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Chen R, Xie J, Chen J, Li X, Lin Q, Xu Q, Chen Y, Wang L, Zheng R, Xu B. Analysis of the Parotid Glands on an Energy Spectrum CT Iodine Map to Evaluate Irradiation-Induced Acute Xerostomia in Patients With Nasopharyngeal Carcinoma. Technol Cancer Res Treat 2024; 23:15330338241256814. [PMID: 38773777 PMCID: PMC11113032 DOI: 10.1177/15330338241256814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/15/2024] [Accepted: 05/02/2024] [Indexed: 05/24/2024] Open
Abstract
Objective: This prospective study aims to evaluate acute irradiation-induced xerostomia during radiotherapy by utilizing the normalized iodine concentration (NIC) derived from energy spectrum computed tomography (CT) iodine maps. Methods: In this prospective study, we evaluated 28 patients diagnosed with nasopharyngeal carcinoma. At 4 distinct stages of radiotherapy (0, 10, 20, and 30 fractions), each patient underwent CT scans to generate iodine maps. The NIC of both the left and right parotid glands was obtained, with the NIC at the 0-fraction stage serving as the baseline measurement. After statistically comparing the NIC obtained in the arterial phase, early venous phase, late venous phase, and delayed phase, we chose the late venous iodine concentration as the NIC and proceeded to analyze the variations in NIC at each radiotherapy interval. Using the series of NIC values, we conducted hypothesis tests to evaluate the extent of change in NIC within the parotid gland across different stages. Furthermore, we identified the specific time point at which the NIC decay exhibited the most statistically significant results. In addition, we evaluated the xerostomia grades of the patients at these 4 stages, following the radiation therapy oncology group (RTOG) xerostomia evaluation standard, to draw comparisons with the changes observed in NIC. Results: The NIC in the late venous phase exhibited the highest level of statistical significance (P < .001). There was a noticeable attenuation in NIC as the RTOG dry mouth grade increased. Particularly, at the 20 fraction, the NIC experienced the most substantial attenuation (P < .001), a significant negative correlation was observed between the NIC of the left, right, and both parotid glands, and the RTOG evaluation grade of acute irradiation-induced xerostomia (P < .001, r = -0.46; P < .001, r = -0.45; P < .001, r = -0.47). The critical NIC values for the left, right, and both parotid glands when acute xerostomia occurred were 0.175, 0.185, and 0.345 mg/ml, respectively, with AUC = 0.73, AUC = 0.75, and AUC = 0.75. Conclusion: The NIC may be used to evaluate changes in parotid gland function during radiotherapy and acute irradiation-induced xerostomia.
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Affiliation(s)
- Runfan Chen
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
- School of Medical Imaging, Fujian Medical University, Fuzhou, China
| | - Jiangao Xie
- Department of Radiology, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Jianmin Chen
- Department of Statistics, University of Connecticut, Storrs, USA
| | - Xiaobo Li
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
- School of Medical Imaging, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumours (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Haematological and Breast Malignancies), Fuzhou, China
| | - Qingliang Lin
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Qizhen Xu
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Yanyan Chen
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Lili Wang
- Department of Radiology, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Rong Zheng
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumours (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Haematological and Breast Malignancies), Fuzhou, China
| | - Benhua Xu
- Department of Radiotherapy, Union Hospital Affiliated to Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumours (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Haematological and Breast Malignancies), Fuzhou, China
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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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Lakshmi Nair S, Faizal B, Hari H. A Prospective Study of Recovery of Salivary Gland Function After Calculus Removal by Sialendoscopy. Indian J Otolaryngol Head Neck Surg 2023; 75:88-93. [PMID: 37007899 PMCID: PMC10050491 DOI: 10.1007/s12070-023-03526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/21/2023] [Indexed: 02/12/2023] Open
Abstract
Sialendoscopy is gaining popularity in treating obstructive sialolithiasis as a gland preserving procedure. The study aimed to determine if the salivary glands recovered apart from symptomatic improvement after interventional sialendoscopy for calculus removal. A prospective comparative study was conducted in a tertiary care center on 24 patients diagnosed with sialolithiasis. The eligibility criterion was patients who underwent calculus removal through interventional sialendoscopy. All patients underwent objective and subjective methods of assessments of function of the salivary glands with the help of salivary Technetium (Tc) 99 Scintigraphy, measurement of salivary flow rate, Chronic obstructive sialadenitis symptoms (COSS), and xerostomia index (XI) questionnaires. Assessments were done before the procedure and repeated after 3 months. Categorical variables were expressed using frequency and percentage. Numerical variables were represented using mean and standard deviation. To test the statistical significance of the difference in the mean of the four parameters Wilcoxen sign ranked test was used. According to our study improvement in functionality was noted in all of the subjective and objective parameters assessed namely Tc scintigraphy, salivary flow rate, COSS questionnaire, and XI questionnaire, with a statistically significant p value (< 0.001). Functionality of salivary gland showed improvement within 3 months of calculus removal through sialendoscopy. There was a marked improvement in the symptoms after sialendoscopy. This study demonstrates that removal of obstructing calculus results in rapid recovery of glandular function thereby emphasizing the need for salivary gland preservation. Level of evidence: Level III.
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Affiliation(s)
- S. Lakshmi Nair
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Bini Faizal
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Harsha Hari
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
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Ansinelli H, Gay C, Nguyen S, Morrison CM, Robbins JR. Personalized precision radiotherapy and its evolving role for human papillomavirus-positive oropharyngeal cancer. JOURNAL OF THE NATIONAL CANCER CENTER 2023; 3:72-82. [PMID: 39036313 PMCID: PMC11256722 DOI: 10.1016/j.jncc.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/19/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022] Open
Abstract
Human papilloma virus (HPV)-associated oropharyngeal cancer (OPC) is a unique entity with increased responsiveness to treatment and excellent oncologic outcomes. The purpose of this narrative review is to highlight how an improved prognosis for HPV (+) tumors and an ever-increasing understanding of the risk factors, risk stratification, and areas of potential spread are shaping management options. Additionally, we aim to detail how advances in treatment technology on both the surgical and radiation fronts are facilitating the delivery of increasingly personalized and precise treatments. This review will describe key aspects of recent and currently-ongoing trials investigating the de-escalation and individualization of treatment in this patient cohort, and how they are building a foundation for distinct treatment paradigms for HPV (+) tumors. Further studies into the integration of biomarker-guided treatments combined with clinical trial enrollment will help ensure a future of personalized treatments and improved outcomes, both in terms of oncologic outcomes and toxicity, for patients with HPV (+) OPC.
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Affiliation(s)
- Hayden Ansinelli
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
| | - Chris Gay
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
| | - Steven Nguyen
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
| | - Christopher M. Morrison
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
| | - Jared R. Robbins
- University of Arizona College of Medicine, Department of Radiation Oncology, Tucson, United States
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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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6
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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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8
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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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9
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Stieb S, Elgohari B, Fuller CD. Repetitive MRI of organs at risk in head and neck cancer patients undergoing radiotherapy. Clin Transl Radiat Oncol 2019; 18:131-139. [PMID: 31341989 PMCID: PMC6630152 DOI: 10.1016/j.ctro.2019.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023] Open
Abstract
First review on MRI changes in head and neck organs at risk during radiotherapy. Focus on dynamics in salivary gland, muscle and bone in the head and neck region. Pointing out the limitations in implementing MRI in guiding radiation therapy.
With emerging technical advances like real-time MR imaging during radiotherapy (RT) with an integrated MR linear accelerator, it will soon be possible to analyze changes in the organs at risk (OARs) during radiotherapy without additional effort for the patients. Until then, patients have to undergo additional MR imaging and often without the same immobilization devices as used for radiotherapy. Consequently, studies with repetitive MRI during the course of radiotherapy are rare, with low patient numbers and with the challenge of registration between the different MR sequences and the varying imaging time points. This review focuses on studies with at least two MRIs, one before and another either during or post-RT, in order to report on RT-induced changes in normal tissues and their correlation with toxicity. We therefore included clinical studies published in English until March 2019, with repetitive MRI of OARs in head and neck cancer patients receiving external beam radiotherapy. OARs analyzed were salivary glands, musculoskeletal structures and bones. MR sequences used included T1, T2, dynamic contrast enhanced (DCE) imaging, diffusion-weighted imaging (DWI), DIXON and MR sialography.
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Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Baher Elgohari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Clinical Oncology and Nuclear Medicine, Mansoura University, Mansoura, Egypt
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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A comparison of conventional and diffusion-weighted magnetic resonance imaging in the diagnosis of sialadenitis and pleomorphic adenoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:451-457. [PMID: 30497909 DOI: 10.1016/j.oooo.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to compare the efficacy of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in correctly identifying the presence of disease in the major salivary glands and correctly distinguish sialadenitis from pleomorphic adenoma. STUDY DESIGN Twenty-one patients diagnosed with unilateral sialadenitis or pleomorphic adenoma were selected. The nonaffected contralateral glands were also analyzed. T1- and T2-weighted MRI and DWI were obtained using spin-echo pulse sequences with a 1.5 Tesla MRI device. The diagnostic performance of 3 observers was evaluated for detection of salivary gland alterations and differentiation between sialadenitis and pleomorphic adenoma based on evaluation of MRI in comparison with DWI. RESULTS Intra-and interobserver reliability ranged from 0.86 to 0.94. DWI demonstrated greater sensitivity and accuracy values compared with MRI for both detection of disease and differentiation of sialadenitis from pleomorphic adenoma, with specificity values that were greater than or equal to those of MRI. DWI yielded significantly higher diagnostic odds ratios compared with MRI for both identification of disease and differentiation between lesions. CONCLUSIONS DWI demonstrated better diagnostic performance in the detection of alterations in the salivary glands and in differentiating between sialadenitis and pleomorphic adenoma compared with conventional T1 and T2-weighted MRI.
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Abstract
This article reviews the role of routine and advanced diffusion imaging modules of the salivary glands. Routine and advanced diffusion imaging modules have a role in differentiation of malignant from benign salivary gland tumors, characterization of some benign salivary gland tumors, and staging of salivary gland cancer. The role of advanced diffusion modules in patients with salivary gland cancer after surgery, radiation therapy, or radioiodine therapy is discussed. Advanced diffusion imaging modules can help in diagnosis and staging of Sjögren syndrome.
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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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14
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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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Apparent diffusion coefficient histogram analysis can evaluate radiation-induced parotid damage and predict late xerostomia degree in nasopharyngeal carcinoma. Oncotarget 2017; 8:70226-70238. [PMID: 29050274 PMCID: PMC5642549 DOI: 10.18632/oncotarget.19602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/27/2017] [Indexed: 12/17/2022] Open
Abstract
We investigated apparent diffusion coefficient (ADC) histogram analysis to evaluate radiation-induced parotid damage and predict xerostomia degrees in nasopharyngeal carcinoma (NPC) patients receiving radiotherapy. The imaging of bilateral parotid glands in NPC patients was conducted 2 weeks before radiotherapy (time point 1), one month after radiotherapy (time point 2), and four months after radiotherapy (time point 3). From time point 1 to 2, parotid volume, skewness, and kurtosis decreased (P < 0.001, = 0.001, and < 0.001, respectively), but all other ADC histogram parameters increased (all P < 0.001, except P = 0.006 for standard deviation [SD]). From time point 2 to 3, parotid volume continued to decrease (P = 0.022), and SD, 75th and 90th percentiles continued to increase (P = 0.024, 0.010, and 0.006, respectively). Early change rates of parotid ADCmean, ADCmin, kurtosis, and 25th, 50th, 75th, 90th percentiles (from time point 1 to 2) correlated with late parotid atrophy rate (from time point 1 to 3) (all P < 0.05). Multiple linear regression analysis revealed correlations among parotid volume, time point, and ADC histogram parameters. Early mean change rates for bilateral parotid SD and ADCmax could predict late xerostomia degrees at seven months after radiotherapy (three months after time point 3) with AUC of 0.781 and 0.818 (P = 0.014, 0.005, respectively). ADC histogram parameters were reproducible (intraclass correlation coefficient, 0.830 - 0.999). ADC histogram analysis could be used to evaluate radiation-induced parotid damage noninvasively, and predict late xerostomia degrees of NPC patients treated with radiotherapy.
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Broggi S, Scalco E, Belli ML, Logghe G, Verellen D, Moriconi S, Chiara A, Palmisano A, Mellone R, Fiorino C, Rizzo G. A Comparative Evaluation of 3 Different Free-Form Deformable Image Registration and Contour Propagation Methods for Head and Neck MRI: The Case of Parotid Changes During Radiotherapy. Technol Cancer Res Treat 2017; 16:373-381. [PMID: 28168934 PMCID: PMC5616054 DOI: 10.1177/1533034617691408] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To validate and compare the deformable image registration and parotid contour propagation process for head and neck magnetic resonance imaging in patients treated with radiotherapy using 3 different approaches—the commercial MIM, the open-source Elastix software, and an optimized version of it. Materials and Methods: Twelve patients with head and neck cancer previously treated with radiotherapy were considered. Deformable image registration and parotid contour propagation were evaluated by considering the magnetic resonance images acquired before and after the end of the treatment. Deformable image registration, based on free-form deformation method, and contour propagation available on MIM were compared to Elastix. Two different contour propagation approaches were implemented for Elastix software, a conventional one (DIR_Trx) and an optimized homemade version, based on mesh deformation (DIR_Mesh). The accuracy of these 3 approaches was estimated by comparing propagated to manual contours in terms of average symmetric distance, maximum symmetric distance, Dice similarity coefficient, sensitivity, and inclusiveness. Results: A good agreement was generally found between the manual contours and the propagated ones, without differences among the 3 methods; in few critical cases with complex deformations, DIR_Mesh proved to be more accurate, having the lowest values of average symmetric distance and maximum symmetric distance and the highest value of Dice similarity coefficient, although nonsignificant. The average propagation errors with respect to the reference contours are lower than the voxel diagonal (2 mm), and Dice similarity coefficient is around 0.8 for all 3 methods. Conclusion: The 3 free-form deformation approaches were not significantly different in terms of deformable image registration accuracy and can be safely adopted for the registration and parotid contour propagation during radiotherapy on magnetic resonance imaging. More optimized approaches (as DIR_Mesh) could be preferable for critical deformations.
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Affiliation(s)
- Sara Broggi
- 1 Medical Physics Department, San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Scalco
- 2 Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Milan, Italy
| | - Maria Luisa Belli
- 1 Medical Physics Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Dirk Verellen
- 4 Vrije Universiteit Brussel, Brussels, Belgium.,5 GZA Sint Augustinus - Iridium Kankernetwerk Antwerpen, Antwerp, Belgium
| | - Stefano Moriconi
- 2 Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Milan, Italy
| | - Anna Chiara
- 6 Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Palmisano
- 7 Clinical and Experimental Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
| | - Renata Mellone
- 7 Clinical and Experimental Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- 1 Medical Physics Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Rizzo
- 2 Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Milan, Italy
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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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18
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Abdel Razek AAK, Mukherji S. Imaging of sialadenitis. Neuroradiol J 2017. [DOI: 10.1177/1971400916682752 and 67=89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sialadenitis is an inflammation or infection of the salivary glands that may affect the parotid, submandibular and small salivary glands. Imaging findings vary among unilateral or bilateral salivary gland enlargement, atrophy, abscess, ductal dilation, cysts, stones and calcification. Imaging can detect abscess in acute bacterial suppurative sialadenitis, ductal changes with cysts in chronic adult and juvenile recurrent parotitis. Imaging is sensitive for detection of salivary stones and stricture in obstructive sialadenitis. Immunoglobulin G4-sialadenitis appears as bilateral submandibular gland enlargement. Imaging is helpful in staging and surveillance of patients with Sjögren’s syndrome. Correlation of imaging findings with clinical presentation can aid diagnosis of granulomatous sialadenitis. Post-treatment sialadenitis can occur after radiotherapy, radioactive iodine or surgery.
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Abstract
Sialadenitis is an inflammation or infection of the salivary glands that may affect the parotid, submandibular and small salivary glands. Imaging findings vary among unilateral or bilateral salivary gland enlargement, atrophy, abscess, ductal dilation, cysts, stones and calcification. Imaging can detect abscess in acute bacterial suppurative sialadenitis, ductal changes with cysts in chronic adult and juvenile recurrent parotitis. Imaging is sensitive for detection of salivary stones and stricture in obstructive sialadenitis. Immunoglobulin G4-sialadenitis appears as bilateral submandibular gland enlargement. Imaging is helpful in staging and surveillance of patients with Sjögren's syndrome. Correlation of imaging findings with clinical presentation can aid diagnosis of granulomatous sialadenitis. Post-treatment sialadenitis can occur after radiotherapy, radioactive iodine or surgery.
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20
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Abdel Razek AAK, Mukherji S. Imaging of sialadenitis. Neuroradiol J 2017. [DOI: 10.1177/1971400916682752 and 21=21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sialadenitis is an inflammation or infection of the salivary glands that may affect the parotid, submandibular and small salivary glands. Imaging findings vary among unilateral or bilateral salivary gland enlargement, atrophy, abscess, ductal dilation, cysts, stones and calcification. Imaging can detect abscess in acute bacterial suppurative sialadenitis, ductal changes with cysts in chronic adult and juvenile recurrent parotitis. Imaging is sensitive for detection of salivary stones and stricture in obstructive sialadenitis. Immunoglobulin G4-sialadenitis appears as bilateral submandibular gland enlargement. Imaging is helpful in staging and surveillance of patients with Sjögren’s syndrome. Correlation of imaging findings with clinical presentation can aid diagnosis of granulomatous sialadenitis. Post-treatment sialadenitis can occur after radiotherapy, radioactive iodine or surgery.
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21
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Terra GTC, Oliveira JXD, Hernandez A, Lourenço SV, Arita ES, Cortes ARG. Diffusion-weighted MRI for differentiation between sialadenitis and pleomorphic adenoma. Dentomaxillofac Radiol 2016; 46:20160257. [PMID: 27845594 DOI: 10.1259/dmfr.20160257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare apparent diffusion coefficient (ADC) values from diffusion-weighted MRI (DWI) among normal salivary glands, cases with sialadenitis and cases with pleomorphic adenoma of major salivary glands. METHODS 22 patients (totalling 44 major salivary glands) diagnosed with either unilateral sialadenitis (on either parotid or submandibular gland) or parotid gland pleomorphic adenoma were selected. Contralateral non-affected glands (normal) were also analyzed. DW images were achieved using a spin-echo pulse sequence with a 1.5-T MRI device. Mean ADC values were compared among the three groups analyzed (contralateral normal glands, sialadenitis and pleomorphic adenoma). RESULTS The mean ADC values were significantly higher in cases of parotid sialadenitis (p = 0.001), but not in cases of submandibular sialadenitis (p = 0.466), as compared with the contralateral non-affected glands. Cases of pleomorphic adenoma presented the highest ADC values of the study. In addition, one-way ANOVA test revealed a significant difference among the three groups of parotid glands analyzed. CONCLUSIONS Within the limitations of this study, the present results suggest that DWI allows for differentiation between parotid sialadenitis and pleomorphic adenoma.
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Affiliation(s)
- Guilherme T C Terra
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Jefferson X D Oliveira
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Adalsa Hernandez
- 2 Department of Oral Radiology, Clinica Felix Boada, Caracas, Venezuela
| | - Silvia V Lourenço
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Emiko S Arita
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Arthur R G Cortes
- 1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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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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Temporal Evolution of Parotid Volume and Parotid Apparent Diffusion Coefficient in Nasopharyngeal Carcinoma Patients Treated by Intensity-Modulated Radiotherapy Investigated by Magnetic Resonance Imaging: A Pilot Study. PLoS One 2015; 10:e0137073. [PMID: 26323091 PMCID: PMC4556378 DOI: 10.1371/journal.pone.0137073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/12/2015] [Indexed: 12/18/2022] Open
Abstract
Purpose To concurrently quantify the radiation-induced changes and temporal evolutions of parotid volume and parotid apparent diffusion coefficient (ADC) in nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy by using magnetic resonance imaging (MRI). Materials and Methods A total of 11 NPC patients (9 men and 2 women; 48.7 ± 11.7 years, 22 parotid glands) were enrolled. Radiation dose, parotid sparing volume, severity of xerostomia, and radiation-to-MR interval (RMI) was recorded. MRI studies were acquired four times, including one before and three after radiotherapy. The parotid volume and the parotid ADC were measured. Statistical analysis was performed using SPSS and MedCalc. Bonferroni correction was applied for multiple comparisons. A P value less than 0.05 was considered as statistically significant. Results The parotid volume was 26.2 ± 8.0 cm3 before radiotherapy. The parotid ADC was 0.8 ± 0.15 × 10−3 mm2/sec before radiotherapy. The parotid glands received a radiation dose of 28.7 ± 4.1 Gy and a PSV of 44.1 ± 12.6%. The parotid volume was significantly smaller at MR stage 1 and stage 2 as compared to pre-RT stage (P < .005). The volume reduction ratio was 31.2 ± 13.0%, 26.1 ± 13.5%, and 17.1 ± 16.6% at stage 1, 2, and 3, respectively. The parotid ADC was significantly higher at all post-RT stages as compared to pre-RT stage reciprocally (P < .005 at stage 1 and 2, P < .05 at stage 3). The ADC increase ratio was 35.7 ± 17.4%, 27.0 ± 12.8%, and 20.2 ± 16.6% at stage 1, 2, and 3, respectively. The parotid ADC was negatively correlated to the parotid volume (R = -0.509; P < .001). The parotid ADC was positively associated with the radiation dose significantly (R2 = 0.212; P = .0001) and was negatively associated with RMI significantly (R2 = 0.203; P = .00096) significantly. Multiple regression analysis further showed that the post-RT parotid ADC was related to the radiation dose and RMI significantly (R2 = 0.3580; P < .0001). At MR stage 3, the parotid volume was negatively associated with the dry mouth grade significantly (R2 = 0.473; P < .0001), while the parotid ADC was positively associated with the dry mouth grade significantly (R2 = 0.288; P = .015). Conclusion Our pilot study successfully demonstrates the concurrent changes and temporal evolution of parotid volume and parotid ADC quantitatively in NPC patients treated by IMRT. Our results suggest that the reduction of parotid volume and increase of parotid ADC are dominated by the effect of acinar loss rather than edema at early to intermediate phases and the following recovery of parotid volume and ADC toward the baseline values might reflect the acinar regeneration of parotid glands.
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Kupelian P, Sonke JJ. Magnetic Resonance–Guided Adaptive Radiotherapy: A Solution to the Future. Semin Radiat Oncol 2014; 24:227-32. [DOI: 10.1016/j.semradonc.2014.02.013] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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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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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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van der Veldt AAM, Smit EF, Comans EFI, Lammertsma AA. Effects of chemotherapy on the parotid and submandibular glands in head and neck cancer patients treated with chemoradiotherapy. Strahlenther Onkol 2013; 190:221-2. [PMID: 24306065 DOI: 10.1007/s00066-013-0487-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A A M van der Veldt
- Department of Internal Medicine, VU University Medical Center, 1007 MB, Amsterdam, Netherlands,
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