联合评估 4D 容积灌注 CT、弥散加权 MRI 和 F-FDG PET-CT 在预测头颈部鳞状细胞癌患者接受放化疗后的结局中的临床应用。
Clinical utility of combined assessments of 4D volumetric perfusion CT, diffusion-weighted MRI and F-FDG PET-CT for the prediction of outcomes of head and neck squamous cell carcinoma treated with chemoradiotherapy.
机构信息
Department of Radiology, Kanazawa Medical University, Daigaku 1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Section of Radiological Technology, Department of Medical Technology, Kanazawa Medical University, Daigaku 1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
出版信息
Radiat Oncol. 2023 Feb 6;18(1):24. doi: 10.1186/s13014-023-02202-x.
BACKGROUND
Multiparametric imaging has been seen as a route to improved prediction of chemoradiotherapy treatment outcomes. Four-dimensional volumetric perfusion CT (4D PCT) is useful for whole-organ perfusion measurement, as it reflects the heterogeneity of the tumor and its perfusion parameters. However, there has been no study using multiparametric imaging including 4D PCT for the prognostic prediction of chemoradiotherapy. The purpose of this study was to determine whether combining assessments of 4D PCT with diffusion-weighted MRI (DWI) and F-fluorodeoxyglucose PET-CT could enhance prognostic accuracy in head and neck squamous cell carcinoma (HNSCC) patients treated with chemoradiotherapy.
METHODS
We examined 53 patients with HNSCC who underwent 4D PCT, DWI and PET-CT before chemoradiotherapy. The imaging and clinical parameters were assessed the relations to locoregional control (LRC) and progression-free survival (PFS) by logistic regression analyses. A receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the significant parameters identified by the multivariate analysis for the prediction of LRC and PFS. We additionally assessed using the scoring system whether these independent parameters could have a complementary role for the prognostic prediction.
RESULTS
The median follow-up was 30 months. In multivariate analysis, blood flow (BF; p = 0.02) and blood volume (BV; p = 0.04) were significant prognostic factors for LRC, and BF (p = 0.03) and skewness of the ADC histogram (p = 0.02) were significant prognostic factors for PFS. A significant positive correlation was found between BF and BV (ρ = 0.6, p < 0.001) and between BF and skewness (ρ = 0.46, p < 0.01). The ROC analysis showed that prognostic accuracy for LRC of BF, BV, and combination of BF and BV were 77.8%, 70%, and 92.9%, and that for PFS of BF, skewness, and combination of BF and skewness were 55.6%, 63.2%, and 77.5%, respectively. The scoring system demonstrated that the combination of higher BF and higher BV was significantly associated with better LRC (p = 0.04), and the combination of lower BF and lower skewness was significantly associated with worse PFS (p = 0.004).
CONCLUSION
A combination of parameters derived from 4DPCT and ADC histograms may enhance prognostic accuracy in HNSCC patients treated with chemoradiotherapy.
背景
多参数成像被认为是提高放化疗治疗结果预测准确性的一种途径。四维容积灌注 CT（4D PCT）可用于整体器官灌注测量，因为它反映了肿瘤及其灌注参数的异质性。然而，目前尚无使用包括 4D PCT 在内的多参数成像来预测放化疗预后的研究。本研究旨在确定在接受放化疗的头颈部鳞状细胞癌（HNSCC）患者中，结合 4D PCT 评估、扩散加权 MRI（DWI）和 F-氟脱氧葡萄糖 PET-CT 评估是否可以提高预后准确性。
方法
我们检查了 53 例接受放化疗前进行 4D PCT、DWI 和 PET-CT 的 HNSCC 患者。通过逻辑回归分析评估影像学和临床参数与局部区域控制（LRC）和无进展生存期（PFS）的关系。通过接收者操作特征（ROC）分析评估多变量分析确定的显著参数对 LRC 和 PFS 预测的准确性。我们还使用评分系统评估这些独立参数是否对预后预测具有互补作用。
结果
中位随访时间为 30 个月。多变量分析显示，血流（BF；p=0.02）和血容量（BV；p=0.04）是 LRC 的显著预后因素，BF（p=0.03）和 ADC 直方图偏度（p=0.02）是 PFS 的显著预后因素。BF 与 BV 之间存在显著正相关（ρ=0.6，p<0.001），BF 与偏度之间也存在显著正相关（ρ=0.46，p<0.01）。ROC 分析显示，BF、BV 和 BF 与 BV 联合的 LRC 预测准确性分别为 77.8%、70%和 92.9%，BF、偏度和 BF 与偏度联合的 PFS 预测准确性分别为 55.6%、63.2%和 77.5%。评分系统显示，较高 BF 和较高 BV 的联合与更好的 LRC 显著相关（p=0.04），较低 BF 和较低偏度的联合与更差的 PFS 显著相关（p=0.004）。
结论
4D PCT 和 ADC 直方图衍生参数的联合可能会提高接受放化疗的 HNSCC 患者的预后准确性。
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