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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Functional Evaluation of Major Salivary Glands Using Viscosity PLUS and 2D Shear-Wave PLUS Elastography Techniques in Healthy Subjects-A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12081963. [PMID: 36010313 PMCID: PMC9406548 DOI: 10.3390/diagnostics12081963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/31/2022] Open
Abstract
Biological soft tissues are characterized by viscoelastic properties. The propagation of shear waves within tissues is influenced by both elasticity, which is linked to the shear wave speed, and viscosity, which is linked to the shear wave dispersion. This study aimed to functionally assess the parotid glands (PG) and submandibular glands (SMG) in a group of 40 healthy subjects using the novel Viscosity PLUS (Vi.PLUS) and 2D Shear-Wave Elastography PLUS (2D-SWE.PLUS) techniques. The viscosity and stiffness of PG and SMG were measured before and after gustatory stimulation with a sialagogue agent (commercially available lemon juice) using the new SuperSonic MACH 30 ultrasound system equipped with a curvilinear C6-1X transducer. PG presented a mean basal viscosity and elasticity of 2.10 ± 0.19 Pa.s and 11.32 ± 1.91 kPa, respectively, which significantly increased poststimulation to 2.39 ± 0.17 Pa.s (p < 0.001) and 12.58 ± 1.92 kPa (p < 0.001), respectively. SMG did not present statistically increased values of viscosity and elasticity following stimulation (2.31 ± 015 Pa.s vs. 2.37 ± 0.18 Pa.s, p = 0.086, and 10.40 ± 1.64 kPa vs. 10.90 ± 1.98 kPa, p = 0.074, respectively). Vi.PLUS measurements presented a good positive correlation with 2D-SWE.PLUS values for PG and SMG, before and after stimulation. Gender and BMI were not confounding factors for these two parameters. Vi.PLUS represents an innovative non-invasive imaging technique that, together with 2D-SWE.PLUS proves to be useful in functionally assessing the major salivary glands in healthy subjects.
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Evaluation of parotid gland function in type 2 diabetes patients using diffusion-weighted imaging before and after acid stimulation. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bruvo M, Mahmood F. Apparent diffusion coefficient measurement of the parotid gland parenchyma. Quant Imaging Med Surg 2021; 11:3812-3829. [PMID: 34341752 DOI: 10.21037/qims-20-1178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Abstract
The measurements of apparent diffusion coefficient (ADC) with diffusion weighted magnetic resonance imaging (DW-MRI) is becoming a popular diagnostic and research tool for examination of parotid glands. However, there is little agreement between the reported ADC values of the parotid gland in published literature. In this review 43 studies on ADC measurement of the parotid glands were included. The analyses indicated several possible culprits of the observed ADC discrepancies. For example, DW-MRI examinations under gustatory stimulation gives higher ADC values compared to the unstimulated parotid gland (P=0.003). The diffusion weighting factors (b-values) can either increase (b-value <200 s/mm2) or decrease ADC values (b-values >1,000 s/mm2). The timing of follow-up DW-MRI after radiotherapy (RT) indicates correlation to the found ADC values (R2 =0.39). Interestingly, the choice of regions of interest (ROI) appears not to affect the measurements of ADC (P=0.75). It can be concluded that there is a critical need for standardization of ADC measurement of the parotid glands to allow valid inter-study comparisons and eventually to reach consensus on the use of ADC as biomarker.
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Affiliation(s)
- Maja Bruvo
- Radiography, Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark.,Research Unit for Oncology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Shi D, Qian JJ, Fan GH, Shen JK, Tian Y, Xu L. Salivary gland function in nasopharyngeal carcinoma before and late after intensity-modulated radiotherapy evaluated by dynamic diffusion-weighted MR imaging with gustatory stimulation. BMC Oral Health 2019; 19:288. [PMID: 31864328 PMCID: PMC6925496 DOI: 10.1186/s12903-019-0951-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/07/2019] [Indexed: 11/15/2022] Open
Abstract
Background Xerostomia caused by radiation-induced salivary glands injury has a considerable impact on patients’ quality of life. Nowadays, the existed different methods of evaluating xerostomia in clinical practice there are still some disadvantages and limitations. This study used diffusion-weighted magnetic resonance imaging (DW-MRI) with gustatory stimulation to assess salivary glands function after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods DW-MRI was performed in 30 NPC patients and swab method was used to calculate rest and stimulated salivary flow rates (SFR). DW sequence at rest and then repeated ten times during stimulation were obtained. Apparent diffusion coefficients (ADCs) maps of three glands were calculated. Patients before and after RT were recorded as xerostomia and non-xerostomia groups separately. Rest and stimulated ADCs, ADCs increase rates (IRs), time to maximum ADCs (Tmax), ADCs change rates (CRs), rest and stimulated SFR, SFR increase rates (IRs) and SFR change rates (CRs) before and after RT were assessed. Results The rest and stimulated ADCs of three glands after RT were higher than those before RT (p < 0.001). The rest and stimulated SFR of all salivary glands after RT were lower than those before RT (p < 0.001). A correlation existed between rest ADCs of submandibular glands and rest SFR of submandibular mixed with sublingual glands and full three glands before RT (p = 0.019, p = 0.009), stimulated ADCs and stimulated SFR in parotid glands before RT (p = 0.047). The rest ADCs of parotid glands after RT correlated to XQ scores (p = 0.037). Conclusions The salivary glands’ ADCs increased after RT both in rest and stimulated state due to the radiation injury and the ADCs correlated with SFR and XQ scores of evaluating the xerostomia in clinical practice.
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Affiliation(s)
- Dai Shi
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Jian-Jun Qian
- Department of Radiotherapy and Oncolog, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Guo-Hua Fan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Jun-Kang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Ye Tian
- Department of Radiotherapy and Oncolog, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Liang Xu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.
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Munhoz L, Ramos EADA, Im DC, Hisatomi M, Yanagi Y, Asaumi J, Arita ES. Application of diffusion-weighted magnetic resonance imaging in the diagnosis of salivary gland diseases: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:280-310. [DOI: 10.1016/j.oooo.2019.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/16/2019] [Accepted: 02/22/2019] [Indexed: 01/02/2023]
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Zhang Y, Ou D, Gu Y, He X, Peng W. Evaluation of Salivary Gland Function Using Diffusion-Weighted Magnetic Resonance Imaging for Follow-Up of Radiation-Induced Xerostomia. Korean J Radiol 2018; 19:758-766. [PMID: 29962882 PMCID: PMC6005952 DOI: 10.3348/kjr.2018.19.4.758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/28/2017] [Indexed: 01/25/2023] Open
Abstract
Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) as a noninvasive tool to assess salivary gland function for follow-up of patients with radiation-induced xerostomia. Materials and Methods This study included 23 patients with nasopharyngeal carcinoma who had been treated with parotid-sparing radiotherapy (RT). Salivary function was assessed by DW-MRI pre-treatment and one week and one year post-RT, respectively. The maximum apparent diffusion coefficient (ADC) of parotid glands (pADCmax) and the time to peak ADC of parotid glands (pTmax) during stimulation were obtained. Multivariate analysis was used to analyze factors correlated with the severity of radiation-induced xerostomia. Results The ADCs of parotid and submandibular glands (1.26 ± 0.10 × 10−3 mm2/s and 1.32 ± 0.07 × 10−3 mm2/s pre-RT, respectively) both showed an increase in all patients at one week post-RT (1.75 ± 0.16 × 10−3 mm2/s, p < 0.001 and 1.70 ± 0.16 × 10−3 mm2/s, p < 0.001, respectively), followed by a decrease in parotid glands at one year post-RT(1.57 ± 0.15 × 10−3 mm2/s, p < 0.001) but not in submandibular glands (1.69 ± 0.18 × 10−3 mm2/s, p = 0.581). An improvement in xerostomia was found in 13 patients at one year post-RT. Multivariate analysis revealed 4 significant predictors for the improvement of xerostomia, including dose to parotid glands (p = 0.009, odds ratio [OR] = 0.639), the ADC of submandibular glands (p = 0.013, OR = 3.295), pADCmax (p = 0.024, OR = 0.474), and pTmax (p = 0.017, OR = 0.729) at one week post-RT. Conclusion The ADC value is a sensitive indicator for salivary gland dysfunction. DW-MRI is potentially useful for noninvasively predicting the severity of radiation-induced xerostomia.
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Affiliation(s)
- Yunyan Zhang
- Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China
| | - Dan Ou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weijun Peng
- Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai 201321, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Liu YJ, Lee YH, Chang HC, Chiu HC, Chiu TW, Hsu K, Pen CM, Hsu HH, Juan CJ. Proton change of parotid glands after gustatory stimulation examined by magnetic resonance imaging. NMR IN BIOMEDICINE 2018; 31:e3885. [PMID: 29315960 DOI: 10.1002/nbm.3885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate proton changes of the parotid gland after gustatory stimulation by semi-quantitative parameters and an empirical mathematical model (EMM) using high-temporal-resolution, double-echo, echo-planar imaging (EPI). Approved by a local institutional review board, this study examined 20 parotid glands from 10 healthy volunteers (male:female = 6: 4; age ± standard deviation =35.1 ± 14.1 years) with written informed consent obtained. All participants underwent 1.5-T, double-echo EPI with gustatory stimulation. Semi-quantitative parameters, including maximal drop ratio (MDR), time to peak (TTP), drop slope (DS), recovery slope (RS) and recovery ratio (RR), were calculated. The effect of temporal resolution on parotid functional parameters was evaluated. An EMM comprising an output function ( Sot=Aoe-kot+B) and an input function ( Sint=Ain1-e-kint) was also applied to fit all dynamic curves. Kruskal-Wallis test, Wilcoxon test, linear regression analysis and goodness of fit were used for statistical analysis. p < 0.05 was considered to be statistically significant. The signal intensity dropped significantly after gustatory stimulation on the proton density (PD) image (p < 0.01). MDR was 8.26% in the PD image. MDR and RR were negatively associated with time interval, whereas DS and TTP were significantly positively associated with time interval (all p < 0.05). EMM parametric values derived from PD-time curves of parotid glands were 12.04 ± 6.81%, 6.43 ± 4.23 min-1 , 88.73 ± 6.18%, 8.41 ± 4.86 min-1 and 1.09 ± 1.35 for Ao , ko , B, Ain and kin , respectively. Semi-quantitative functional parameters and EMM parameters using high-temporal-resolution, double-echo EPI allow the quantification of parotid proton changes after gustatory stimulation.
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Affiliation(s)
- Yi-Jui Liu
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
| | - Yi-Hsiung Lee
- PhD Program in Electrical and Communication Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Hing-Chiu Chang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Hui-Chu Chiu
- PhD Program of Technology Management, Chung Hua University, Hsinchu, Taiwan, Republic of China
| | - Ta-Wei Chiu
- Department of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Kang Hsu
- Department of Dentistry, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Cheng-Ming Pen
- PhD Program in Electrical and Communication Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
- Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Jung Juan
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Zhang Q, Wei YM, Qi YG, Li BS. Early Changes in Apparent Diffusion Coefficient for Salivary Glands during Radiotherapy for Nasopharyngeal Carcinoma Associated with Xerostomia. Korean J Radiol 2018. [PMID: 29520191 PMCID: PMC5840062 DOI: 10.3348/kjr.2018.19.2.328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective To evaluate the early changes in the apparent diffusion coefficient (ADC) of the salivary glands during radiotherapy (RT) and their association with the degree of xerostomia at 6 months after RT in patients with nasopharyngeal carcinoma (NPC). Materials and Methods We enrolled 26 patients with NPC who underwent RT. Each patient underwent diffusion-weighted MRI of the salivary glands at rest and with gustatory stimulation within 1 week before RT and 2 weeks after the beginning of RT. The ADC at rest (ADCR) and increase and increase rate with stimulation (ADCI, ADCIR) of the submandibular and parotid glands were calculated. The differences in the variables' values between 2 weeks after the beginning of RT and baseline (ΔADCR, ΔADCI, and ΔADCIR) were compared to the degree of xerostomia at 6 months after RT. Results The ADCR of the submandibular and parotid glands were both significantly higher at 2 weeks after the beginning of RT than found at baseline (both p < 0.01). The ADCI and ADCIR for the parotid glands were both significantly lower at 2 weeks after the beginning of RT than found at baseline (both p < 0.01). ΔADCI and ΔADCIR of the parotid glands were associated with the degree of xerostomia at 6 months after RT (r = −0.61 and −0.72, both p < 0.01). Conclusion The ADCs of the salivary glands change early during RT. The differences in the ADC increase and increase rate of the parotid glands between 2 weeks after the beginning of RT and baseline were associated with the degree of xerostomia at 6 months after RT.
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Affiliation(s)
- Qing Zhang
- Department of Radiology, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan 250031, China.,Postdoctoral Mobile Station, Tianjin Medical University, Tianjin 300070, China
| | - Yu-Mei Wei
- Department of Head and Neck Radiotherapy, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250022, China
| | - Yuan-Gang Qi
- Department of Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250017, China
| | - Bao-Sheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250017, China
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Diffusion-weighted magnetic resonance imaging for evaluation of salivary gland function in head and neck cancer patients treated with intensity-modulated radiotherapy. Radiother Oncol 2017; 122:178-184. [DOI: 10.1016/j.radonc.2016.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/30/2016] [Accepted: 07/05/2016] [Indexed: 12/17/2022]
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12
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Chu C, Zhou N, Zhang H, Dou X, Li M, Liu S, Zhu Y, Chen W, Chan Q, He J, Sun L, Zhou Z. Use of T1ρMR imaging in Sjögren's syndrome with normal appearing parotid glands: Initial findings. J Magn Reson Imaging 2016; 45:1005-1012. [PMID: 27726238 DOI: 10.1002/jmri.25494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To explore the feasibility of parotid spin-lattice relaxation time in the rotating frame (T1ρ) MR imaging in the diagnosis of Sjögren's syndrome (SS) without morphological changes of the parotid glands. MATERIALS AND METHODS The study enrolled 32 consecutive SS patients without morphological changes of parotid glands and 32 age- and gender-matched healthy volunteers who underwent parotid 3.0 Tesla MR imaging, including T1ρ sequences. Follow-up imaging was performed at 3 months. T1 signal intensities and T1ρ values of bilateral parotid glands were compared using paired samples t-test. Parotid T1 signal intensities and T1ρ values were compared using two independent samples t-test. Diagnostic performance of the parotid T1ρ values was evaluated by receiver operating characteristic analysis. The intraclass correlation coefficient (ICC) was calculated to evaluate the reproducibility of parotid T1ρ measurements. RESULTS There were no significant differences of T1 signal intensities and T1ρ values between bilateral parotid glands in SS patients and healthy volunteers (P = 0.170, 0.886 and 0.942, 0.229). The parotid T1ρ values of SS patients (96.47 ± 15.38 ms) were significantly higher than those of healthy volunteers (84.25 ± 6.11 ms) (P < 0.001), while there were no significant differences of T1 signal intensities between SS patients and healthy volunteers (P = 0.655). With a cutoff value of 88.02 ms, the sensitivity and specificity of the parotid T1ρ value was 75.0% and 100.0% in the diagnosis of SS. The reproducibility of parotid T1ρ measurement was excellent (ICC: 0.934-0.995). CONCLUSION Parotid T1ρ MR imaging held a potential role in diagnosing SS without morphological changes of parotid glands. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:1005-1012.
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Affiliation(s)
- Chen Chu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Nan Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Huayong Zhang
- Department of Rheumatology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xin Dou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ming Li
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yun Zhu
- Department of Rheumatology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | | | | | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lingyun Sun
- Department of Rheumatology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Chiu TW, Liu YJ, Chang HC, Lee YH, Lee JC, Hsu K, Wang CW, Yang JM, Hsu HH, Juan CJ. Evaluating Instantaneous Perfusion Responses of Parotid Glands to Gustatory Stimulation Using High-Temporal-Resolution Echo-Planar Diffusion-Weighted Imaging. AJNR Am J Neuroradiol 2016; 37:1909-1915. [PMID: 27339952 DOI: 10.3174/ajnr.a4852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/03/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Parotid glands secrete and empty saliva into the oral cavity rapidly after gustatory stimulation. However, the role of the temporal resolution of DWI in investigating parotid gland function remains uncertain. Our aim was to design a high-temporal-resolution echo-planar DWI pulse sequence and to evaluate the instantaneous MR perfusion responses of the parotid glands to gustatory stimulation. MATERIALS AND METHODS This prospective study enrolled 21 healthy volunteers (M/F = 2:1; mean age, 45.2 ± 12.9 years). All participants underwent echo-planar DWI (total scan time, 304 seconds; temporal resolution, 4 s/scan) on a 1.5T MR imaging scanner. T2WI (b = 0 s/mm2) and DWI (b = 200 s/mm2) were qualitatively assessed. Signal intensity of the parotid glands on T2WI, DWI, and ADC was quantitatively analyzed. One-way ANOVA with post hoc group comparisons with Bonferroni correction was used for statistical analysis. P < .05 was statistically significant. RESULTS Almost perfect interobserver agreement was achieved (κ ≥ 0.656). The parotid glands had magnetic susceptibility artifacts in 14.3% (3 of 21) of volunteers during swallowing on DWI but were free from perceptible artifacts at the baseline and at the end of scans on all images. Increased ADC and reduced signal intensity of the parotid glands on T2WI and DWI occurred immediately after oral administration of lemon juice. Maximal signal change of ADC (24.8% ± 10.8%) was significantly higher than that of T2WI (-10.1% ± 5.2%, P < .001). The recovery ratio of ADC (100.71% ± 42.34%) was also significantly higher than that of T2WI (22.36% ± 15.54%, P < .001). CONCLUSIONS Instantaneous parotid perfusion responses to gustatory stimulation can be quantified by ADC by using high-temporal-resolution echo-planar DWI.
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Affiliation(s)
- T-W Chiu
- From the Departments of Radiology (T.-W.C., C.-W.W., H.-H.H., C.-J.J.)
- Department of Medicine (T.-W.C.), Taipei Medical University, Taipei, Taiwan
| | - Y-J Liu
- Department of Medicine (T.-W.C.), Taipei Medical University, Taipei, Taiwan
| | - H-C Chang
- Department of Diagnostic Radiology (H.-C.C.), The University of Hong Kong, Hong Kong
| | - Y-H Lee
- Department of Medicine (T.-W.C.), Taipei Medical University, Taipei, Taiwan
| | - J-C Lee
- Department of Otolaryngology-Head and Neck Surgery (J.-C.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Biological Science and Technology (J.-C.L., J.-M.Y.), Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - K Hsu
- Dentistry (K.H.), National Defense Medical Center, Taipei, Taiwan
| | - C-W Wang
- From the Departments of Radiology (T.-W.C., C.-W.W., H.-H.H., C.-J.J.)
- Department of Radiology (C.-W.W., H.-H.H., C.-J.J.), Tri-Service General Hospital, Taipei, Taiwan
| | - J-M Yang
- Department of Biological Science and Technology (J.-C.L., J.-M.Y.), Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - H-H Hsu
- From the Departments of Radiology (T.-W.C., C.-W.W., H.-H.H., C.-J.J.)
- Department of Radiology (C.-W.W., H.-H.H., C.-J.J.), Tri-Service General Hospital, Taipei, Taiwan
| | - C-J Juan
- From the Departments of Radiology (T.-W.C., C.-W.W., H.-H.H., C.-J.J.)
- Department of Radiology (C.-W.W., H.-H.H., C.-J.J.), Tri-Service General Hospital, Taipei, Taiwan
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14
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Becker AS, Manoliu A, Wurnig MC, Boss A. Intravoxel incoherent motion imaging measurement of perfusion changes in the parotid gland provoked by gustatory stimulation: A pilot study. J Magn Reson Imaging 2016; 45:570-578. [DOI: 10.1002/jmri.25393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/05/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Anton S. Becker
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Andrei Manoliu
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Moritz C. Wurnig
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Andreas Boss
- Department of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
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15
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Ding C, Xing X, Guo Q, Liu D, Guo Y, Cui H. Diffusion-weighted MRI findings in Sjögren's syndrome: a preliminary study. Acta Radiol 2016; 57:691-700. [PMID: 26339039 DOI: 10.1177/0284185115603245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 08/02/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parotid glands diffusion-weighted imaging (DWI) in Sjögren's syndrome patients have provided conflicting results currently. PURPOSE To determine if parotid gland DWI using a small region of interest (ROI) can provide diagnosis and assess therapeutic efficacy in Sjögren's syndrome. MATERIAL AND METHODS Twenty-three women with Sjögren's syndrome, five with dry mouth who did not meet diagnostic criteria for Sjögren's syndrome, and 11 healthy volunteers (controls) were evaluated with DWI. All participants received routine T1-weighted (T1W) imaging and T2-weighted (T2W) fat-suppressed imaging, and DWI. The SI ratios (SIRs) and ADC ratios (ADCRs) for parotid gland/spinal cord were then calculated. Approximately 8-10 round ROIs measuring approximately 5 mm(2) were placed on each lobe of the parotid gland, and the signal intensity (SI) was measured while avoiding fat, ducts, and blood vessels. A ROI encompassing the entire lobe of the parotid gland was also used to measure SI. RESULTS Using 5 mm(2) ROIs significantly higher DWI SIRs were noted in participants with Sjögren's syndrome compared with either participants with dry mouth without Sjögren's syndrome or healthy volunteers (all, P <0.001). The difference was not related to the presence of fat. No differences were noted when the larger ROI was used. In addition, parotid gland from untreated Sjögren's participants showed significantly higher SIRs compared with those from treated participants (P = 0.015). CONCLUSION A small ROI DWI can provide morphological and functional information on the parotid gland in Sjögren's syndrome patients, and can aid in the diagnosis and evaluation of therapeutic efficacy.
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Affiliation(s)
- Changwei Ding
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Xiaofei Xing
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Dongwu Liu
- Departments of Rheumatology and Immunology, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, PR China
| | - Yun Guo
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Huadong Cui
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
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16
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Kami YN, Sumi M, Takagi Y, Sasaki M, Uetani M, Nakamura T. Arterial Spin Labeling Imaging for the Parotid Glands of Patients with Sjögren's Syndrome. PLoS One 2016; 11:e0150680. [PMID: 26959680 PMCID: PMC4784920 DOI: 10.1371/journal.pone.0150680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/16/2016] [Indexed: 11/18/2022] Open
Abstract
Sjögren's syndrome (SS) is characterized by hypofunction of the salivary and lacrimal glands. The salivary function is largely dependent upon the blood supply in the glands. However, the diseased states of the gland perfusion are not well understood. The arterial spin labeling (ASL) technique allows noninvasive quantitative assessment of tissue perfusion without the need for contrast agent. Here, we prospectively compared the perfusion properties of the parotid glands between patients with SS and those with healthy glands using ASL MR imaging. We analyzed salivary blood flow (SBF) kinetics of 22 healthy parotid glands from 11 volunteers and 28 parotid glands from 14 SS patients using 3T pseudo-continuous ASL imaging. SBF was determined in resting state (base SBF) and at 3 sequential segments after gustatory stimulation. SBF kinetic profiles were characterized by base SBF level, increment ratio at the SBF peak, and the differences in segments where the peak appeared (SBF types). Base SBFs of the SS glands were significantly higher than those of healthy glands (59.2 ± 22.8 vs. 46.3 ± 9.0 mL/min/100 g, p = 0.01). SBF kinetic profiles of the SS glands also exhibited significantly later SBF peaks (p < 0.001) and higher SBF increment ratios (74 ± 49% vs. 47 ± 39%, p = 0.04) than the healthy glands. The best SBF criterion (= 51.2 mL/min/100 mg) differentiated between control subjects and SS patients with 71% sensitivity and 82% specificity. Taken together, these results showed that the SS parotid glands were mostly hyperemic and the SS gland responses to gustatory stimulation were stronger and more prolonged than those of the healthy glands. The ASL may be a promising technique for assessing the diseased salivary gland vascularization of SS patients.
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Affiliation(s)
- Yukiko N. Kami
- Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan
| | - Misa Sumi
- Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan
| | - Yukinori Takagi
- Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan
| | - Miho Sasaki
- Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiology, Nagasaki University Graduate School of Biosciences, Nagasaki, Japan
| | - Takashi Nakamura
- Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan
- * E-mail:
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17
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Salivary hypofunction: An update on aetiology, diagnosis and therapeutics. Arch Oral Biol 2015; 60:242-55. [DOI: 10.1016/j.archoralbio.2014.10.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/15/2014] [Accepted: 10/28/2014] [Indexed: 12/25/2022]
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18
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Koyasu S, Iima M, Umeoka S, Morisawa N, Porter DA, Ito J, Le Bihan D, Togashi K. The clinical utility of reduced-distortion readout-segmented echo-planar imaging in the head and neck region: initial experience. Eur Radiol 2014; 24:3088-96. [DOI: 10.1007/s00330-014-3369-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/14/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
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19
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Chang HC, Juan CJ, Chiu HC, Cheng CC, Chiu SC, Liu YJ, Chung HW, Hsu HH. Effects of gender, age, and body mass index on fat contents and apparent diffusion coefficients in healthy parotid glands: an MRI evaluation. Eur Radiol 2014; 24:2069-76. [PMID: 24972952 DOI: 10.1007/s00330-014-3265-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 05/13/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To establish standard apparent diffusion coefficient (ADC) and the fat content as a function of age, gender and body mass index (BMI) in healthy parotid glands, and to address the influences of fat suppression on ADC measurements. METHODS A total of 100 healthy adults (gender and age evenly distributed) were prospectively recruited, with parotid fat content measured from gradient-echo images with fat-water separated using iterative decomposition with echo asymmetry and least squares (IDEAL). The ADCs were estimated using both fat-saturated and non-fat-saturated diffusion-weighted imaging via a periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique. RESULTS Parotid fat content was larger in men than in women by about 10 percentage points (P < 0.005), and positively associated with BMI and age for both genders (mostly with P < 0.001). ADCs estimated with non-fat-saturated PROPELLER were significantly lower in men than in women (P < 0.005), but showed no gender difference if measured using fat-saturated PROPELLER (P = 0.840). The negative association between parotid ADC and age/BMI/fat (P < 0.001) showed greater regression slopes in non-fat-saturated PROPELLER than in fat-saturated data. CONCLUSIONS Parotid fat content in healthy adults correlates positively with both age and BMI; the correlation with age is gender-dependent. Parotid ADC measurements are strongly influenced by fat saturation. KEY POINTS Parotid fat content in healthy adults correlates positively with age and BMI. The rate of aging-related increase in fat contents is gender-dependent. Parotid ADC measurements are strongly influenced by fat saturation.
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Affiliation(s)
- Hing-Chiu Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
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20
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Marzi S, Forina C, Marucci L, Giovinazzo G, Giordano C, Piludu F, Landoni V, Spriano G, Vidiri A. Early radiation-induced changes evaluated by intravoxel incoherent motion in the major salivary glands. J Magn Reson Imaging 2014; 41:974-82. [PMID: 24700435 DOI: 10.1002/jmri.24626] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/06/2014] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To investigate the potential of intravoxel incoherent motion (IVIM) MRI for early evaluation of irradiated major salivary glands. MATERIALS AND METHODS Thirty-four patients with head-neck cancer were included in a prospective study. All patients underwent three serial IVIM-MRI: before, half-way through, and at the end of radiotherapy (RT). Apparent diffusion coefficient (ADC), ADClow derived in the low b-value range, perfusion fraction f, and pure diffusion coefficient D were estimated. Pretreatment values and early changes of diffusion parameters were correlated with parotid mean dose (Dmean ) and volume reduction after RT. RESULTS Changes in diffusion parameters over time were all significant (P < 0.001 for ADC, ADClow , and D, P = 0.003 for f). Variations of ADC, ADClow , and f were not correlated with Dmean (P = 0.089, P = 0.252 and P = 0.884, respectively), whereas a significant relationship was found between changes in D and Dmean (r = 0.197 with CI95% = 0.004-0.375, P = 0.046). Pretreatment f and Dmean were the best independent predictors for the percentage shrinkage (P = 0.0003 and 0.0597 respectively; R(2) = 0.391). CONCLUSION Early changes of irradiated major salivary glands can be noninvasively evaluated by IVIM-MRI. Perfusion-related coefficients in conjunction with dosimetric information increase our capability to predict the change in parotid volume and hence, if further validated, guide treatment strategy in RT.
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Affiliation(s)
- Simona Marzi
- Medical Physics Laboratory, Regina Elena National Cancer Institute, Rome, Italy
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21
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Zhang Y, Ou D, Gu Y, He X, Peng W, Mao J, Yue L, Shen X. Diffusion-weighted MR imaging of salivary glands with gustatory stimulation: comparison before and after radiotherapy. Acta Radiol 2013; 54:928-33. [PMID: 23821773 DOI: 10.1177/0284185113491089] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Xerostomia is the most prominent complication in patients with head and neck carcinoma after radiotherapy (RT). Diffusion-weighted magnetic resonance imaging (DWI) with gustatory stimulation may contribute to the evaluation of salivary gland function. PURPOSE To investigate the value of DWI for quantifying physiological changes of the parotid gland during gustatory stimulation in patients before and after RT. MATERIAL AND METHODS Magnetic resonance imaging (MRI) was performed in 28 consecutive patients with nasopharyngeal carcinoma before and after RT and clinical xerostomia was also assessed. A DWI sequence was performed once at rest and continually repeated seven times during stimulation with ascorbic acid. Apparent diffusion coefficient (ADC) maps for parotid glands at different time points and the range of increase with stimulation were calculated. Paired two-tailed Student t tests were used to compare the ADC values before and after stimulation, and before and after RT. RESULTS Before RT, the ADC showed an initial increase (P < 0.001) and then fluctuated during stimulation. After RT, as the clinical xerostomia changed from Grade 0 to Grade 2, the mean ADC at rest increased compared with the pre-RT value (P < 0.001). A similar response to stimulation was observed, but the range of increase between the maximum ADC during stimulation and the baseline value at rest was higher post-RT than pre-RT (P = 0.022). The minimum ADC during stimulation was higher than the baseline value post-RT (P = 0.028), but there was no difference pre-RT (P = 0.603). CONCLUSION DWI combined with gustatory stimulation seems to display the physiological changes of the parotid gland following RT and may be a potential tool for non-invasively assessing salivary gland function.
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Affiliation(s)
- Yunyan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Dan Ou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Jian Mao
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Lei Yue
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Xigang Shen
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
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