| Part I:Diffusion-weighted imaging predicts theraputic effect of concurrent chemoradiation on nasopharyngeal carcinoma[Purpose]:To evaluate the application of pre-treatment diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) value on predicting therapeutic effect of concurrent chemoradiation in nasopharyngeal carcinoma.[Materials and methods]:65patients with confirmed nasopharyngeal carcinoma by nasopharyngoscope and biopsy pathology from October2009to December2012underwent DWI (b value=0,800s/mm2) before concurrent chemoradiation and were reexamined during treatment (receiving dose of50Gy) and after treatment (at the end of conventional treatment) on3.0T MR. The mean, maximum and minimum ADC value of tumor on DWI were achieved, in addition to the delineation of maximum area of tumor on pretreatment, during and after treatment respectively to calculate the tumor regression rate respectively. The subjects were classified into two groups according to the tumor regression rate after treatment as group complete response (CR) and group non-CR including partial response (PR) and stable disease (SD). Spearman correlation analysis was applied between ADC values and tumor regression rate. Use independent T-test to compare the ADC values between group CR and non-CR. Moreover, receiver operating characteristic curve (ROC) was applied for the evaluation of ADC values on predicting group CR.[Results]:The mean and maximum ADC demonstrated negative correlation to tumor regression rate of during and after treatment respectively (r=-0.463～-0.552, P<0.001). There were statistical differences between group CR and non-CR for mean ADC (0.98±0.12×10-3mm2/s VS.1.14±0.13×10-3mm2/s) and for maximum ADC (1.16±0.21±0.13×10-3mm2/s VS.1.42±0.23×10-3mm2/s) with both of P value less than0.001. ROC curve indicated that a threshold of mean ADC value set lower than1.09×10-3mm2/s on predicting group CR provided the specificity, sensitivity, and accuracy of82.50%(33/40),76.00%(19/25) and80.0%(52/65) respectively, with area under curve of0.816(P<0.001).[Conclusion]:DWI and ADC value before treatment were capable to predict theraputic effect after concurrent chemoradiation in nasopharyngeal carcinoma, which has potential to be helpful in individualized therapy. Part II:DCE-MRI predicts therapeutic outcome of concurrent chemoradiation on nasopharyngeal carcinoma[Purpose]:To evaluate pre-treatment dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) on predicting therapeutic response of concurrent chemoradiation in nasopharyngeal carcinoma.[Materials and methods]:61patients with nasopharyngeal carcinoma confirmed by nasopharyngoscope and biopsy pathology from October2009to December2012were conducted DCE-MRI before concurrent chemoradiation and reexamined on during treatment (receiving dose of50Gy) and after treatment (at the end of conventional treatment). Time-signal intensity curve (TIC) and semiquantitative parameters of pretreatment tumor mean, high-enhanced areas and low-enhanced areas, including time to peak (TTP), positive enhancement integral (PEI), maximum slop of increase (MSI) and maximum slop of decrease (MSD) were achieved. The patients were classified into two groups according to the tumor regression rate after treatment as group complete response (CR) and group non-CR including partial response (PR) and stable disease (SD) Spearman correlation analysis was performed between semiquantitative parameters and tumor regression rate. Use Mann-Whitney U test to compare the pretreatment semiquantitative parameters between group CR and non-CR, and the value of parameters on predicting CR were evaluated by receiver operating characteristic curve (ROC).[Results]:The semiquantitative parameters observed to possess statistical significant correlations with tumor regression rate consisted of TIC, TTP of pretreatment tumor mean, high-enhanced areas and low-enhanced areas, and PEI of tumor high-enhanced areas (r:-0.307--0.724, P:<0.001-0.016), MSI of tumor mean and low-enhanced areas, MSD of tumor mean, high-enhanced areas and low-enhanced areas(r:0.2620.329, P:<0.001-0.037). There were statistical significances between group CR and non-CR in TIC and TTP of tumor mean, high-enhanced areas and low-enhanced areas, MSI of tumor low-enhanced areas, MSD of tumor mean, high-enhanced areas (P:<0.001-0.038). ROC indicated that on predicting CR, a threshold at tumor low-enhanced area TTP set lower than70s provided the specificity, sensitivity, and accuracy were83.33%(30/36),76.00%(19/25) and80.33%(49/61) respectively, with area under curve of0.817(P<0.001).[Conclusion]:Pretreatment semiquantitative parameters of DCE-MRI could predict tumor regression and therapeutic effect of concurrent chemoradiation in nasopharyngeal carcinoma, which would to be helpful in clinical decision in individualized therapy.. Part Ⅲ:Pretreatment semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging predict therapeutic effect of concurrent chemoradiation in nasopharyngeal carcinoma[Purpose]:To evaluate pretreatment semiquantitative and quantitative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) on predicting therapeutic effect of concurrent chemoradiation in nasopharyngeal carcinoma.[Materials and methods]:36patients with nasopharyngeal carcinoma proved by nasopharyngoscope and biopsy pathology from January to December2013were conducted DCE-MRI before concurrent chemoradiation. Measure the mean (delineation of maximum area of tumor) and hot area (depicted on Ktrans map) semiquantitative and quantitative parameters processed by GenIQ software (GE) including MaxSlop, CER, IAUGC, Ktrans, Kep and Ve. The patients were reexamined by MRI during treatment (receiving dose of50Gy) and after treatment (at the end of conventional treatment), and classified into two groups according to the tumor regression rate after treatment as group complete response (CR) and group non-CR including partial response (PR) and stable disease (SD) Analyze the correlations between pretreatment parameters and tumor regression rate. Parameters between group CR and non-CR were compared by independent T-test, and the value of parameters on predicting sensitive therapeutic effect was evaluated by receiver operating characteristic curve (ROC).[Results]:Tumor regression rate during and after treatment had positive correlation with tumor mean and hot area IAUGC, Ktrans, Kep, mean Maxslop and hot area CER (r:0.341-0.608, P:<0.001-0.042), and tumor mean CER only demonstrated positive correlation to tumor regression rate after treatment (r=0.350, P=0.036). Statistical significances were existed between group CR and non-CR in tumor hot area CER (1.802±0.297VS.1.567±0.293) and IAUGC (0.236±0.040VS.0.193±0.031), mean Ktrans (0.178±0.033min-1VS.0.136±0.033min-1), hot area Ktrans (0.228±0.042min-1VS.0.177±0.031min-1) and mean Kep (1.246±0.313min-1VS.0.925±0.228min-1)(P:<0.001-0.024). ROC indicated that when setting threshold of Kep on more than and equal to1.11min-1for predicting CR after treatment, the specificity, sensitivity and accuracy were71.43%(15/21),86.67%(13/15) and77.78%(28/36) respectively, with area under curve of0.832(P=0.001).[Conclusion]:Pretreatment semiquantitative and quantitative DCE-MRI were capable to predict therapeutic effect of concurrent chemoradiation in nasopharyngeal carcinoma, which would to be helpful in clinical decision in individualized therapy. |
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