Multiparametric positron emission tomography/magnetic resonance imaging in nasopharyngeal carcinoma: Correlations between magnetic resonance imaging functional parameters and  18 F-fluorodeoxyglucose positron emission tomography imaging biomarkers and their predictive value for treatment failure

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Abstract

Objectives:

The clinical significance of positron emission tomography/magnetic resonance imaging (PET/MRI) functional parameters in nasopharyngealcarcinoma (NPC) remains unclear. The purpose of this prospective study was two-fold: (1) to investigate the associations between simultaneously acquired PET/MRI perfusion, diffusion, and glucose metabolism parameters in patients with NPC and (2) to analyze their predictive value with respect to treatment failure.

Materials and Methods:

We enrolled 85 patients with primary NPC who simultaneously underwent ¹⁸F-fluorodeoxyglucose PET/CT and PET/MRI before definitive treatment. The following variables were determined: (1) functional parameters from the MRI component, including perfusion values ( K ^trans , k _ep , v _e , and initial area under the enhancement curve) and apparent diffusion coefficient (ADC) values, and (2) PET parameters, including metabolic tumor volume (MTV). The reciprocal interrelationships between these parameters and their correlations with treatment failure were examined.

Results:

We observed significant negative associations between K ^trans and ADC ( r = −0.215, P = 0.049) as well as between v _e and ADC ( r = −0.22, P = 0.04). Correlations between PET and MRI functional parameters were not statistically significant. Treatment failures were observed in 21.2% of patients without distant metastases. Multivariate analysis identified v _e as a significant independent predictor for treatment failure ( P = 0.022), whereas MTV showed a borderline significance ( P = 0.095). Patients in whom both v _e and MTV values were increased had a significantly higher rate of treatment failure (62.5%) than those with either one (21.9%) or no (7.7%) increased parameter ( P = 0.004).

Conclusion:

Correlation analyses revealed complex interrelationships among PET and MRI indices measured in patients with NPC. These parameters may have a complementary role in predicting treatment failure in this clinical setting.

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Most cited references 37

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Epidemiological trends during the past decade suggest that although incidence of nasopharyngeal carcinoma is gradually declining, even in endemic regions, mortality from the disease has fallen substantially. This finding is probably a result of a combination of lifestyle modification, population screening coupled with better imaging, advances in radiotherapy, and effective systemic agents. In particular, intensity-modulated radiotherapy has driven the improvement in tumour control and reduction in toxic effects in survivors. Clinical use of Epstein-Barr virus (EBV) as a surrogate biomarker in nasopharyngeal carcinoma continues to increase, with quantitative assessment of circulating EBV DNA used for population screening, prognostication, and disease surveillance. Randomised trials are investigating the role of EBV DNA in stratification of patients for treatment intensification and deintensification. Among the exciting developments in nasopharyngeal carcinoma, vascular endothelial growth factor inhibition and novel immunotherapies targeted at immune checkpoint and EBV-specific tumour antigens offer promising alternatives to patients with metastatic disease.

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In this article, we present the basic principles of diffusion-weighted imaging (DWI) that can aid radiologists in the qualitative and quantitative interpretation of DW images. However, a detailed discussion of the physics of DWI is beyond the scope of this article. A short discussion ensues on the technical aspects of performing DWI in the body. The emerging applications of DWI for tumor detection, tumor characterization, distinguishing tumor tissue from nontumor tissue, and monitoring and predicting treatment response are highlighted. The challenges to widespread adoption of the technique for cancer imaging in the body are discussed. DWI derives its image contrast from differences in the motion of water molecules between tissues. Such imaging can be performed quickly without the need for the administration of exogenous contrast medium. The technique yields qualitative and quantitative information that reflects changes at a cellular level and provides unique insights about tumor cellularity and the integrity of cell membranes. Recent advances enable the technique to be widely applied for tumor evaluation in the abdomen and pelvis and have led to the development of whole-body DWI.

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To evaluate the potential of diffusion-weighted (DW) magnetic resonance (MR) imaging with an apparent diffusion coefficient (ADC) map in the prediction of response to neoadjuvant chemotherapy in patients with breast cancer. This retrospective study was approved by the institutional review board, which waived the informed consent requirement. Fifty-three consecutive women (mean age, 43.7 years; median age, 42.0 years; age range, 24-65 years) with 53 invasive breast cancers (mean diameter, 5.0 cm; median diameter, 4.2 cm; diameter range, 2.0-13.3 cm) who had undergone chemotherapy were included. Both DW MR imaging (b values, 0 and 750 sec/mm(2)) and dynamic contrast material-enhanced (DCE) MR imaging were performed at 1.5 T before and after chemotherapy prior to surgery. Mean time from initiation of chemotherapy to posttreatment ADC measurement was 54 days (range, 48-62 days). Average ADC for three regions of interest per tumor on ADC maps was calculated. Patients with a reduction in tumor diameter of at least 30% after chemotherapy at DCE MR imaging were defined as responders. Pretreatment ADCs and percentage increases in ADC after chemotherapy in responders and nonresponders were compared. The best pretreatment ADC cutoff with which to differentiate between responders and nonresponders was calculated with receiver operating characteristic curve analysis. After chemotherapy, 36 (68%) patients were classified as responders, and 17 (32%) were classified as nonresponders. Pretreatment mean ADC ([1.036 ± 0.015] × 10(-3) mm(2)/sec [standard error]) of responders was significantly lower than that of nonresponders ([1.299 ± 0.079] × 10(-3) mm(2)/sec) (P = .004). Furthermore, mean percentage ADC increase of responders (47.9% ± 4.8) was higher than that of nonresponders (18.1% ± 4.5) (P < .001). The best pretreatment ADC cutoff with which to differentiate between responders and nonresponders was 1.17 × 10(-3) mm(2)/sec, which yielded a sensitivity of 94% (95% confidence interval [CI]: 81%, 99%) and a specificity of 71% (95% CI: 44%, 90%). Patients with breast cancer and a low pretreatment ADC tended to respond better to chemotherapy. Prediction of response to neoadjuvant chemotherapy with DW MR imaging might help physicians individualize treatments and avoid ineffective chemotherapy.

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Author and article information

Journal

Journal ID (nlm-ta): Tzu Chi Med J

Journal ID (iso-abbrev): Tzu Chi Med J

Journal ID (publisher-id): TCMJ

Title: Tzu-Chi Medical Journal

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 1016-3190

ISSN (Electronic): 2223-8956

Publication date Collection: Jan-Mar 2021

Publication date (Electronic): 10 April 2020

Volume: 33

Issue: 1

Pages: 61-69

Affiliations

[a ]Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

[b ]Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

[c ]Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

Author notes

[* ] Address for correspondence: Dr. Shu-Hang Ng, Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital, 5, Fuxing Street, Guishan District, Taoyuan, Taiwan. E-mail: shuhangng@ 123456gmail.com

Article

Publisher ID: TCMJ-33-61

DOI: 10.4103/tcmj.tcmj_4_20

PMC ID: 7821831

SO-VID: f3394432-7358-4c48-a020-41de83e85802

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

History

Date received : 08 January 2020

Date revision received : 10 February 2020

Date accepted : 27 February 2020

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