of fibrosis volume in swallowing musculature from existing clinical MRIs and identified that larger fibrosis volume was associated with worse swallowing function. The reliable capture of fibrosis volume offers a pragmatic method for early detection of fibrosis and concomitant dysphagia.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was funded by Dr. Martino’s career award Canada Research Chair in Swallowing Disorders.

Author information

Authors and Affiliations

  1. Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada

    Zhiyao Che & Rosemary Martino

  2. Department of Speech-Language Pathology, University of Torontto, Toronto, ON, Canada

    Zhiyao Che & Rosemary Martino

  3. The Swallowing Lab, University of Toronto, Swallowing Lab 160-500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada

    Zhiyao Che, Aliaa Sabry & Rosemary Martino

  4. Krembil Research Institute, University Health Network, Toronto, ON, Canada

    Zhiyao Che, Aliaa Sabry & Rosemary Martino

  5. Medical Imaging, University Health Network, Toronto, ON, Canada

    Aamir Suhail, Nicolin Hainc & Eugene Yu

  6. Diagnostic Imaging, Nova Scotia Health, Dartmouth, NS, Canada

    Aamir Suhail

  7. Radiology, Dalhousie University, Halifax, NS, Canada

    Aamir Suhail

  8. Neuroradiology, University Hospital of Zurich, Zurich, Switzerland

    Nicolin Hainc

  9. Biostatistics, University of Toronto, Toronto, ON, Canada

    Wei Xu

  10. Biostatistics, University Health Network, Toronto, ON, Canada

    Wei Xu

  11. Otolaryngology-Head & Neck Surgery, University Health Network, Toronto, ON, Canada

    David Goldstein

  12. Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada

    John Waldron & Shao Hui Huang

  13. Radiation Oncology, University of Toronto, Toronto, ON, Canada

    John Waldron & Shao Hui Huang

  14. Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada

    David Goldstein & Rosemary Martino

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  1. Zhiyao Che
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  2. Aamir Suhail
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Contributions

ZC and RM led the study conceptualization and design, with contributions from EY, WX, NH, JW, and DG. Material preparation was done by ZC, data collection was completed by ZC, AS, NH, and AS, and analyses were performed by ZC, RM, and WX. The first draft of the manuscript was written by ZC and all authors provided review and final approval.

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Correspondence to Rosemary Martino.

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Che, Z., Suhail, A., Hainc, N. et al. The Quantification of Radiation Fibrosis Using Clinically Indicated Magnetic Resonance Imaging for Head and Neck Cancer Patients. Dysphagia (2024). https://doi.org/10.1007/s00455-024-10678-2

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