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Intravoxel water diffusion heterogeneity MR imaging of nasopharyngeal carcinoma using stretched exponential diffusion model

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Abstract

Purpose

To determine the utility of stretched exponential diffusion model in characterisation of the water diffusion heterogeneity in different tumour stages of nasopharyngeal carcinoma (NPC).

Materials and methods

Fifty patients with newly diagnosed NPC were prospectively recruited. Diffusion-weighted MR imaging was performed using five b values (0–2,500 s/mm2). Respective stretched exponential parameters (DDC, distributed diffusion coefficient; and alpha (α), water heterogeneity) were calculated. Patients were stratified into low and high tumour stage groups based on the American Joint Committee on Cancer (AJCC) staging for determination of the predictive powers of DDC and α using t test and ROC curve analyses.

Results

The mean ± standard deviation values were DDC = 0.692 ± 0.199 (×10−3 mm2/s) for low stage group vs 0.794 ± 0.253 (×10−3 mm2/s) for high stage group; α = 0.792 ± 0.145 for low stage group vs 0.698 ± 0.155 for high stage group. α was significantly lower in the high stage group while DDC was negatively correlated. DDC and α were both reliable independent predictors (p < 0.001), with α being more powerful. Optimal cut-off values were (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio) DDC = 0.692 × 10−3 mm2/s (94.4 %, 64.3 %, 2.64, 0.09), α = 0.720 (72.2 %, 100 %, −, 0.28).

Conclusion

The heterogeneity index α is robust and can potentially help in staging and grading prediction in NPC.

Key Points

• Stretched exponential diffusion models can help in tissue characterisation in nasopharyngeal carcinoma

• α and distributed diffusion coefficient (DDC) are negatively correlated

• α is a robust heterogeneity index marker

• α can potentially help in staging and grading prediction

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Abbreviations

α:

Alpha (intravoxel water diffusion heterogeneity)

AJCC:

American Joint Committee on Cancer

AUC:

Area under curve

DDC:

Distributed diffusion coefficient

DW:

Diffusion-weighted

F-FDG:

18-fluoro-2-deoxyglucose

IVIM:

Intravoxel incoherent motion

MR:

Magnetic resonance

NPC:

Nasopharyngeal carcinoma

PET/CT:

Positron emission tomography with computed tomography

ROC:

Receiver operating characteristic

ROI:

Region-of-interest

SD:

Standard deviation

SNR:

Signal-to-noise ratio

SPIR:

Spectral presaturation inversion recovery

STIR:

Short TI inversion recovery

TFE:

Turbo-field-echo

TR/TE:

Repetition time/echo time

TSE:

Turbo spin echo

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Acknowledgments

The scientific guarantor of this publication is Prof. Khong Pek Lan. The authors of this manuscript declare relationships with the following companies: Dr. Q Chan is currently employed by Philips Medial Systems. This study has received funding by University Grants Council (UGC) seed funding from The University of Hong Kong, project no. 201112159010.

No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required because this study did not involve animals. Study subjects or cohorts have not been previously reported.

Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam, Hong Kong

    Vincent Lai & Pek Lan Khong

  2. Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, University of Hong Kong, 1/F Professorial Block, Pok Fu Lam, Hong Kong

    Victor Ho Fun Lee, Ka On Lam & Henry Chun Kin Sze

  3. Philips Healthcare, Hong Kong, 6/F, Core Building 1, 1 Science Park East Avenue, Hong Kong Science Park, Shatin, New Territories, Hong Kong

    Queenie Chan

Authors
  1. Vincent Lai
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  2. Victor Ho Fun Lee
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  3. Ka On Lam
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  4. Henry Chun Kin Sze
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  5. Queenie Chan
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  6. Pek Lan Khong
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Correspondence to Vincent Lai.

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Lai, V., Lee, V.H.F., Lam, K.O. et al. Intravoxel water diffusion heterogeneity MR imaging of nasopharyngeal carcinoma using stretched exponential diffusion model. Eur Radiol 25, 1708–1713 (2015). https://doi.org/10.1007/s00330-014-3535-9

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  • DOI: https://doi.org/10.1007/s00330-014-3535-9

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