Distinguishing early-stage nasopharyngeal carcinoma from benign hyperplasia using intravoxel incoherent motion diffusion-weighted MRI
- 373 Downloads
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.
• 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.
KeywordsDiffusion magnetic resonance imaging Nasopharyngeal carcinoma Hyperplasia
Apparent diffusion coefficient
Area under the curve
Pure diffusion coefficient
Perfusion volume fraction
Intra-class correlation coefficient
Intravoxel incoherent motion
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.
Written informed consent was obtained from all subjects (patients) in this study.
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: https://doi.org/10.1056/NEJMoa1701717).
• diagnostic or prognostic study
• performed at one institution
- 4.King AD, Wong LYS, Law BKH et al (2018) MR imaging criteria for the detection of nasopharyngeal carcinoma: discrimination of early-stage primary tumors from benign hyperplasia. AJNR Am J Neuroradiol 39:515–523Google Scholar
- 13.Sakamoto J, Imaizumi A, Sasaki Y et al (2014) Comparison of accuracy of intravoxel incoherent motion and apparent diffusion coefficient techniques for predicting malignancy of head and neck tumors using half-Fourier single-shot turbo spin-echo diffusion-weighted imaging. Magn Reson Imaging 32:860–866CrossRefPubMedGoogle Scholar
- 16.Tan H, Chen J, Zhao Y et al (2018) Feasibility of intravoxel incoherent motion for differentiating benign and malignant thyroid nodules. Acad Radiol. https://doi.org/10.1016/j.acra.2018.05.011
- 22.Xiao Y, Pan J, Chen Y et al (2015) Intravoxel incoherent motionmagnetic resonance imaging as an early predictor of treatment response to neoadjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma. Medicine (Baltimore) 94:e973Google Scholar