Research On Diagnosis And Evaluation In Laryngeal Carcinoma And Hypopharyngeal Carcinoma Received Chemoradiation Based Functional MRI

Part 1Preliminary study on intravoxel incoherent motion imaging(IVIM)in laryngeal and hypopharyngeal squamous cell carcinomaPurpose:To evaluate the diagnostic performance of bi-exponential modeling of intravoxel incoherent motion(IVIM)imaging for laryngeal and hypopharyngeal carcinoma.Material and Methods:Thirty two patients with pathologically proven laryngeal and hypopharyngeal squamous cell carcinoma were included in this study.All patients underwent IVIM-DWI by using twelve b values(0,10,20,30,50,70,100,150,200,400,800 and 1000s/mm2).Using the IVIM approach,D,D*and f were extracted using a bi-exponential fit.These quantitative parameters of primary carcinoma and normal pharyngeal tissue were compared.Statistical methods were to assess differences between the tumor and normal pharyngeal tissue.Results:There were no significant difference of D(P=0.903)and f(P=0.223)values were observed among laryngeal carcinoma and hypopharyngeal carcinoma,and D*value was significantly different among the two groups(P=0.028).The values of D,D*,and f for primary carcinoma were(0.84±0.22)×10-3mm2/s,(65.71±19.66)x 10-3mm2/s,and 44.90%± 14.49%,respectively;for normal pharyngeal tissue were(1.48±1.04)×10-3mm2/s,(37.85±14.04)×10’3mm2/s,and 35.88%±11.51%,respectively(P = 0.001,0.000,and 0.006,respectively).Setting D value 0.949×10-3mm2/s was threshold to distinguish abnormal and normal tissues,the sensitivity,specificity and accuracy were 91.2%,88.2%and 85.5%,respectively.There was no significant difference between D(P=0.558)and f(P=0.809)in different pathological grades of primary carcinoma,and there was significant difference in D*values found among the different pathological grades of primary carcinoma 001).There were significant differences in D*values between the well differentiated group and the other two group(P=0.027,0.000),and there was no significant difference between the moderately differentiated group and poorly differentiated group(P=0.110).Conclusion:I VIM parameters can reflect the difference between laryngeal and hypopharyngeal carcinoma and normal pharyngeal tissue,and the D value have the best diagnostic performance.The D*values in different pathological grades of laryngeal and hypopharyngeal squamous cell carcinoma were distinct,and it could reflect the pathological grade of tumor to some extent.Part 2Pretreatment Intra-voxel incoherent motion diffusion-weighted imaging(IVIM-DWI)in predicting induction chemotherapy response in locally advanced hypopharyngeal carcinomaPurpose:The aim of this study was to predict response to induction chemotherapy in patients with locally advanced hypopharyngeal carcinoma by IVIM values.Material and Methods:Twenty eight patients with locally advanced hypopharyngeal carcinoma underwent IVIM studies using twelve different b values(b=0,10,20,30,50,70100,150,200,400,800 and 1000 s/mm2).All patients underwent two MRI studies:a baseline exam before any treatment and a mid-treatment exam 3 weeks after induction chemotherapy.In IVIM approach,D*,f and D were extracted from a bi-exponential fit.For comparison,ADC map were extracted from a mono-exponential fit.At the end of induction chemotherapy,patients were classified as responders or non-responders group according to the Response Evaluation Criteria in Solid Tumors criteria(RECIST),based on their MRI measurement.The patients were classified into high grade group(G1),moderate grade group(G2)and low grade group(G3)according to the tumor pathological grading.The predictive value of IVIM parameters were examined with Student’s t-test,analysis of variance(ANOVA)and receiver operating characteristic(ROC)curves.Results:After two cycles of induction chemotherapy,18 patients were categorized into the responder group whereas the other 10 patients were considered non-responders.Compared with the pretreatment value,the posttreatment ADC value and D value was significantly higher and the posttreatment D*value was significantly lower(all P<0.05).In contrast,posttreatment f parameter only changed slightly(P>0.05).Compared with non-responders,a notably lower pretreatment ADC value,D value,posttreatment D*value,and higher posttreatment ADC value,D value,△ADC,△D,and △D*were observed in responders(all P<0.05),but no significant change in △ f among the two group(P>0.05).The ROC curve analysis indicated that,the cutoff of pretreatment D value in best predicting tumor’s chemotherapeutic response was 0.847×10-3 mm2/s,and the corresponding AUC,sensitivity,and specificity were 0.806,75.0%and 88.9%,respectively.Although pretreatment IVIM-derived parameters had no significant differences between high grade,moderate grade and low grade group,a trend towards lower D*was observed with increasing tumor grading from G3 to G1.Conclusion:IVIM-DWI can potentially predict the treatment response to induction chemotherapy for hypopharyngeal carcinoma.Part 3Semi-quantitative Dynamic Contrast-Enhanced magnetic resonance imaging for pretreatment Prediction of early chemo-radiotherapy response in larynx and hypopharynx carcinomaPurpose:This study was aimed to determine the utility of dynamic contrast-enhanced magnetic resonance imaging(MRI)in predicting early response to CRT(chemo-radiotherapy)in patients with larynx and hypopharynx carcinoma from primary tumors.Method:Sixty-two patients with larynx and hypopharynx carcinoma underwent two DCE-MRI studies:a baseline exam before any treatment and a post-treatment exam 3 weeks after CRT.The patients were classified as responders,or non-responders according to the Response Evaluation Criteria in Solid Tumors criteria(RECIST),based on their MRI measurement.The time intensity curves(TIC)were extracted and processed to acquire time to peak(TTP),maximum slope of increase(MSI),maximum slope of decrease(MSD)and positive enhancement integral(PEI),and the semi-quantitative MRI parameters were compared and analyzed.Results:Fifty-four patients were categorized into the responder group whereas the other 8 patients were considered non-responders.Compared with the pretreatment parameters,the posttreatment values of the MSI,MSD,and PEI were significantly lower(all P<0.05).The pretreatment values of MSI,MSD,and PEI of the responders were significantly higher than those of non-responders(all P<0.05).The posttreatment values of the MSI,MSD,and PEI of the responders were significantly lower than those of non-responders(all P<0.05).In contrast,pre and post treatment TTP values only changed slightly(P>0.05).The ROC curve analysis indicated that,the threshold of the pretreatment MSI value in the best predicting tumors chemotherapeutic response was 154.81 and the corresponding AUC,sensitivity,and specificity were 0.882,89.3%and 73.5%,respectively.Conclusion:The semi-quantitative DCE-MRI may aid in the prediction of early response to CRT in patients with larynx and hypopharynx carcinoma.Part 4Quantitative Dynamic Contrast Enhanced Magnetic Resonance Imaging in Predicting sensitivity of laryngeal and hypopharyngeal squamous cell carcinoma received concurrent chemoradiationPurpose:To evaluate the value of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)performed before treatment in predicting the sensitivity of laryngeal and hypopharyngeal carcinoma to concurrent chemo-radiation.Methods:Thirty-six patients with pathologically proven laryngeal and hypopharyngeal squamous cell carcinoma received concurrent chemoradiation.All patients underwent pretreatment DCE-MRI to obtain the quantitative parameters of the tumors,including volume transfer constant(Ktrans),exchange rate constant(Kep),and extravascular extracellular space volume ratio(Ve)were measured.After receiving 50Gy dose,the patients were re-examined with routine MRI.According to the tumor response,the patients were divided into CR and PR group.Results:20 cases after chemo-radiation were divided into CR group,and other 16 cases were PR group.There were no significant difference of DCE-MRI parameters were observed among laryngeal and hypopharyngeal cancer(all P>0.05).The pretreatment values of Ktrans,Kep,and Ve were(0.307 ± 0.055)/min,(0.527 ±0.114)/min,and 0.587±0.045 in CR group.The pretreatment values of Ktrans,Kep,and Ve were(0.234 ±0.049)/min,(0.390± 0.090)/min,and 0.602±0.037 in PR group.There were no significant difference of Ve observed among CR and PR group(P>0.05),however Ktrans and Kep were significantly different among the two group(all P<0.05).ROC curve analysis revealed that the threshold of Ktrans value was 0.283/min to distinguish CR and PR,the corresponding AUC,sensitivity,and specificity were 0.839,70.0%and 82.5%,respectively.Setting Kep value 0.446/min was threshold to distinguish CR and PR,the AUC,sensitivity,and specificity were 0.809,75%and 75%,respectively.Conclusion:Pretreatment DCE-MRI parameters were helpful to predict the early response of laryngeal and hypopharyngeal squamous cell carcinoma received concurrent chemoradiation.