Li Qiao, Wang TingTing, Huang Yan, Li Qin, Liu PeiYao, Grimm Robert, Fu CaiXia, Zhang YunYan, Gu Yajia
Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Oncol. 2021 Mar 9;11:610804. doi: 10.3389/fonc.2021.610804. eCollection 2021.
We aimed to investigate whether Epstein-Barr virus (EBV) could produce differences on MRI by examining the histogram and texture imaging features. We also sought to determine the predictive value of pretreatment MRI texture analyses incorporating with EBV status for disease progression (PD) in patients with primary nasopharyngeal carcinoma (NPC). Eighty-one patients with primary T2-T4 NPC and known EBV status who underwent contrast-enhanced MRI were included in this retrospective study. Whole-tumor-based histogram and texture features were extracted from pretreatment T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and contrast-enhanced (CE)-T1WI images. Mann-Whitney -tests were performed to identify the differences in histogram and texture parameters between EBV DNA-positive and EBV DNA-negative NPC images. The effects of clinical variables as well as histogram and texture features were estimated by using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to predict the EBV status and PD. Finally, an integrated model with the best performance was built. Of the 81 patients included, 54 had EBV DNA-positive NPC, and 27 had EBV DNA-negative NPC. Patients who were tested EBV DNA-positive had higher overall stage ( = 0.016), more lymphatic metastases ( < 0.0001), and easier distant metastases ( = 0.026) than the patients who were tested EBV DNA-negative. Tumor volume, T1WI and T2WI showed significant differences between the two groups. The combination of the three features achieved an AUC of 0.783 [95% confidence interval (CI) 0.678-0.888] with a sensitivity and specificity of 70.4 and 74.1%, respectively, in differentiating EBV DNA-positive tumors from EBV DNA-negative tumors. The combination of overall stage and tumor volume of T2WI and EBV status was the most effective model for predicting PD in patients with primary NPC. The overall accuracy was 84.6%, with a sensitivity and specificity of 93.8 and 66.2%, respectively (AUC, 0.800; 95% CI 0.700-0.900). This study demonstrates that MRI-based radiological features and EBV status can be used as an aid tool for the evaluation of PD, in order to develop tailored treatment targeting specific characteristics of individual patients.
我们旨在通过检查直方图和纹理成像特征，研究爱泼斯坦-巴尔病毒（EBV）是否会在磁共振成像（MRI）上产生差异。我们还试图确定结合EBV状态的治疗前MRI纹理分析对原发性鼻咽癌（NPC）患者疾病进展（PD）的预测价值。本回顾性研究纳入了81例接受增强MRI检查且已知EBV状态的原发性T2-T4期NPC患者。从治疗前的T1加权成像（T1WI）、T2加权成像（T2WI）和增强（CE）-T1WI图像中提取基于全肿瘤的直方图和纹理特征。进行曼-惠特尼检验以确定EBV DNA阳性和EBV DNA阴性NPC图像之间直方图和纹理参数的差异。使用单变量和多变量逻辑回归分析评估临床变量以及直方图和纹理特征的影响。采用受试者操作特征（ROC）曲线分析来预测EBV状态和PD。最后，构建了性能最佳的综合模型。在纳入的81例患者中，54例为EBV DNA阳性NPC，27例为EBV DNA阴性NPC。检测为EBV DNA阳性的患者比检测为EBV DNA阴性的患者总体分期更高（P = 0.016），有更多的淋巴结转移（P < 0.0001），且更容易发生远处转移（P = 0.026）。两组之间肿瘤体积、T1WI和T2WI显示出显著差异。这三个特征的组合在区分EBV DNA阳性肿瘤和EBV DNA阴性肿瘤方面，曲线下面积（AUC）为0.783 [95%置信区间（CI）0.678 - 0.888]，敏感性和特异性分别为70.4%和74.1%。总体分期、T2WI的肿瘤体积和EBV状态的组合是预测原发性NPC患者PD的最有效模型。总体准确率为84.6%，敏感性和特异性分别为93.8%和66.2%（AUC，0.800；95% CI 0.700 - 0.900）。本研究表明，基于MRI的放射学特征和EBV状态可作为评估PD的辅助工具，以便针对个体患者的特定特征制定个性化治疗方案。
