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Nasopharyngeal carcinoma: comparison of diffusion and perfusion characteristics between different tumour stages using intravoxel incoherent motion MR imaging

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Abstract

Objective

To explore intravoxel incoherent motion (IVIM) characteristics of nasopharyngeal carcinoma (NPC) and relationships with different tumour stages.

Methods

We prospectively recruited 80 patients with newly diagnosed undifferentiated NPC. Diffusion-weighted MR imaging was performed and IVIM parameters (D, pure diffusion; f, perfusion fraction; D*, pseudodiffusion coefficient) were calculated. Patients were stratified into low and high tumour stage groups based on American Joint Committee on Cancer (AJCC) and TNM staging for determination of the predictive powers of IVIM parameters using t test, multiple logistic regression and ROC curve analyses.

Results

D, f and D* were all statistically significantly lower in high-stage groups in AJCC, T and N staging. D, f and D* were all independent predictors of AJCC staging, f and D* were independent predictors of T staging, and D was an independent predictor of N staging. D was most powerful for AJCC and N staging, whereas f was most powerful for T staging. Optimal cut-off values (area under the curve, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio) were as follows: AJCC stage, D = 0.782 × 10−3 mm2/s (0.915, 93.3 %, 76.2 %, 3.92, 0.09); T staging, f = 0.133 (0.905, 80.5 %, 92.5 %, 10.73, 0.21); N staging, D = 0.761 × 10−3 mm2/s (0.848, 87.5 %, 66.7 %, 2.62, 0.19). Multivariate analysis showed no diagnostic improvement.

Conclusion

Nasopharyngeal carcinoma has distinctive intravoxel incoherent motion characteristics parameters in different tumour staging, potentially helping pretreatment staging.

Key Points

• Magnetic resonance imaging is increasingly used to assess nasopharyngeal carcinoma (NPC).

NPC has distinctive diffusion/perfusion characteristics at different stages.

Non-invasive MR imaging may help pretreatment staging prediction.

Diffusion properties of NPC best correlate with AJCC and N staging.

Perfusion properties of NPC best correlate with T staging.

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Abbreviations

AJCC:

American Joint Committee on Cancer

AUC:

Area under the curve

D :

Pure diffusion

D* :

Pseudodiffusion coefficient

DW:

Diffusion weighted

f :

Perfusion fraction

IVIM:

Intravoxel incoherent motion

NPC:

Nasopharyngeal carcinoma

ROC:

Receiver operating characteristic

ROI:

Region of interest

SD:

Standard deviation

SNR:

Signal-to-noise ratio

SPIR:

Spectral presaturation inversion recovery

STIR:

Short T1 inversion recovery

TFE:

Turbo-field-echo

TR/TE:

Repetition time/echo time

TSE:

Turbo-spin-echo

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Acknowledgments

Our study was supported by University Grants Council (UGC) seed funding from The University of Hong Kong, project no. 201112159010.

Dr. Q Chan is currently employed by Philips Medical Systems.

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Correspondence to Vincent Lai.

Additional information

A subset of our patients (55/80) from the present study was previously reported in our earlier paper “Intravoxel incoherent motion MR imaging: comparison of diffusion and perfusion characteristics between nasopharyngeal carcinoma and post-chemoradiation fibrosis” published in European Radiology (doi:10.1007/s00330-013-2889-8). In that paper we only focused on describing the diffusion and perfusion characteristics in differentiating between newly diagnosed nasopharyngeal carcinomas and post-chemoradiation fibrosis, but not their characteristics between different tumor stages.

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Lai, V., Li, X., Lee, V.H.F. et al. Nasopharyngeal carcinoma: comparison of diffusion and perfusion characteristics between different tumour stages using intravoxel incoherent motion MR imaging. Eur Radiol 24, 176–183 (2014). https://doi.org/10.1007/s00330-013-2995-7

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  • DOI: https://doi.org/10.1007/s00330-013-2995-7

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