Treatment response prediction of nasopharyngeal carcinoma based on histogram analysis of diffusional kurtosis imaging

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Abstract

BACKGROUND AND PURPOSE: The prediction of treatment response is important in planning and modifying the chemoradiation therapy regimen. This study aimed to explore the quantitative histogram indices for treatment-response prediction of nasopharyngeal carcinoma based on diffusional kurtosis imaging compared with a standard ADC value (ADC standard ). MATERIALS AND METHODS: Thirty-six patients with an initial diagnosis of locoregionally advanced nasopharyngeal carcinoma and diffusional kurtosis imaging acquisitions before and after neoadjuvant chemotherapy were enrolled. Patients were divided into respondversus- nonrespond groups after neoadjuvant chemotherapy and residual-versus-nonresidual groups after radiation therapy. Histogram parameters of diffusional kurtosis imaging- derived parameters (ADC, ADC coefficient corrected by the non-Gaussain model [D], apparent kurtosis coefficient without a unit [K]) were calculated. The ADC standard was calculated on the basis of intravoxel incoherent movement data. The intraclass correlation coefficient, Kolmogorov-Smirnov test, Student t test or Mann-Whitney U test, and receiver operating characteristic analysis were performed. RESULTS: Most of the parameters had good-to-excellent consistency (intraclass correlation coefficient = 0.675-0.998). The pre-ADC standard , pre-ADC (10th, 25th, 50th percentiles), pre-D (10th, 25th, 50th percentiles), and pre-K50th were significantly different between the respond and nonrespond groups, while the pre-ADC 10th , pre-K 90th , post-ADC 50th , post-K 75th , post-K 90th , and the percentage change of parameters before and after neoadjuvant chemotherapy (Δ ADC 50th %) were significantly different between the residual and nonresidual groups (all P < .05). Receiver operating characteristic analysis indicated that setting pre-D 50th = 0.875 × 10 -3 mm 2 /s as the cutoff value could result in optimal diagnostic performance for neoadjuvant chemotherapy response prediction (area under the curve=0.814, sensitivity=0.70, specificity=0.92), while the post-K 90th =1.035 (area under the curve=0.829, sensitivity=0.78, specificity=0.72), and Δ ADC 50th %=0.253 (area under the curve=0.833, sensitivity=0.94, specificity=0.72) were optimal for radiation therapy response prediction. CONCLUSIONS: Histogram analysis of diffusional kurtosis imaging may potentially predict the neoadjuvant chemotherapy and shortterm radiation therapy response in locoregionally advanced nasopharyngeal carcinoma, therefore providing evidence for modification of the treatment regimen.

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Tu, N., Zhong, Y., Wang, X., Xing, F., Chen, L., & Wu, G. (2019). Treatment response prediction of nasopharyngeal carcinoma based on histogram analysis of diffusional kurtosis imaging. American Journal of Neuroradiology, 40(2), 326–333. https://doi.org/10.3174/ajnr.A5925

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