Heterogeneity analysis of diffusion-weighted MRI for prediction and assessment of microstructural changes early after one cycle of induction chemotherapy in nasopharyngeal cancer patients



To evaluate whether the pretreatment apparent diffusion coefficient (ADC) heterogeneity parameters and their alterations, after one cycle of induction chemotherapy, can be used as reliable markers of treatment response to induction chemotherapy in patients with nasopharyngeal cancer.

Materials and methods

Ten patients were recruited and received induction chemotherapy (IC). Diffusion-weighted imaging was performed prior to, during, and after IC. The first-order ADC histogram parameters at the intra-treatment time-point were compared to the baseline time-point in the metastatic lymph nodes (LNs). Some ADC pretreatment parameters were combined with each other, employing discriminant analysis to achieve a feasible model to separate the complete response (CR) from the partial response (PR) groups.


For ten patients, significant rise in Mean and Txt1Mean (p = 0.048 and 0.015, respectively) was observed in the metastatic nodes following one cycle of IC. Txt5Energy significantly decreased (p = 0.002). Discriminant analysis on pretreatment parameters illustrated that Txt5Energypre was the best parameter to use to correctly classify CR and PR patients. This was followed by Txt9Percentile75pre, Txt1Meanpre, and Txt2Standard Deviationpre.


Our results suggest that heterogeneity metrics extracted from ADC-maps in metastatic lymph nodes, before and after IC, can be used as supplementary IC response indicators.

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This work was fully supported by a Grant from the Shahid Beheshti University of Medical Science (Grant number: 5232), Tehran, Iran. We are extremely grateful to Ms Aramesh Safari and Mr Pedram Rostami for providing imaging data in Payambaran MRI center. Also, we would like to thank Clinical Research Development Center in Imam Hosein Hospital for highly contributing to the progression of this project.

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Corresponding author

Correspondence to Ahmad Ameri.

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This study was funded by Grant number 5232.

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The authors declare no conflict of interest

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Beigi, M., Kazerooni, A.F., Safari, M. et al. Heterogeneity analysis of diffusion-weighted MRI for prediction and assessment of microstructural changes early after one cycle of induction chemotherapy in nasopharyngeal cancer patients. Radiol med 123, 36–43 (2018). https://doi.org/10.1007/s11547-017-0808-9

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  • Nasopharyngeal cancer
  • Lymph node
  • Induction chemotherapy
  • Diffusion-weighted MRI