| Part 1 Utility of three intravoxel incoherent motion diffusion weighted imaging(IVIMDWI)models to predict prognosis and survival risk in laryngeal and hypopharyngeal squamous cell carcinoma patients after chemoradiotherapyPurpose:To investigate the predicted prognosis and survival risk power of three IVIMDWI models in laryngeal and hypopharyngeal squamous cell carcinoma patients after chemoradiotherapy.Materials and methods:45 patients with laryngeal or hypopharyngeal squamous cell carcinoma were retrospectively enrolled.All patients had undergone pretreatment IVIMDWI examination,then mean apparent diffusion coefficient(ADCmean),maximum ADC(ADCmax),minimum ADC(ADCmin)and ADCrange(ADCmax-ADCmean)by mono-exponential model,and true diffusion coefficient(D),pseudo diffusion coefficient(D*),perfusion fraction(/)by bi-exponential model,and distributed diffusion coefficient(DDC),diffusion heterogeneity index(α)by stretched exponential model were all measured.Survival data were followed up for 5 years.Results:There were 31 cases in treatment failure group and 14 cases in local control group.Significantly lower ADCmean,ADCmax,ADCmin,D,f and higher D*values were presented in the treatment failure group than local control group(p<0.05).D*got the greatest AUC of 0.802,with the sensitivity 77.4%and specificity 85.7%when D*was 38.85×10-3 mm2/s.The survival curve of ADCmean,ADCmax,ADCmin,D,D*,f,DDC,and a values were found significant.Cox regression analysis showed ADCmean and D*were independently correlated with progression-free survival(PFS)(HR=0.125,p=0.001;HR=1.008,p=0.002,respectively).Conclusion:The pretreatment IVIM-DWI parameters were significantly correlated with prognosis of laryngeal and hypopharyngeal squamous cell carcinoma after chemoradiotherapy,ADCmean and D*values were independent factors for survival risk prediction.Part 2 Nomogram based on radiomics analysis of intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)bi-exponential model images:prediction of prognosis and survival risk in primary laryngeal and hypopharyngeal squamous cell carcinoma patients after chemoradiotherapyPurpose:To establish a prediction model by IVIM-DWI bi-exponential model for evaluating the survival risk of laryngeal and hypopharyngeal squamous cell carcinoma patients after chemoradiotherapy.Material and Methods:45 patients with laryngeal or hypopharyngeal squamous cell carcinoma were retrospectively enrolled.All patients had undergone pretreatment IVIMDWI examination with parameters including true diffusion coefficient(D),pseudo diffusion coefficient(D*),perfusion fraction(f)measured by bi-exponential model.With 5 years of follow-up,survival data was obtained for patients.Radiomics features were obtained using the PyRadiomics package,and the radiomics score was established by least absolute shrinkage and selection operator regression.A nomogram of radiomics score was generated,and Kaplan-Meier analysis was used for risk stratification.Results:31 cases were assigned in the treatment failure group,14 cases were local control group.The radiomics score consisted of 6 IVIM-DWI bi-exponential model features constructed the model and nomogram.The area under the curve(AUC)of the model was 0.804(95%CI:0.647-0.913),and sensitivity,specificity,accuracy of the model were 93.6%,64.3%,and 84.4%.Kaplan-Meier analysis of N stage and radiomics score showed significant difference in risk stratification.The hazard ratio of radiomics score was 1.306(95%CI:1.082-1.577),p<0.05.Conclusion:Radiomics analysis of IVIM-DWI bi-exponential model images could establish a prediction model and normogram to predict the long-term prognosis and survival risk of patients with laryngeal and hypopharyngeal squamous cell carcinoma after chemoradiotherapy,which can be used to guide the individualized treatment of patients.Part 3 Predictive value of dynamic contrast-enhanced MRI(DCE-MRI)quantitative parameters in long-term prognosis and survival risk of laryngeal and hypopharyngeal cancers after chemoradiotherapyPurpose:To investigate the relationship between quantitative parameters of dynamic contrast-enhanced MRI and long-term prognosis of patients with laryngeal and hypopharyngeal squamous cell carcinoma after chemoradiotherapy.Material and Methods:A total of 88 patients with laryngeal and hypopharyngeal squamous cell carcinoma treated from January 2013 to March 2016 were analyzed.DCEMRI was performed two weeks before standard chemoradiotherapy.Quantitative parameters including volume transfer constant(Ktrans),rate constant(Kep)and extravascular extracellular volume fraction(Ve)were measured.Patients were followed up 5 years to obtain the survival data.Results:61 cases were treatment failure group and 27 cases were local control group.The Ktrans(1.19±1.08/min vs 0.60±0.37/min)and Kep(2.49±3.43/min vs 1.05±0.56/min)in the treatment failure group were higher than those in the tumor control group,Ve was lower than tumor control group(0.52±0.27 vs 0.71±0.26),p<0.05.Kep got the greast AUC of 0.747,and when Kep was 1.15/min,the sensitivity and specificity for predicting long-term prognosis were 75.4%and 63.0%,respectively.Univariate Kaplan-Meier survival curve showed that Ktrans,Ve and Kep had significant differences in high and low risk groups(p<0.05),while there were no significant differences in T stage,N stage and tumor stage.Multivariate Cox regression analysis showed that Ktrans and Ve were independently correlated with progression free survival(PFS)(HR=2.912,p=0.000;HR=0.12,p=0.000).Conclusion:DCE-MRI quantitative parameters could predict the long-term prognosis of laryngeal and hypopharyngeal carcinoma after chemoradiotherapy.Ktrans and Ve values were independent factors for survival risk prediction.Part 4 The predictive value of time-signal intensity curve and semi-quantitative parameters of dynamic contrast-enhanced MRI(DCE-MRI)in long-term prognosis of laryngeal and hypopharyngeal carcinomas after chemoradiotherapyPurpose:To investigate the predictive value of time-signal intensity curve(TIC)and semi-quantitative parameters of dynamic contrast-enhanced MRI in long-term prognosis of patients with laryngeal and hypopharyngeal squamous cell carcinoma after chemoradiotherapy.Material and Methods:A total of 89 patients with laryngeal and hypopharyngeal squamous cell carcinoma treated from January 2013 to March 2016 were analyzed.DCEMRI was performed two weeks before standard chemoradiotherapy.Semi-quantitative parameters including time to peak(TTP),maximum slope of increase(MSI),maximum slope of decrease(MSD),positive enhancement integra(PEI),signal enhancement ratio(SER),SERmax and SERtime at 28s,42s,56s,70s,84s,98s after injection of contrast agent,and TIC types were measured.Patients were followed up 5 years to obtain the survival data.Results:There were 63 cases in the treatment failure group and 26 cases in local control group.There were significant differences in T stage and tumor stage,no difference in N stage and TIC type between the two groups.MSI value(106.67±30.39 vs 77.85±31.35),SER(%)value(48.46±63.70 vs 16.87±19.30),PEI(%)value(117.61±28.36 vs 94.28±29.83)of treatment failure group measured by 1.5T machine were higher than those of tumor control group,TTP(s)was lower than that of tumor control group(73.52±27.63 vs 91.03±20.49),SER(%)of 3.0T machine was higher in treatment failure group(8.84±4.37 vs 6.04±1.93),p<0.05.Whereas SERmax and SERtime had no statistical difference.MSI value of 1.5T machine got the greast AUC of 0.758,and when MSI was 75.53,the sensitivity and specificity for predicting long-term prognosis were 84.2%and 64.3%.Univariate Kaplan-Meier survival curve showed that there were significant differences in T stage,SER,MSI,PEI values of 1.5T machine and SER of 3.0T machine(p<0.05).Multivariate Cox regression analysis showed that MSI of 1.5T machine and SER of 3.0T machine were independently correlated with progression free survival(PFS)(HR=1.012,p=0.012;HR=1.12,p=0.009).Conclusion:DCE-MRI semi-quantitative parameters were correlated with long-termprognosis,and MSI value of 1.5T machine,SER value of 3.0T machine were predictors of 5-year survival risk of laryngeal and hypopharyngeal squamous cell carcinoma after chemoradiotherapy. |
PDF Full Text Request