Intravoxel incoherent motion imaging kinetics during chemoradiotherapy for human papillomavirus-associated squamous cell carcinoma of the oropharynx: preliminary results from a prospective pilot study.
Intravoxel incoherent motion imaging kinetics during chemoradiotherapy for human papillomavirus-associated squamous cell carcinoma of the oropharynx: preliminary results from a prospective pilot study.
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DOI：
10.1002/nbm.3412
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发表时间：
2015-12
影响因子：
2.9
通讯作者：
Fuller CD
中科院分区：
文献类型：
--
作者：
Ding Y;Hazle JD;Mohamed AS;Frank SJ;Hobbs BP;Colen RR;Gunn GB;Wang J;Kalpathy-Cramer J;Garden AS;Lai SY;Rosenthal DI;Fuller CD
本研究旨在确定人乳头瘤病毒相关 (HPV+) 口咽鳞状细胞癌患者体素内不相干运动 (IVIM) 磁共振成像 (MRI) 的时间动力学。作为正在进行的前瞻性临床试验的一部分，患者根据 IRB 批准的方案进行招募。所有患者均接受了两次 MRI 研究，一次是放化疗前的基线扫描，另一次是治疗开始后 3-4 周的治疗中期扫描。生成代表纯扩散系数 (D)、伪扩散系数 (D*)、灌注分数 (f) 和表观扩散系数 (ADC) 的参数图。 Mann-Whitney U 检验用于评估 IVIM 指标的时间变化。贝叶斯二次判别分析 (QDA) 用于评估治疗中期 IVIM 指标变化可以在多大程度上组合起来，以预测在多变量分析中实现完全缓解 (CR) 的部位。最终分析31例患者，59个病灶。完全缓解（CR）病灶（n=19）的治疗前ADC和D值显着低于非CR病灶（n=33）。所有病灶的治疗中期 ADC、D 和 f 值均显着高于治疗前值 (P < .0001)。标准化 ΔADC 每增加 0.1 个单位，CR 几率就会增加 1.45 倍（P<.0003），标准化 ΔD 每增加 0.1 个单位，CR 几率就会增加 1.53 倍（P<.0002），而 Δf 每增加一个单位，CR 几率就会增加 2.29 倍（P <.02）。将 ΔD 和 ΔADC 组合整合到多变量预测模型中，并在留一交叉验证下获得 AUC=0.87（95% CI：0.79，0.96）以及灵敏度=0.63、特异性=0.85 和准确度=0.78。总之，IVIM 在预测和评估 HPV+ 口咽鳞状细胞癌对放化疗的早期反应方面是可行的，并且可能有用。我们的数据显示，较低的治疗前表观扩散系数 (ADC) 和纯扩散系数 (D) 值与放化疗期间的早期放射学 CR 相关。所有病灶的治疗中期 ADC、D 和 f 值均显着高于治疗前值 (P < .0001)。结合 ΔADC 和 ΔD 的模型可以高度预测早期 CR。无创 IVIM MRI 是可行的，并且可能有助于预测和评估 HPV+ 口咽 SCC 对放化疗的早期反应。
This study aims to identify the temporal kinetics of intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in patients with human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma. Patients were enrolled under an IRB-approved protocol as part of ongoing prospective clinical trial. All patients underwent two MRI studies, a baseline scan before chemoradiotherapy and a midtreatment scan 3–4 weeks of treatment initiation. Parametric maps representing pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC) were generated. The Mann-Whitney U test was used to assess temporal variation of IVIM metrics. Bayesian quadratic discriminant analysis (QDA) was used to evaluate the extent to which midtreatment changes in IVIM metrics could be combined to predict sites that would achieve complete response (CR) in multivariate analysis. A total of 31 patients were included in the final analysis with 59 lesions. Pretreatment ADC and D values of the complete response (CR) lesions (n=19) were significantly lower than non-CR lesions (n=33). Midtreatment ADC, D, and f values were significantly higher (P < .0001) than pretreatment values for all lesions. Each increase in normalized ΔADC of size 0.1 yielded a 1.45-fold increase in the odds of CR (P<.0003), each increase in normalized ΔD of size 0.1 yielded a 1.53-fold increase in the odds of CR (P<.0002), and each unit increase in Δf yielded a 2.29-fold increase in the odds of CR (P < .02). Combined ΔD and ΔADC were integrated into a multivariate prediction model and attained an AUC=0.87 (95% CI: 0.79, 0.96) as well as sensitivity=0.63, specificity=0.85, and accuracy=0.78 under leave-one-out cross-validation. In conclusion, IVIM is feasible and potentially useful in prediction and assessment of early response of HPV+ oropharyngeal squamous cell carcinoma to chemoradiotherapy. Our data showed that a low pretreatment apparent diffusion coefficient (ADC) and pure diffusion coefficient (D) values were associated with early radiologic CR during chemoradiotherapy. Midtreatment ADC, D, and f values were significantly higher (P < .0001) than pretreatment values for all lesions. A model combining ΔADC and ΔD is highly predictive of early CR. Noninvasive IVIM MRI is feasible and potentially useful for predicting and assessing early responses of HPV+ oropharyngeal SCC to chemoradiotherapy.