European Radiology

, Volume 29, Issue 10, pp 5627–5634 | Cite as

Distinguishing early-stage nasopharyngeal carcinoma from benign hyperplasia using intravoxel incoherent motion diffusion-weighted MRI

  • Qi-Yong Ai
  • Ann D. KingEmail author
  • Janet S. M. Chan
  • Weitian Chen
  • K. C. Allen Chan
  • John K. S. Woo
  • Benny C. Y. Zee
  • Anthony T. C. Chan
  • Darren M. C. Poon
  • Brigette B. Y. Ma
  • Edwin P. Hui
  • Anil T. Ahuja
  • Alexander C. Vlantis
  • Jing Yuan
Head and Neck



MRI can detect early-stage nasopharyngeal carcinoma (NPC), but the detection is more challenging in early-stage NPCs because they must be distinguished from benign hyperplasia in the nasopharynx. This study aimed to determine whether intravoxel incoherent motion diffusion-weighted imaging (IVIM DWI) MRI could distinguish between these two entities.


Thirty-four subjects with early-stage NPC and 30 subjects with benign hyperplasia prospectively underwent IVIM DWI. The mean pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and apparent diffusion coefficient (ADC) values were calculated for all subjects and compared between the 2 groups using Student’s t test. Receiver operating characteristics with the area under the curve (AUC) was used to identify the optimal threshold for all significant parameters, and the corresponding diagnostic performance was calculated. A p value of < 0.05 was considered statistically significant.


Compared with benign hyperplasia, early-stage NPC exhibited a significantly lower D mean (0.64 ± 0.06 vs 0.87 ± 0.11 × 10−3 mm2/s), ADC0–1000 mean (0.77 ± 0.08 vs 1.00 ± 0.13 × 10−3 mm2/s), ADC300–1000 (0.63 ± 0.05 vs 0.86 ± 0.10 × 10−3 mm2/s) and a higher D* mean (32.66 ± 4.79 vs 21.96 ± 5.21 × 10−3 mm2/s) (all p < 0.001). No significant difference in the f mean was observed between the two groups (p = 0.216). The D and ADC300–1000 mean had the highest AUC of 0.985 and 0.988, respectively, and the D mean of < 0.75 × 10−3 mm2/s yielded the highest sensitivity, specificity and accuracy (100%, 93.3% and 96.9%, respectively) in distinguishing early-stage NPC from benign hyperplasia.


DWI has potential to distinguish early-stage NPC from benign hyperplasia and D and ADC300–1000 mean were the most promising parameters.

Key Points

• Diffusion-weighted imaging has potential to distinguish early-stage nasopharyngeal carcinoma from benign hyperplasia in the nasopharynx.

• The pure diffusion coefficient, pseudo-diffusion coefficient from intravoxel incoherent motion model and apparent diffusion coefficient from conventional diffusion-weighted imaging were significant parameters for distinguishing these two entities in the nasopharynx.

• The pure diffusion coefficient, followed by apparent diffusion coefficient, may be the most promising parameters to be used in screening studies to help detect early-stage nasopharyngeal carcinoma.


Diffusion magnetic resonance imaging Nasopharyngeal carcinoma Hyperplasia 



Apparent diffusion coefficient


Area under the curve


Confidence interval


Pure diffusion coefficient


Pseudo-diffusion coefficient


Diffusion-weighted imaging


Epstein–Barr virus


Perfusion volume fraction


Intra-class correlation coefficient


Intravoxel incoherent motion


Nasopharyngeal carcinoma



This study has received funding by the Research Grant Council of Hong Kong. The work described in this paper was partially supported by grants from the Research Grants council of the Hong Kong Special Administrative Region, China (Project No. 14107216 and SEG_CUHK02).

Compliance with ethical standards


The scientific guarantor of this publication is Ann D King.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in New England Journal of Medicine entitled “Analysis of Plasma Epstein-Barr Virus DNA to Screen for Nasopharyngeal Cancer” (doi:


• prospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Qi-Yong Ai
    • 1
  • Ann D. King
    • 1
    Email author
  • Janet S. M. Chan
    • 1
  • Weitian Chen
    • 1
  • K. C. Allen Chan
    • 2
  • John K. S. Woo
    • 3
  • Benny C. Y. Zee
    • 4
  • Anthony T. C. Chan
    • 5
  • Darren M. C. Poon
    • 5
  • Brigette B. Y. Ma
    • 5
  • Edwin P. Hui
    • 5
  • Anil T. Ahuja
    • 1
  • Alexander C. Vlantis
    • 3
  • Jing Yuan
    • 6
  1. 1.Department of Imaging and Interventional RadiologyThe Chinese University of Hong Kong, Prince of Wales HospitalSha TinChina
  2. 2.Department of Chemical Pathology, State Key Laboratory Translational Oncology, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong Kong, Prince of Wales HospitalShatinChina
  3. 3.Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinChina
  4. 4.Jockey Club School of Public Health and Primary CareThe Chinese University of Hong KongShatinChina
  5. 5.Department of Clinical Oncology, State Key Laboratory Translational OncologyThe Chinese University of Hong Kong, Prince of Wales HospitalShatinChina
  6. 6.Medical Physics and Research DepartmentHong Kong Sanatorium & HospitalHappy ValleyChina

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