title: Pretreatment Dynamic Contrast-Enhanced MRI Improves Prediction of Early Distant Metastases in Patients With Nasopharyngeal Carcinoma.
abstract: The identification of early distant metastases (DM) in patients with newly diagnosed, previously untreated nasopharyngeal carcinoma (NPC) plays an important role in selecting the most appropriate treatment approach. Here, we sought to investigate the predictive value of distinct MRI parameters for the detection of early DM.Between November 2010 and June 2011, a total of 51 newly diagnosed NPC patients were included. All of the study participants were followed until December 2014 at a single institution after completion of therapy. DM was defined as early when they were detected on pretreatment FDG-PET scans or within 6 months after initial diagnosis. The following parameters were tested for their ability to predict early DM: pretreatment FDG-PET standardized uptake value (SUV), MRI-derived AJCC tumor staging, tumor volume, and dynamic contrast-enhanced (DCE) values. The DCE-derived ve was defined as the volume fraction of the extravascular, extracellular space.Compared with patients without early DM, patients with early DM had higher SUV, tumor volume, DCE mean (median) ve, ve skewness, ve kurtosis, and the largest mean ve selected among sequential slices (P < 0.05). No differences were identified when early DM were defined only according to the results of pretreatment FDG-PET. Among different quantitative DCE parameters, the mean ve had the highest area under curve (AUC, 0.765). However, the AUCs of SUV, tumor volume, mean ve, ve skewness, ve kurtosis, or the largest mean ve selected among the sequential slices did not differ significantly from one another (P = 0.82).Taken together, our results suggest that DCE-derived ve may be a useful parameter in combination with SUV and tumor volume for predicting early DM. Dynamic contrast-enhanced MRI may be complementary to FDG-PET for selecting the most appropriate treatment approach in NPC patients.
authors.affiliation: From the Department of Medical Imaging and Intervention (C-SC, K-YK); Department of Radiation Oncology (L-CY, H-BS, T-NM, F-KH); Division of Medical Oncology, Department of Internal Medicine (H-CL); Molecular Imaging Center and Department of Nuclear Medicine (C-SC); Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University (H-SF, L-CT), Taoyuan; Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University (L-CH), Hsinchu; Biostatistical Center for Clinical Research, Linkou Chang Gung Memorial Hospital and Chang Gung University (T-HJ), Taoyuan, Taiwan, ROC; Department of Imaging Physics, University of Texas MD Anderson Cancer Center (L-HL), Houston, TX; and Department of Radiological Sciences, University of California (S-K), Los Angeles, CA.
authors.forename: Shy-Chyi
authors.initials: SC
authors.lastname: Chin
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Bing-Shen
authors.initials: BS
authors.lastname: Huang
authors.forename: Ngan-Ming
authors.initials: NM
authors.lastname: Tsang
authors.forename: Kang-Hsing
authors.initials: KH
authors.lastname: Fan
authors.forename: Yi-Kang
authors.initials: YK
authors.lastname: Ku
authors.forename: Cheng-Lung
authors.initials: CL
authors.lastname: Hsu
authors.forename: Sheng-Chieh
authors.initials: SC
authors.lastname: Chan
authors.forename: Shiang-Fu
authors.initials: SF
authors.lastname: Huang
authors.forename: Cheng-He
authors.initials: CH
authors.lastname: Li
authors.forename: Hsiao-Jung
authors.initials: HJ
authors.lastname: Tseng
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.forename: Ho-Ling
authors.initials: HL
authors.lastname: Liu
authors.forename: Kyunghyun
authors.initials: K
authors.lastname: Sung
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000175:diagnosis* / Q000556:secondary*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000556:secondary*; D002648:Child; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium