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J Magn Reson Imaging. 2018 Nov;48(5):1208-1216. doi: 10.1002/jmri.26164. Epub 2018 Apr 25.

Integrating dynamic contrast-enhanced magnetic resonance imaging and diffusion kurtosis imaging for neoadjuvant chemotherapy assessment of nasopharyngeal carcinoma.

Author information

1
Department of Radiology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian Province, P.R. China.
2
Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian Province, P.R. China.
3
Philips Healthcare, Shanghai, P.R. China.
4
Philips Healthcare, Hong Kong, China.

Abstract

BACKGROUND:

Since neoadjuvant chemotherapy (NAC) has proven a benefit for locally advanced nasopharyngeal carcinoma (NPC), early response evaluation after chemotherapy is important to implement individualized therapy for NPC in the era of precision medicine.

PURPOSE:

To determine the combined and independent contribution between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion kurtosis imaging (DKI) in the early monitoring of NAC response for NPC.

STUDY TYPE:

Prospective.

POPULATION:

Fifty-three locally advanced NPC patients.

FIELD STRENGTH/SEQUENCE:

Four examinations before and at 4, 20, and 40 days after NAC initiation were performed at 3T MRI including DCE-MRI and DKI (b values = 0, 500, 1000, 1500 s/mm2 ).

ASSESSMENT:

DCE-MRI parameters (Ktrans [the volume transfer constant of Gd-DTPA], kep [rate constant], νe [the extracellular volume fraction of the imaged tissue], and νp [the blood volume fraction]) and DKI parameters (Dapp [apparent diffusion for non-Gaussian distribution] and Kapp [apparent kurtosis coefficient]) were analyzed using dedicated software.

STATISTICAL TESTS:

MRI parameters and their corresponding changes were compared between responders and nonresponders after one or two NAC cycles treatment using independent-samples Student's t-test or Mann-Whitney U-test depending on the normality contribution test and then followed by logistic regression and receiver operating characteristic curve (ROC) analyses.

RESULTS:

The responder group (RG) patients presented significantly higher mean Ktrans and Dapp values at baseline and larger Δ K ( 0 - 4 ) trans , Δvp(0-4) , and ΔDapp(0-4) values after either one or two NAC cycles compared with the nonresponder group (NRG) patients (all P < 0.05). ROC analyses demonstrated the higher diagnostic accuracy of combined DCE-MRI and DKI model to distinguish nonresponders from responders after two NAC cycles than using DCE-MRI (0.987 vs. 0.872, P = 0.033) or DKI (0.987 vs. 0.898, P = 0.047) alone.

DATA CONCLUSION:

Combined DCE-MRI and DKI models had higher diagnostic accuracy for NAC assessment compared with either model used independently.

LEVEL OF EVIDENCE:

2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1208-1216.

KEYWORDS:

diffusion kurtosis imaging; dynamic contrast-enhanced magnetic resonance imaging; nasopharyngeal carcinoma; neoadjuvant chemotherapy

PMID:
29693765
DOI:
10.1002/jmri.26164

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