| PartⅠPreliminary study on diffusion weighted imaging and dynamic contrast-enhanced MRI of laryngeal and hypopharyngeal carcinoma[Purpose] To study the DCE-MRI findings of laryngeal and hypopharyngeal carcinoma, compare TIC and semi-quantitative parameters among the tumor, normal pharyngeal wall tissue, and the same layer neck muscle.[Materials and methods] Fifty-eight patients with laryngeal and hypopharyngeal squamous cell carcinoma proven pathologically were collected, underwent DCE-MRI before therapy, obtained the TIC type, ADC value, time to peak (TTP), maximum signal enhancement percentage (SERmax), positive enhancement integral(PEI), maximum slope of increase(MSI), maximum slope of decrease(MSD), respectively. Compare the TIC types and semi-quantitative parameters among them, and draw the ROC curve to analysis of the diagnostic performance of each index. P<0.05was considered statistically significance.[Results] TIC types of primary tumor included type Ⅰ (n=10), type Ⅱ(n=13), type III(n=35), a significant difference in SERmax and MSD were observed among these three groups (P<0.05), and no difference in ADC values (P>0.05). ADC values of different b values (b=300s/mm2,500s/mm2) were significantly different. There’re statistically differences in semi-parameters among the primary cancer, normal pharyngeal wall tissue and the same layer neck muscles (P<0.05). Set PEI value66.68%as threshold to distinguish abnormal and normal tissues, sensitivity and specificity were92.3%and87.0%, respectively.[Conclusion] DCE-MRI can reflect morphology and signal difference among neck muscles, normal and abnormal laryngeal and hypopharyngeal tissues, providing help for diagnosis primary carcinoma. Part ⅡThe value of DWI and DCE-MRI semi-quantitative parameters in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy on laryngeal and hypopharyngeal carcinoma[Purpose] Using1.5T MRI to evaluate the value of dynamic contrast-enhanced MRI semi-quantitative parameters and ADC values in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy on laryngeal and hypopharyngeal carcinoma.[Materials and methods] Fifty-eight patients with laryngeal and hypopharyngeal squamous cell carcinoma proven pathologically were collected, including56males and2females [median age57years old] in our hospital from August2012to March2013. Measured, before treatment(pointl), during treatment (at the radiation dose of50Gy, point2), at the end of treatment(piont3), time signal curves (TIC) and related semi-quantitative parameters including:time to peak(TTP), maximum signal enhancement ratio(SERmax), signal enhancement ratio at28s,42s,56s,70s,84s, maximum slope of increase(MSI), maximum slope of decrease(MSD), positive enhancement integral (PEI). ADC values were calculated including mean ADC (ADCmean) and minimum ADC(ADCmin). At the end of treatment determine tumor remission. Using paired sample t test to compare the semi-quantitative parameters between point1and point2. Using independent sample t test to compare the semi-quantitative parameters, ADC values and change values form point1to point2) between complete response group(CR) and partial response group(PR), and draw the ROC curve to analysis of the diagnostic performance of each index. Using pearson chi-square test and Fisher’s exact test to compare therapeutic efficacy with different TIC types.[Results] Forty-four patients underwent DCE-MRI and DWI before treatment, during treatment and at the end of treatment,14patients only underwent DCE-MRI and DWI before treatment. Twenty-two patients were grouped into CR and22were PR. Comparison between point1and point2showed that:the parameters of TTP, SERmax, PEI, SER70, SER84and ADC values at point1were higher than point2. There was significant difference between the two groups(P values were <0.001,0.010,<0.001,0.040,0.014,<0.001). Comparison between CR group and the PR group showed that:the pretreatment of SERmax, SER42, SER56, SER70, SERg4in CR group were higher than PR group. There was significant difference between the two groups (P values were0.014,0.040,0.010,0.009,0.012). And there was no significant difference in ADC values at pointl, ADC values at point2, semi-quantitative parameters at point2, and kinetic changes in these parameters between CR group and PR group (P values>0.05). The area under ROC curve of SER56was0.743, set129.4%as threshold for predicting therapeutic efficacy, sensitivity and specificity were60%and86.4%, respectively. Comparison among different TIC types showed that:complete response rate in TIC Ⅰ group and TICⅢ group were87.5%and39.3%,respenctively. There was significant difference between the two groups(P value=0.041).[Conclusion] TIC curve types and DCE-MRI semi-quantitative parameters can predict therapeutic efficacy of concurrent chemoradiotherapy on laryngeal and hypopharyngeal carcinoma, SER56was the most useful predictive index of semi-quantitative parameters, and prognosis was better in pretreatment TIC I than TICⅢ. Pretreatment ADC values were insufficient to predict the efficacy. ADC values at point2, semi-quantitative parameters at point2and their kinetic changes can monitor hemodynamic and water molecules diffusion changes after treatment, but was insufficient to predict the efficacy, either. PartⅢThe value of DCE-MRI quantitative parameters in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy on laryngeal and hypopharyngeal carcinoma[Purpose] Using1.5T MRI to evaluate the value of dynamic contrast-enhanced MRI quantitative parameters in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy on laryngeal and hypopharyngeal carcinoma.[Materials and methods] Forty-five patients with laryngeal and hypopharyngeal squamous cell carcinoma proven pathologically were collected, including43males and2females [median age58years old] in our hospital from August2012to March2013. Measured, before treatment (pointl), during treatment (at the radiation dose of50Gy, point2), at the end of treatment (piont3), related quantitative parameters including: volume transfer constant (Ktrans), exchange rate constant (Kep), and extravascular extracellular space volume ratio (Ve). At the end of treatment determine tumor remission. Using independent sample t test to compare the pretreatment quantitative parameters, non-parametric Mann-Whitney rank sum test to compare the quantitative parameters at point2and changes in kinetic parameters between complete response group(CR) and partial response group(PR), P value<0.05was statistically significant. Draw the ROC curve to analysis of the diagnostic performance of each index.[Results] Thirty-two patients underwent multiple flip angle DCE-MRI before treatment, during treatment and at the end of treatment,13patients only underwent multiple flip angle DCE-MRI before treatment. Thirteen patients were grouped into CR and19were PR. Comparison between CR group and the PR group showed that:Pretreatment parameters (Ktrans,Kep,Ve) were (0.234±0.115)/min,(1.208±0.366)/min,(0.231±0.084) in CR group and (0.186±0.038)/min,(0.930±0.283)/min,(0.241±0.063) in PR group, Ktrans and Kep were higher in CR group while Ve was higher in PR group. There was significant difference in KeP between the two groups (t value was2.419, P value was0.022). And there was no significant difference in quantitative parameters at point2, and kinetic changes in these parameters between CR group and PR group (P values>0.05). The area under ROC curve of KeP was0.745, set0.893/min as threshold for predicting therapeutic efficacy, sensitivity, specificity and accuracy were92.3%、52.6%and68.75%, respectively.[Conclusion] DCE-MRI quantitative parameters can predict therapeutic efficacy of concurrent chemoradiotherapy on laryngeal and hypopharyngeal carcinoma, KeP was the most useful predictive index of quantitative parameters. Quantitative parameters at point2and their kinetic changes can monitor hemodynamic and water molecules diffusion changes after treatment, but was insufficient to predict the efficacy, either. |
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