Department of Radiology, Faculty of Medicine, Division of Diagnostic Radiology, 26683Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Department of Radiology, Faculty of Medicine, Division of Radiation Oncology, 26683Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Neuroradiol J. 2022 Aug;35(4):477-485. doi: 10.1177/19714009211055191. Epub 2021 Nov 3.
Predicting the treatment response in patients with nasopharyngeal carcinoma (NPC) is challenging. This study evaluated the utility of diffusion-weighted imaging (DWI) in predicting the treatment response in patients with NPC.
We prospectively enrolled 33 patients with newly diagnosed NPC who underwent magnetic resonance imaging with the propeller DWI and apparent diffusion coefficient (ADC) map before and at 5 weeks after chemoradiation. The following ADC values of the primary tumor were calculated: pre-treatment ADC (pre-ADC), pre-treatment ADC ratio (pre-ADC ratio), ADC change (▵ADC), ADC change ratio (▵ADC ratio), and percentage of ADC change (▵%ADC). The correlations between these parameters and treatment outcomes were explored, and the patients were classified as good responders (complete response) and poor responders (stable disease, partial response, or progressive disease) based on the Response Evaluation Criteria in Solid Tumors, version 1.1.
The ▵ADC, ▵ADC ratio, and ▵%ADC were significantly lower in the poor-responder group ( = 12) than in the good-responder group ( = 21; = 0.001, = 0.002, and = 0.004, respectively). There was no significant difference between groups in the pre-ADC and pre-ADC ratios ( = 0.602 and = 0.685, respectively). The optimal ▵ADC, ▵ADC ratio, and ▵%ADC cutoff values for predicting poor response were >0.65 mm/sec, 0.28, and 60%, respectively (sensitivity: 83.3%, 75%, and 83.3%; specificity: 71.4%, 85.7%, and 71.4%, respectively).
The ▵ADC, ▵ADC ratio, and ▵%ADC obtained during the pre-treatment and mid-treatment periods could be potential biomarkers for predicting treatment response in patients with NPC.
预测鼻咽癌（NPC）患者的治疗反应具有挑战性。本研究评估了扩散加权成像（DWI）在预测 NPC 患者治疗反应中的效用。
我们前瞻性招募了 33 名新诊断为 NPC 的患者，这些患者在放化疗前和 5 周后接受了螺旋 DWI 和表观扩散系数（ADC）图的磁共振成像。计算了原发肿瘤的以下 ADC 值：治疗前 ADC（pre-ADC）、治疗前 ADC 比值（pre-ADC 比值）、ADC 变化（ΔADC）、ADC 变化比值（ΔADC 比值）和 ADC 变化百分比（Δ%ADC）。探讨了这些参数与治疗结果之间的相关性，并根据实体瘤反应评价标准 1.1 将患者分为良好反应者（完全缓解）和不良反应者（稳定疾病、部分缓解或进展性疾病）。
在 12 名不良反应者（poor-responder 组）中，ΔADC、ΔADC 比值和Δ%ADC 明显低于 21 名良好反应者（good-responder 组；=12，=0.001，=0.002 和=0.004）。两组之间的 pre-ADC 和 pre-ADC 比值无显著差异（=0.602 和=0.685）。预测不良反应的最佳ΔADC、ΔADC 比值和Δ%ADC 截断值分别为>0.65 mm/sec、0.28 和 60%（灵敏度：83.3%、75%和 83.3%；特异性：71.4%、85.7%和 71.4%）。
治疗前和中期获得的ΔADC、ΔADC 比值和Δ%ADC 可能是预测 NPC 患者治疗反应的潜在生物标志物。
