MRI differentiation of recurrent nasopharyngeal carcinoma from postradiation fibrosis

doi:10.1016/0895-6111(91)90170-Z

Computerized Medical Imaging and Graphics

Volume 15, Issue 6, November–December 1991, Pages 423-429

https://doi.org/10.1016/0895-6111(91)90170-Z Get rights and content

Abstract

A prospective study was performed to determine the usefulness of magnetic imaging (MRI) in differentiating local recurrence versus post-irradiation fibrosis in 72 patients after radiotherapy of nasopharyngeal carcinoma (NPC). All patients had a soft-tissue mass in the nasopharynx demonstrated by computed tomography. A total of 29 patients had tumor recurrence; 40 patients had only radiation fibrosis; 1 patient had postradiation edema and 2 patients had inflammatory changes. Based on the differences in signal intensity on T2-weighted Images, MRI may be promising as a noninvasive method for differentlating radiation fibrosis from local recurrent NPC. However, the signal intensity pattern of the tumor is not specific and may be seen in radiation edema and infection.

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MRI is the routine examination to surveil the recurrence of nasopharyngeal carcinoma, but it has relatively lower sensitivity than PET/CT. We aimed to find if artificial intelligence (AI) could be competent pre-inspector for MRI radiologists and whether AI-aided MRI could perform better or even equal to PET/CT.
This multicenter study enrolled 6916 patients from five hospitals between September 2009 and October 2020. A 2.5D convolutional neural network diagnostic model and a nnU-Net contouring model were developed in the training and test cohorts and used to independently predict and visualize the recurrence of patients in the internal and external validation cohorts. We evaluated the area under the ROC curve (AUC) of AI and compared AI with MRI and PET/CT in sensitivity and specificity using the McNemar test. The prospective cohort was randomized into the AI and non-AI groups, and their sensitivity and specificity were compared using the Chi-square test.
The AI model achieved AUCs of 0.92 and 0.88 in the internal and external validation cohorts, corresponding to the sensitivity of 79.5% and 74.3% and specificity of 91.0% and 92.8%. It had comparable sensitivity to MRI (e.g., 74.3% vs. 74.7%, P = 0.89) but lower sensitivity than PET/CT (77.9% vs. 92.0%, P < 0.0001) at the same individual-specificities. The AI model achieved moderate precision with a median dice similarity coefficient of 0.67. AI-aided MRI improved specificity (92.5% vs. 85.0%, P = 0.034), equaled PET/CT in the internal validation subcohort, and increased sensitivity (81.9% vs. 70.8%, P = 0.021) in the external validation subcohort. In the prospective cohort of 1248 patients, the AI group had higher sensitivity than the non-AI group (78.6% vs. 67.3%, P = 0.23), albeit nonsignificant. In future randomized controlled trials, a sample size of 3943 patients in each arm would be required to demonstrate the statistically significant difference.
The AI model equaled MRI by expert radiologists, and AI-aided MRI by expert radiologists equaled PET/CT. A larger randomized controlled trial is warranted to demonstrate the AI's benefit sufficiently.
The Sun Yat-sen University Clinical Research 5010 Program (2015020), Guangdong Basic and Applied Basic Research Foundation (2022A1515110356), and Guangzhou Science and Technology Program (2023A04J1788).
Imaging considerations for salvage surgery in nasopharyngeal carcinoma: what surgeons need to know
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Citation Excerpt :
T1 tumours, involving only the mucosal space of the nasopharynx or extending into the nasal cavity or oropharynx, are resectable. Tumours that are small with limited involvement of the nasopharynx are ideal for nasopharyngectomy, although it may be difficult to map the full extent of minimal mucosal/submucosal tumour involvement of the nasopharynx accurately in the post-radiation therapy (RT) patient.20 T1 disease with inferior extension into the oropharynx or below the level of the floor of the nasal cavity requires an extended field of resection.
Nasopharyngeal carcinoma is frequently an undifferentiated squamous cell carcinoma, which is primarily treated with radiotherapy with or without chemotherapy; however, for residual or recurrent cancer, salvage surgery is the treatment of choice for resectable disease because it reduces the significant morbidity associated with re-irradiation. This review highlights the current surgical approach, mapping the extent of disease with an emphasis on magnetic resonance imaging (MRI) and integrated positron-emission tomography (PET)/computed tomography (CT), imaging features that determine operability for nasopharyngectomy and neck dissection, and need for a succinct radiological report and multidisciplinary team discussion, which are of paramount importance for successful surgical planning.
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This chapter aims to discuss the multifaceted roles of anatomical, functional, and molecular imaging in the management of nasopharyngeal carcinoma from diagnosis to therapy and surveillance, in light of its increasing use in patient care. Each imaging modality presents advantages and disadvantages regarding anatomical resolution, temporal resolution, sensitivity, and specificity in various clinical scenarios. Ultrasonography is suitable for a quick screening of cervical nodal involvement due to the ease of handling, wide availability, and real-time nature. Computed tomography offers high-resolution images with undistorted attenuation information for radiation dose planning. Magnetic resonance imaging (MRI) offers excellent soft tissue resolution with high spatial resolution for primary tumor delineation. Moreover, with advanced functional imaging sequences, it can be used to probe functional parameters of tumor tissue. Positron emission tomography (PET) is unique in providing information about tumor metabolism. Finally, hybrid imaging modalities that combine anatomic, metabolic, and functional information, like integrated whole body PET/CT and PET/MRI, may provide a comprehensive imaging workup to derive multiparametric information of the primary tumor, and nodal and distant metastases.
Diagnostic Capacity of RASSF1A Promoter Methylation as a Biomarker in Tissue, Brushing, and Blood Samples of Nasopharyngeal Carcinoma
2017, EBioMedicine
Methylation of the RAS association domain family protein 1A (RASSF1A) promoter has been observed in nasopharyngeal carcinoma (NPC). This study investigated the correlation of RASSF1A promoter methylation with clinicopathological features and its utility as a diagnostic biomarker in NPC. A total of 926 patients with NPC and 495 non-tumor controls were analyzed in this study. RASSF1A promoter methylation was notably higher in NPC compared with non-tumor tissue, brushing and blood samples. RASSF1A promoter methylation was associated with clinical stage, lymph node status, distant metastasis, and T classification of patients with NPC, although it was not linked to age and sex. The pooled sensitivity, specificity, and AUC (area under the curve) of RASSF1A promoter methylation were determined in NPC samples vs. non-tumor samples (tissue: sensitivity = 0.72, specificity = 0.99, AUC = 0.98; brushing: sensitivity = 0.56, specificity = 1.00, AUC = 0.94; blood: sensitivity = 0.11, specificity = 0.98, AUC = 0.97). Our findings show that RASSF1A promoter methylation may be correlated with the development, progression and metastasis of NPC. RASSF1A promoter methylation is a promising noninvasive biomarker for the diagnosis of NPC from tissue and brushing samples.
Comparison of (18)F-FDG PET/CT, MRI and SPECT in the diagnosis of local residual/recurrent nasopharyngeal carcinoma: A meta-analysis
2016, Oral Oncology
The objective of this study was to assess the overall diagnostic value of MRI, SPECT and (18)F-FDG PET/CT in detecting local NPC residual/recurrence with a meta-analysis. We performed a systematic review with meta-analyses to compare the diagnostic performance of nuclear magnetic resonance Imaging (MRI), single photon emission computed tomography (SPECT) and 18-fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG PET/CT) as imaging modalities for the detection of local residual or recurrent nasopharyngeal carcinoma (NPC). MEDLINE, EMBASE and publisher databases were searched in December 2014. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Pooled estimation and subgroup analysis data were obtained by statistical analysis. Seventeen studies were included in the meta-analysis. The pooled sensitivity estimates for (18)F-FDG PET/CT (90%) and SPECT (85%) were not significantly higher than MRI (77%) (p = 0.096 and 0.164, respectively). The pooled specificity estimates for (18)F-FDG PET/CT (93%) and SPECT (81%) were significantly higher than MRI (76%) (p = 0.033 and 0.042, respectively). The pooled DOR (Diagnostic odds ratio) estimates for (18)F-FDG PET/CT (73.27) were significantly higher than MRI (12.09) (p = 0.019) while the pooled DOR estimates for SPECT (78.69) were not significantly higher than MRI (12.09) (p = 0.872). For (18)F-FDG PET/CT, there were no significant differences between PET–CT and PET on all of the variables including sensitivity, specificity, PLR (Positive likelihood ratio), NLR (Negative likelihood ratio) and DOR (P > 0.05). For SPECT, there were no significant differences between 201TI-SPECT and MIBI-SPECT on all of the variables including sensitivity, specificity, PLR, NLR and DOR (P > 0.05). Both (18)F-FDG PET/CT and SPECT are very accurate for the detection of local residual or recurrent NPC, they are superior to MRI in distinguishing recurrent NPC from fibrosis or scar tissue after RT in irradiated fields with distortion of normal architecture. For (18)F-FDG PET/CT, the diagnostic accuracy PET/CT was not significantly different than that of PET alone. For SPECT, 201TI-SPECT and MIBI-SPECT have the same diagnostic accuracy.
Low radiation dose 256-MDCT angiography of the carotid arteries:Effect of hybrid iterative reconstruction technique on noise, artifacts,and image quality
2013, European Journal of Radiology
To evaluate the effect of hybrid iterative reconstruction on qualitative and quantitative parameters at low dose carotid CTA.
44 consecutive patients were enrolled in the study. First group (n = 22) was examined under 120 kV 250 mAs, second group (n = 22) – 100 kV 250 mAs. CT images in first group were reconstructed only with the filtered back projection (FBP). CT data in second group were reconstructed both with FBP and three levels of hybrid iterative reconstruction algorithm (iDose). We compared quantitative and qualitative parameters among the two groups and among four different reconstructions in second group.
Effective dose in 120 kV and 100 kV group was 7.18 ± 1.19 mSv and 4.14 ± 1.03 mSv, respectively (p < 0.0001). Mean arterial attenuation was about 25% higher in second group (236.5 ± 46 HU vs. 302.6 ± 32.7 HU; p < 0.0001). Image noise at the level of humeral belt was 32.5 ± 12.5 in 100 kV group and 26.3 ± 13.3 in 120 kV (p = 0.115).
Average noise decreased when using 3 levels of iDose up to 23.6 ± 6.4, 17.7 ± 5.6 and 13.7 ± 5.1, respectively (p = 0.00001). Mean CNR increased to 10.38 ± 3.87, 14.5 ± 5.21 and 18.32 ± 8.61, respectively (p < 0.05).
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According to the results of our study low dose CT angiography using hybrid iterative reconstruction may provide sufficient image quality and allows for significant reduction of patient dose.

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MRI differentiation of recurrent nasopharyngeal carcinoma from postradiation fibrosis

Abstract

Radiol. Clin. North Am.

Computed tomographic scanning in nasopharyngeal carcinoma

Chin. J. Cancer

CT in clinical staging on nasopharyngeal carcinoma

Chin. J. Cancer

Computed tomography in the management of nasopharyngeal carcinoma

Clin. Radiol.

Differentiation of postradiation injuries from recurrence in the nasopharynx

Chin. J. Med.

Magnetic resonance imaging of the nasopharynx

Radiology

MRI image of nasopharyngeal carcinoma

Chin. J. Radiol.

Recurrent thyroid carcinoma: Characteristics on MR images

Radiology

Recurrent rectal cancer: diagnosis with MR imaging versus CT

Radiology

MR imaging of recurrent colorectal carcinoma versus fibrosis

J. Comput. Assist. Tomogr.