背景:多参数成像已被视为改善放化疗治疗结果预测的途径。四维容积灌注CT(4DPCT)可用于全器官灌注测量,因为它反映了肿瘤及其灌注参数的异质性。然而,目前尚无使用包括4DPCT在内的多参数成像技术预测放化疗预后的研究.这项研究的目的是确定将4DPCT评估与扩散加权MRI(DWI)和18F-脱氧葡萄糖PET-CT相结合是否可以提高接受放化疗的头颈部鳞状细胞癌(HNSCC)患者的预后准确性。
方法:我们检查了53例接受4DPCT的HNSCC患者,放化疗前的DWI和PET-CT。通过逻辑回归分析评估影像学和临床参数与局部控制(LRC)和无进展生存期(PFS)的关系。进行接收器工作特性(ROC)分析,以评估通过多变量分析确定的重要参数的准确性,以预测LRC和PFS。我们还使用评分系统评估这些独立参数是否对预后预测具有补充作用。
结果:中位随访时间为30个月。在多变量分析中,血流量(BF;p=0.02)和血容量(BV;p=0.04)是LRC的重要预后因素,BF(p=0.03)和ADC直方图的偏度(p=0.02)是PFS的重要预后因素。BF与BV呈显著正相关(ρ=0.6,p<0.001),BF与偏度呈显著正相关(ρ=0.46,p<0.01)。ROC分析表明,BF的LRC预后的准确性,BV,BF和BV的组合为77.8%,70%,和92.9%,对于BF的PFS,偏斜度,BF和偏度的组合为55.6%,63.2%,77.5%,分别。评分系统表明,较高的BF和较高的BV的组合与较好的LRC显着相关(p=0.04),较低的BF和较低的偏度与较差的PFS显著相关(p=0.004)。
结论:来自4DPCT和ADC直方图的参数组合可以提高放化疗HNSCC患者的预后准确性。
BACKGROUND: Multiparametric imaging has been seen as a route to improved prediction of chemoradiotherapy treatment outcomes. Four-dimensional volumetric perfusion CT (4D PCT) is useful for whole-organ perfusion measurement, as it reflects the heterogeneity of the tumor and its perfusion parameters. However, there has been no study using multiparametric imaging including 4D PCT for the prognostic prediction of chemoradiotherapy. The purpose of this study was to determine whether combining assessments of 4D PCT with diffusion-weighted MRI (DWI) and 18F-fluorodeoxyglucose PET-CT could enhance prognostic accuracy in head and neck squamous cell carcinoma (HNSCC) patients treated with chemoradiotherapy.
METHODS: We examined 53 patients with HNSCC who underwent 4D PCT, DWI and PET-CT before chemoradiotherapy. The imaging and clinical parameters were assessed the relations to locoregional control (LRC) and progression-free survival (PFS) by logistic regression analyses. A receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the significant parameters identified by the multivariate analysis for the prediction of LRC and PFS. We additionally assessed using the scoring system whether these independent parameters could have a complementary role for the prognostic prediction.
RESULTS: The median follow-up was 30 months. In multivariate analysis, blood flow (BF; p = 0.02) and blood volume (BV; p = 0.04) were significant prognostic factors for LRC, and BF (p = 0.03) and skewness of the ADC histogram (p = 0.02) were significant prognostic factors for PFS. A significant positive correlation was found between BF and BV (ρ = 0.6, p < 0.001) and between BF and skewness (ρ = 0.46, p < 0.01). The ROC analysis showed that prognostic accuracy for LRC of BF, BV, and combination of BF and BV were 77.8%, 70%, and 92.9%, and that for PFS of BF, skewness, and combination of BF and skewness were 55.6%, 63.2%, and 77.5%, respectively. The scoring system demonstrated that the combination of higher BF and higher BV was significantly associated with better LRC (p = 0.04), and the combination of lower BF and lower skewness was significantly associated with worse PFS (p = 0.004).
CONCLUSIONS: A combination of parameters derived from 4DPCT and ADC histograms may enhance prognostic accuracy in HNSCC patients treated with chemoradiotherapy.