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Consistency of T2WI-FS/ASL fusion images in delineating the volume of nasopharyngeal carcinoma.

ABSTRACT: Tumor extent assessment of nasopharyngeal carcinoma (NPC) is critical for delineating the radiotherapeutic target region. We aimed to investigate the use of the fusion images of fat suppressed T2WI (T2WI-FS) with arterial spin labeling (ASL) in measuring the volume of NPC. Two observers measured the volume of 21 untreated NPC using T2WI-FS, T2WI-FS/ASL (with PLD = 1.0, 1.5 and 2.0 s) fusion images and enhanced T1WI separately. Correlation and consistency were used to compare 1) measurements using T2WI-FS/ASL and T2WI-FS alone, taking enhanced T1WI images as a benchmark; 2) measurements between observers. Significant correlations existed between different series (r: 0.896~0.973). Measurements from the two observers using T2WI-FS/ASL had relatively higher intra-class correlation (ICC) (0.980~0.997) and lower within-subject coefficients of variation (wsCV) (14.76%~22.96%) when compared to using T2WI-FS alone (ICC: 0.978, 0.951, wsCV: 21.61%, 24.21%), while the T2WI-FS/ASL 1.0 s exhibited the best performance. Remarkably high ICC value (0.981~0.996) and relatively low wsCV (9.95%~17.91%) were obtained for the two observers using same series. Compared to those obtained using T2WI-FS alone, measurements made using T2WI-FS/ASL were more consistent with those made using enhanced T1WI. The T2WI-FS/ASL fusion images has the potential to be an alternative to enhanced T1WI, when contrast administration can not be performed.

SUBMITTER: Lin M

PROVIDER: S-EPMC4680888 | biostudies-other | 2015 Dec

REPOSITORIES: biostudies-other

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Project description:IntroductionTo evaluate the prognostic value of gross tumor volume (TV) in patients with locally recurrent, nonmetastatic nasopharyngeal carcinoma.MethodsBetween 2001 and 2012, 291 consecutive patients with locally recurrent, nonmetastatic nasopharyngeal carcinoma underwent salvage IMRT were retrospectively reviewed. The correlations between TV and recurrent T classification were analyzed. Survival analyses were performed. Receiver operating characteristic (ROC) curves were calculated to identify cut-off point of TV. The Akaike information criterion and Harrell's concordance index (c-index) were utilized to test the prognostic value.ResultsThe median TV significantly increased with advancing recurrent T classification (P<0.001). The 5-year overall survival rate was 33.2% for the entire cohort. On multivariate analysis, TV was an independent negative prognostic factor for distant metastasis-free survival (hazard ratio =1.013, P =0.003), overall survival (hazard ratio = 1.015, P<0.001) and toxicity-related death (hazard ratio = 1.014, P<0.001). The 5-year overall survival rates were 63.1% and 20.8% for patients with a TV < 22 cm3 and TV ?22 cm3, respectively (P < 0.001). In patient with TV <22 cm3, locoregional failure is the leading cause of death. In patients with TV?22 cm3, distant metastasis rate is higher and occurred within short term after local recurrence; meanwhile, radiation-induced injuries became more common and led to half of deaths in this group. The Akaike information criterion and c-index analyses indicated that the predictive ability of recurrent T classification improved when combined with TV.ConclusionsOur data suggests TV is a significant prognostic factor for predicting the distant metastasis, overall survival and toxicity-related death of patients with locally recurrent, nonmetastatic nasopharyngeal carcinoma after salvage IMRT. TV should be considered when designing personalized salvage treatments for these patients. For patients with bulky local recurrent tumor, radiation may need to be de-emphasized in favor of systemic treatment or best supportive care.

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Consistency of T2WI-FS/ASL fusion images in delineating the volume of nasopharyngeal carcinoma.

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