Assessment Of DCE-MRI?DWI And Serum Amino Acids In The Patients With Nasopharyngeal Carcinoma With Neoadjuvant Chemotherapy And Intensity Modulated Radiation Therapy

Objective:To determine the quantitative parameters(K^trans,K_ep,V_e)before and after neoadjuvant chemotherapy plus modulated radiation therapy in patients with nasopharyngeal carcinoma by using quantitative dynamic contrast-enhanced magnetic resonance imaging?DCE-MRI?and diffusion-weighted imaging?DWI?.Apparent diffusion coefficient?ADC?value changes in order to explore the DCE-MRI and DWI in nasopharyngeal carcinoma neoadjuvant chemotherapy plus intensity modulated radiotherapy efficacy evaluation and prognostic judgment.Methods:This study analyzed the clinical data of 30 patients with nasopharyngeal carcinoma diagnosed with poorly differentiated squamous cell carcinoma in our hospital pathology.All patients received neoadjuvant chemotherapy plus modulated radiotherapy,neoadjuvant chemotherapy plus modulated radiotherapy.Dynamic contrast-enhanced magnetic resonance imaging?DCE-MRI?and diffusion-weighted imaging?DWI?scans were performed before and after the study.Analysis of the correlation between different clinical stages of nasopharyngeal carcinoma and DCE-MRI parameters(K^trans,K_ep,V_e)and apparent diffusion coefficient?ADC?of DWI;comparison of DCE-MRI parameters before and after induction chemotherapy plus radiotherapy(K^trans,K_ep,V_e)and DWI Apparent Diffusion Coefficient?ADC?changes;and to compare the differences in the parameters of different efficacy and prognosis of patients with different prognosis.Thirty patients with nasopharyngeal carcinoma were included in this study.The concentration of plasma amino acids profiling were measured using high-performance liquid chromatography spectroscopy.Statistical analyses were performed using the paried t-test,correlation were performed using Pearson correlation test with SPSS 13.0.A p value<0.05 was considered statistically significant.Results:?1?Prior to chemoradiation,DCE-MRI parameters(K^trans,K_ep,V_e)and apparent diffusion coefficient?ADC?of DWI were higher in the nasopharyngeal carcinoma tumor area than in the contralateral outer muscle.There was a statistically significant difference in K^trans,K_ep,V_eand ADC values??during different clinical periods(except for K_epbetween stage II and III and ADCs between stage III and IV).Clinical staging and T staging of NPC were positively correlated with K_transand negatively correlated with ADC.The difference in ADC between stage III and IV was not statistically significant?P>0.05?.?2?The values??of K^trans,K_ep,and V_eafter radiotherapy and chemotherapy were all lower than those before and after radiotherapy and chemotherapy?P<0.05?.The ADC value after radiotherapy and chemotherapy was higher than before radiotherapy and chemotherapy,and the difference was statistically significant.?P<0.05?.?3?After the end of treatment,there were 6 cases who were fully effective,17cases were partially effective,7 cases were stable,and no deterioration occurred.The effective rate was 76.67%.Percentage change was calculated based on changes in DCE-MRI quantitative parameters and ADC values??before and after treatment in patients with different therapeutic effects:?pre-treatment-post-treatment?/pretreatment X 100%,DCE-MRI of patients with different efficacy The percentage of changes in each quantitative parameter and ADC value(K_?PC?^trans,K_ep?PC?,V_e?PC?,ADC_?PC?)were significantly different?P<0.05?.?4?During the follow-up period,there were 3 cases of recurrence after radiotherapy and chemotherapy.The T1WI of the recurrent tumor showed iso-and slightly hypo-intensity signals,and the T2WI showed inhomogeneous and slightly hyper-intensity signals.DWI showed high or slightly high signal intensity in recurrent tumors.The ADC value was?0.91±0.06?×10-3mm2/s.Most DWIs with no recurrence showed equal,slightly high signal,and a few showed low signal.The ADC value was?1.29±0.21?×10-3mm2/s,there was a statistically significant difference in the ADC values??between relapsers and those without recurrence?P<0.05?.?5?Thirty patients with nasopharyngeal carcinoma were included in this study.The concentration of 20 plasma amino acids profiling were measured using high-performance liquid chromatography spectroscopy.The concentrations of ASP,THR,SER,CIT,ORN,PRO and ARG in patients with post-treatment were significantly higher than those with pre-treatment?P<0.05?,but the concentrations of TAU,GLU,GLN,VAL,CYS,LEU and LYS were significantly lower?P<0.05?.There were no significant differences in ALA,TYR,PHE and HIS between pre-treatment and post-treatment?P>0.05?.?6?Before treatment,the concentration of TAU,THR,GLU,GLN,GLY,CIT,VAL,CYS,LEU and LYS was positively correlated with DCE-MRI parameter K^trans,respectivily?P<0.05?.The concentrations of TAU,GLU,VAL and CYS were positively correlated with DCE-MRI parameter K_ep,respectivily?P<0.05?.The concentrations of GLN and VAL were positively correlated with DCE-MRI parameter Ve,respectivily?P<0.05?.The concentrations of GLU,GLN and VAL were positively correlated with ADC values of DWI,respectivily?P<0.05?.However,the concentrations of PRO were negatively correlated with K^transand K_ep,respectivily?P<0.05?.Conclusions:?1?The measurement of K^trans,K_ep,V_eand ADC values??by quantitative DCE-MRI and DWI can reflect the difference between normal tissue structure and nasopharyngeal carcinoma lesions,and help to judge whether the tumor invaded the surrounding tissue.Ktrans and ADC can distinguish the early and late stages of nasopharyngeal carcinoma and can be used to diagnose the clinical stage of nasopharyngeal carcinoma.?2?The values??of K^trans,K_ep,and V_ewere significantly decreased after treatment with radiotherapy and chemotherapy.The ADC value was significantly increased with an effective rate of 76.67%,indicating that radiotherapy and chemotherapy have good clinical efficacy for nasopharyngeal carcinoma.In addition,the better the efficacy of radiotherapy and chemotherapy,the higher the percentage change of quantitative DCE-MRI parameters and ADC values,so the clinical efficacy of radiotherapy and chemotherapy can be evaluated by the percentage change of each parameter.?3?Quantitative DCE-MRI can basically reflect the local changes after radiotherapy and chemotherapy of nasopharyngeal carcinoma,and has important diagnostic value for the recurrence of nasopharyngeal carcinoma.DWI can provide the characteristic information of the lesion from the molecular level,combined with DWI and ADC values??can provide a certain reference for the diagnosis of recurrence after radiotherapy and chemotherapy for nasopharyngeal carcinoma.?4?Quantitative DCE-MRI and DWI can quantitatively evaluate the effect of radiotherapy and chemotherapy for nasopharyngeal carcinoma from different pathophysiological perspectives,and provide objective imaging evidence for the adjustment and adjustment of clinical nasopharyngeal carcinoma treatment programs.?5?The plasma amino acid profiling high-performance liquid chromatography spectroscopy revealed,to some extent,the effect of radiotherapy and chemotherapy.Measurement of amino aicds is of certain significance for evaluating the clinical treatment of patients with nasopharyngeal carcinoma and providing guidance on clinical treatment.