Treatment Response Prediction of Nasopharyngeal Carcinoma Based on Histogram Analysis of Diffusional Kurtosis Imaging

摘要

BACKGROUND AND PURPOSE: The prediction of treatment response is important in planning and modifying the chemoradiation therapy regimen. This study aimed to explore the quantitative histogram indices for treatment-response prediction of nasopharyngeal carcinoma based on diffusional kurtosis imaging compared with a standard ADC value (ADC(standard)). MATERIALS AND METHODS: Thirty-six patients with an initial diagnosis of locoregionally advanced nasopharyngeal carcinoma and diffusional kurtosis imaging acquisitions before and after neoadjuvant chemotherapy were enrolled. Patients were divided into respond-versus-nonrespond groups after neoadjuvant chemotherapy and residual-versus-nonresidual groups after radiation therapy. Histogram parameters of diffusional kurtosis imaging-derived parameters (ADC, ADC coefficient corrected by the non-Gaussain model [D], apparent kurtosis coefficient without a unit [K]) were calculated. The ADC(standard) was calculated on the basis of intravoxel incoherent movement data. The intraclass correlation coefficient, Kolmogorov-Smirnov test, Student t test or Mann-Whitney U test, and receiver operating characteristic analysis were performed. RESULTS: Most of the parameters had good-to-excellent consistency (intraclass correlation coefficient = 0.675-0.998). The pre-ADC(standard), pre-ADC (10th, 25th, 50th percentiles), pre-D (10th, 25th, 50th percentiles), and pre-K-50th were significantly different between the respond and nonrespond groups, while the pre-ADC(10th), pre-K-90th, post-ADC(50th), post-K-75th, post-K-90th, and the percentage change of parameters before and after neoadjuvant chemotherapy (ADC(50th)%) were significantly different between the residual and nonresidual groups (all P .05). Receiver operating characteristic analysis indicated that setting pre-D-50th = 0.875 x 10(-3)mm(2)/s as the cutoff value could result in optimal diagnostic performance for neoadjuvant chemotherapy response prediction (area under the curve = 0.814, sensitivity = 0.70, specificity = 0.92), while the post-K-90th = 1.035 (area under the curve = 0.829, sensitivity = 0.78, specificity = 0.72), andADC(50th)% = 0.253 (area under the curve = 0.833, sensitivity = 0.94, specificity = 0.72) were optimal for radiation therapy response prediction. CONCLUSIONS: Histogram analysis of diffusional kurtosis imaging may potentially predict the neoadjuvant chemotherapy and short-term radiation therapy response in locoregionally advanced nasopharyngeal carcinoma, therefore providing evidence for modification of the treatment regimen.