Cancer Res Treat.  2019 Jan;51(1):345-356. 10.4143/crt.2018.089.

Longitudinal Assessment of Intravoxel Incoherent Motion Diffusion Weighted Imaging in Evaluating the Radio-sensitivity of Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiation Therapy

• Xiao Y
• Chen Y
• Chen Y
• He Z
• Yao Y
• Pan J

• KMID: 2437625
• DOI: http://doi.org/10.4143/crt.2018.089

Abstract

PURPOSE
Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI)was evaluated regarding its ability to preliminarily predict the short-term treatment response of nasopharyngeal carcinoma (NPC) following intensity-modulated radiation therapy.
MATERIALS AND METHODS
IVIM-DWI with 14 b-factors (0-1,000 sec/mm2) was performed with a 3T MR system on 47 consecutive NPCs before, during (end of the 5th, 10th, 15th, 20th, and 25th fractions), and after fractional radiotherapy. IVIM parametrics (D, f, and D*) were calculated and compared to the baseline and xth fraction. Patients were categorized into responders and non-responders after radiotherapy. IVIM parametrics were also compared between subgroups.
RESULTS
After fractional radiations, the D (except D5 and D at the end of the 5th fraction) after radiations were larger than the baseline D0 (p < 0.05), and the post-radiation D* (except D*5 and D*10) were smaller than D*0 (p < 0.05). f0 was smaller than f5 and f10 (p < 0.001) but larger than fend (p < 0.05). Furthermore, greater D5, D10, D15, and f10 coupled with smaller f0, D*20, and D*25 were observed in responders than non-responders (all p < 0.01). Responders also presented larger ΔD10, Δf10, ΔD*20, and δD*20 than non-responders (p < 0.05). Receiver operating characteristic curve analysis indicated that the D5, D*20, and f10 could better differentiate responders from non-responders.
CONCLUSION
IVIM-DWI could efficiently assess tumor treatment response to fractional radiotherapy and predict the radio-sensitivity for NPCs.

Keyword

Intravoxel incoherent motion; Diffusion-weighted imaging; Nasopharyngeal carcinoma; Radiosensitivity; Intensity-modulated radiotherapy

MeSH Terms

Diffusion*
Humans
Radiation Tolerance
Radiotherapy
Radiotherapy, Intensity-Modulated
ROC Curve

Figure

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  Fig. 1. Comparison of intravoxel incoherent motion parametrics. D (A), f (B), and D* (C) between responders versus nonresponders during intensity-modulated radiation therapy. RT, radiotherapy.

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  Fig. 2. Intravoxel incoherent motion diffusion-weighted imaging analysis identifies a 37-year-old man with undifferentiated non-keratinizing nasopharyngeal carcinoma as a responder to radiotherapy. The regions of interests (yellow lines) were manually contoured along the bordering of primary nasophayngeal carcinoma on the maps of T2-weighted imaging with short TI inversion recovery (T2WI-STIR) (A), D (B), f (C), and D* (D) before initial radiotherapy, respectively. The baseline D0, f0, and D*0 are calculated as 0.703×10–3 mm2/sec, 0.238, and 144.623×10–3 mm2/sec, respectively. Maps represent the postradiation T2WI-STIR (E), D (F), f (G), and D* (H) following the completion of the 15th fraction radiation, and the corresponding D15, f15, and D*15 are measured as 1.216×10–3 mm2/sec, 0.235, and 97.138×10–3 mm2/sec, respectively.

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  Fig. 3. A 67-year-old male patient with nasopharyngeal carcinoma was identified by intravoxel incoherent motion diffusion-weighted imaging analysis as a non-responder after radiotherapy. Maps depict the baseline T2-weighted imaging with short TI inversion recovery (T2WI-STIR) (A), D (B), f (C), and D* (D) before radiotherapy as well as the T2WI-STIR (E), D (F), f (G), and D* (H) following completion of the 20th fraction radiation. By manually drawing the regions of interest (yellow lines) along the edge of primary nasophayngeal carcinoma, the baseline D0, f0, and D*0 are calculated as 0.918×10–3 mm2/sec, 0.257, and 150.137×10–3 mm2/sec, whereas the corresponding D20, f20, and D*20 measured are 1.035×10–3 mm2/sec, 0.239, and 133.021×10–3 mm2/sec, respectively.

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  Fig. 4. The receiver operating characteristic curves of intravoxel incoherent motion parametrics. D (A), f (B), and D* (C) in predicting tumor responsiveness to radiotherapy.

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