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Lucas JT, Abramson ZR, Epstein K, Morin CE, Jaju A, Lee JW, Lee CL, Sitaram R, Voss SD, Hudson MM, Constine LS, Hua CH. Imaging Assessment of Radiation Therapy-Related Normal Tissue Injury in Children: A PENTEC Visionary Statement. Int J Radiat Oncol Biol Phys 2024; 119:669-680. [PMID: 38760116 DOI: 10.1016/j.ijrobp.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 05/19/2024]
Abstract
The Pediatric Normal Tissue Effects in the Clinic (PENTEC) consortium has made significant contributions to understanding and mitigating the adverse effects of childhood cancer therapy. This review addresses the role of diagnostic imaging in detecting, screening, and comprehending radiation therapy-related late effects in children, drawing insights from individual organ-specific PENTEC reports. We further explore how the development of imaging biomarkers for key organ systems, alongside technical advancements and translational imaging approaches, may enhance the systematic application of imaging evaluations in childhood cancer survivors. Moreover, the review critically examines knowledge gaps and identifies technical and practical limitations of existing imaging modalities in the pediatric population. Addressing these challenges may expand access to, minimize the risk of, and optimize the real-world application of, new imaging techniques. The PENTEC team envisions this document as a roadmap for the future development of imaging strategies in childhood cancer survivors, with the overarching goal of improving long-term health outcomes and quality of life for this vulnerable population.
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Affiliation(s)
| | - Zachary R Abramson
- Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Katherine Epstein
- Division of Radiology and Medical Imaging, UC Department of Radiology, Cincinnati, Ohio
| | - Cara E Morin
- Division of Radiology and Medical Imaging, UC Department of Radiology, Cincinnati, Ohio
| | - Alok Jaju
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Chang-Lung Lee
- Department of Radiation Oncology and; Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Ranganatha Sitaram
- Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephan D Voss
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Louis S Constine
- Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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Muraoka H, Kaneda T, Kondo T, Hirahara N, Kohinata Y, Tokunaga S. Differentiation of submandibular sialadenitis based on apparent diffusion coefficient. Oral Dis 2024. [PMID: 38566274 DOI: 10.1111/odi.14953] [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: 01/04/2024] [Revised: 03/07/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES This study aimed to quantify the submandibular gland in suppurative sialadenitis, primary Sjögren's syndrome (pSS) and radiation-induced sialadenitis using the apparent diffusion coefficient (ADC) for differential diagnosis. SUBJECTS AND METHODS This retrospective study included 16 patients with suppurative sialadenitis (n = 9), pSS (n = 3) and radiation-induced sialadenitis (n = 4) who underwent magnetic resonance imaging between June 2006 and May 2022. The ADC of the submandibular glands in each state was calculated, and the differences were analysed using a one-way analysis of variance and Tukey's post hoc test. Receiver operating characteristic curves were used to assess the ability of the ADC to distinguish each condition. Statistical significance was set at p < 0.05. RESULTS The mean ADC value (×10-3 mm2/s) ± standard deviation in the control (non-affected side of the suppurative sialadenitis group), suppurative sialadenitis, pSS and radiation-induced groups were 0.94 ± 0.16, 1.24 ± 0.16, 1.33 ± 0.13 and 1.5 ± 0.12, respectively (p < 0.001). The diagnostic value for distinguishing each group was ≥0.75. CONCLUSION ADC values are useful for quantitatively assessing and distinguishing submandibular glands in suppurative sialadenitis, primary Sjögren's syndrome and radiation-induced sialadenitis.
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Affiliation(s)
- Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Takumi Kondo
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Naohisa Hirahara
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Yuta Kohinata
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Satoshi Tokunaga
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
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McDonald BA, Dal Bello R, Fuller CD, Balermpas P. The Use of MR-Guided Radiation Therapy for Head and Neck Cancer and Recommended Reporting Guidance. Semin Radiat Oncol 2024; 34:69-83. [PMID: 38105096 DOI: 10.1016/j.semradonc.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Although magnetic resonance imaging (MRI) has become standard diagnostic workup for head and neck malignancies and is currently recommended by most radiological societies for pharyngeal and oral carcinomas, its utilization in radiotherapy has been heterogeneous during the last decades. However, few would argue that implementing MRI for annotation of target volumes and organs at risk provides several advantages, so that implementation of the modality for this purpose is widely accepted. Today, the term MR-guidance has received a much broader meaning, including MRI for adaptive treatments, MR-gating and tracking during radiotherapy application, MR-features as biomarkers and finally MR-only workflows. First studies on treatment of head and neck cancer on commercially available dedicated hybrid-platforms (MR-linacs), with distinct common features but also differences amongst them, have also been recently reported, as well as "biological adaptation" based on evaluation of early treatment response via functional MRI-sequences such as diffusion weighted ones. Yet, all of these approaches towards head and neck treatment remain at their infancy, especially when compared to other radiotherapy indications. Moreover, the lack of standardization for reporting MR-guided radiotherapy is a major obstacle both to further progress in the field and to conduct and compare clinical trials. Goals of this article is to present and explain all different aspects of MR-guidance for radiotherapy of head and neck cancer, summarize evidence, as well as possible advantages and challenges of the method and finally provide a comprehensive reporting guidance for use in clinical routine and trials.
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Affiliation(s)
- Brigid A McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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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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Ermongkonchai T, Khor R, Wada M, Lau E, Xing DT, Ng SP. A review of diffusion-weighted magnetic resonance imaging in head and neck cancer patients for treatment evaluation and prediction of radiation-induced xerostomia. Radiat Oncol 2023; 18:20. [PMID: 36710364 PMCID: PMC9885695 DOI: 10.1186/s13014-022-02178-0] [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: 11/18/2021] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
The incidence of head and neck cancers (HNC) is rising worldwide especially with HPV-related oropharynx squamous cell carcinoma. The standard of care for the majority of patients with locally advanced pharyngeal disease is curative-intent radiotherapy (RT) with or without concurrent chemotherapy. RT-related toxicities remain a concern due to the close proximity of critical structures to the tumour, with xerostomia inflicting the most quality-of-life burden. Thus, there is a paradigm shift towards research exploring the use of imaging biomarkers in predicting treatment outcomes. Diffusion-weighted imaging (DWI) is a functional MRI feature of interest, as it quantifies cellular changes through computation of apparent diffusion coefficient (ADC) values. DWI has been used in differentiating HNC lesions from benign tissues, and ADC analyses can be done to evaluate tumour responses to RT. It is also useful in healthy tissues to identify the heterogeneity and physiological changes of salivary glands to better understand the inter-individual differences in xerostomia severity. Additionally, DWI is utilised in irradiated salivary glands to produce ADC changes that correlate to clinical xerostomia. The implementation of DWI into multi-modal imaging can help form prognostic models that identify patients at risk of severe xerostomia, and thus guide timely interventions to mitigate these toxicities.
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Affiliation(s)
- Tai Ermongkonchai
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| | - Richard Khor
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| | - Morikatsu Wada
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| | - Eddie Lau
- grid.410678.c0000 0000 9374 3516Department of Radiology, Austin Health, Heidelberg, Melbourne, Australia ,grid.410678.c0000 0000 9374 3516Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Radiology, The University of Melbourne, Parkville, Melbourne, Australia
| | - Daniel Tao Xing
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| | - Sweet Ping Ng
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
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Zhou L, Zheng W, Huang S, Yang X. Integrated radiomics, dose-volume histogram criteria and clinical features for early prediction of saliva amount reduction after radiotherapy in nasopharyngeal cancer patients. Discov Oncol 2022; 13:145. [PMID: 36581739 PMCID: PMC9800672 DOI: 10.1007/s12672-022-00606-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Previously, the evaluation of xerostomia depended on subjective grading systems, rather than the accurate saliva amount reduction. Our aim was to quantify acute xerostomia with reduced saliva amount, and apply radiomics, dose-volume histogram (DVH) criteria and clinical features to predict saliva amount reduction by machine learning techniques. MATERIAL AND METHODS Computed tomography (CT) of parotid glands, DVH, and clinical data of 52 patients were collected to extract radiomics, DVH criteria and clinical features, respectively. Firstly, radiomics, DVH criteria and clinical features were divided into 3 groups for feature selection, in order to alleviate the masking effect of the number of features in different groups. Secondly, the top features in the 3 groups composed integrated features, and features selection was performed again for integrated features. In this study, feature selection was used as a combination of eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) to alleviate multicollinearity. Finally, 6 machine learning techniques were used for predicting saliva amount reduction. Meanwhile, top radiomics features were modeled using the same machine learning techniques for comparison. RESULT 17 integrated features (10 radiomics, 4 clinical, 3 DVH criteria) were selected to predict saliva amount reduction, with a mean square error (MSE) of 0.6994 and a R2 score of 0.9815. Top 17 and 10 selected radiomics features predicted saliva amount reduction, with MSE of 0.7376, 0.7519, and R2 score of 0.9805, 0.9801, respectively. CONCLUSION With the same number of features, integrated features (radiomics + DVH criteria + clinical) performed better than radiomics features alone. The important DVH criteria and clinical features mainly included, white blood cells (WBC), parotid_glands_Dmax, Age, parotid_glands_V15, hemoglobin (Hb), BMI and parotid_glands_V45.
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Affiliation(s)
- Lang Zhou
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China
- Department of Biomedical Engineering, South China University of Technology, Guangzhou, 510640, Guangdong Province, China
| | - Wanjia Zheng
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China
- Department of Radiation Oncology, Southern Theater Air Force Hospital of the People's Liberation Army, Guangzhou, 510050, Guangdong Province, China
| | - Sijuan Huang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China.
| | - Xin Yang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China.
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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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Duffton A, Kemp O, Devlin L, Hay L, McLoone P, Paterson C. Feasibility of DW-MRI analysis of salivary glands during head and neck radiotherapy. Tech Innov Patient Support Radiat Oncol 2021; 19:46-51. [PMID: 34527819 PMCID: PMC8430428 DOI: 10.1016/j.tipsro.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION With no effective treatment for xerostomia, there remains an unmet need to reduce radiation induced toxicity. Measuring physiological changes during RT in salivary glands using DW-MRI may predict which patients are most at risk of severe toxicity. This study evaluated the feasibility of measuring apparent diffusion coefficient (ADC) in the major salivary glands and describes the observed changes in volume and ADC during RT. METHODS Scans were acquired at baseline (MR_base) and after 10 fractions (MR_rpt). Sequences included T1 post contrast fat saturated (T1PCFS) and DW-MRI (5b values, 0-1000 s/mm2). Ipsilateral and contralateral parotid (iPG/cPG), submandibular (iSMG/cSMG) and sublingual glands (iSLG/cSLG) were delineated on T1PCFS, modified on b0 and copied to the ADC map. RESULTS 31 patients with intermediate/high risk squamous cell carcinoma (SCC) of the oropharynx were evaluated. On 124 scans, SMG and SLG delineations were successful on all; parotids were fully contoured in 90.7%. Baseline mean ADC were significantly different between each gland type (p < 0.0001). IPG and cPG volume decreased during treatment by 6.7% and 11.2%. ISMG, cSMG, iSLG and cSLG volume increased by 6.9, 0.9, 60.8 and 60.3% respectively. All structures showed an increase in mean_ADC values. For each gland the increase in ADC was statistically significant p < 0.0001. A smaller mean percentage increase in ADC was observed in the group experiencing a higher grade (2 or > ) of toxicity. CONCLUSION It is feasible to measure volume and ADC of the salivary glands prior to and during RT for HNC. Early data suggests a lower rise in ADC during treatment is associated with more severe late xerostomia.
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Affiliation(s)
- Aileen Duffton
- Department of Radiotherapy, The Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
| | - Olivia Kemp
- School of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Lynsey Devlin
- Department of Radiotherapy, The Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
| | - Lisa Hay
- Department of Radiotherapy, The Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
| | - Philip McLoone
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Claire Paterson
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
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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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Chen W, Su GY, Zhou Y, Jiang JS, Jiang RH, Bao ML, Xu XQ, Wu FY. Longitudinal Multiparametric MRI Assessment of Irradiated Salivary Gland in a Rat Model: Correlated With Histological Findings. J Magn Reson Imaging 2021; 54:1730-1741. [PMID: 34278649 DOI: 10.1002/jmri.27836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Several magnetic resonance imaging (MRI) sequences have been applied to assess injured glands but without histological validation. PURPOSE To evaluate longitudinal changes in multiparametric MRI (mp-MRI) of irradiated salivary glands in a rat model and investigate correlations between mp-MRI and histological findings. STUDY TYPE Prospective. ANIMAL MODEL Submandibular glands of 36 rats were radiated using a single dose of 15 Gy X-ray (irradiation [IR] group), and 6 other rats were enrolled into sham-IR group. mp-MRI were scanned 1 day after sham-IR (n = 6), or 1, 2, 4, 8, 12, 24 weeks after IR (n = 36, 6 per subgroup). FIELD STRENGTH/SEQUENCE A 3.0-T/Diffusion-weighted imaging (DWI), readout-segmented echo-planar imaging (EPI) sequence; intravoxel incoherent motion DWI, single-shot EPI sequence; T1 mapping, dual-flip-angle gradient-echo sequence with volumetric interpolated breath-hold examination; T2 mapping, turbo spin-echo sequence. ASSESSMENT Parameters including apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D* ), perfusion fraction (f), T1 and T2 value were obtained. Histological examinations, including hematoxylin and eosin staining (for acinar cell fraction [AC%] detection), Masson's trichrome staining (for degree of fibrosis [F%] determination) and CD34-immunohistochemical staining (for microvessel density [MVD] calculation), were performed at corresponding time points. STATISTICAL TESTS One-way analysis of variance was used to compare the mp-MRI and histological parameters among different groups. Spearman correlation analysis was applied to determine the correlation between mp-MRI and histological parameters. Two-sided P ≤ 0.05 was considered statistically significant. RESULTS Changes of mp-MRI parameters (ADC, D, D* , f, T1, T2) and histological results (AC%, F%, MVD) among the seven groups were all significant. ADC, D, and T2 values negatively correlated with AC% (ADC, r = -0.728; D, r = -0.773; T2, r = -0.600), f positively correlated with MVD (r = 0.496), and T1 values positively correlated with F% (r = 0.714). DATA CONCLUSION: mp-MRI might be able to noninvasively and quantitatively evaluate the dynamic pathological changes within the irradiated salivary glands. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Wei Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-Suo Jiang
- Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou, China
| | - Run-Hao Jiang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mei-Ling Bao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Boucher F, Liao E, Srinivasan A. Diffusion-Weighted Imaging of the Head and Neck (Including Temporal Bone). Magn Reson Imaging Clin N Am 2021; 29:205-232. [PMID: 33902904 DOI: 10.1016/j.mric.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diffusion techniques provide valuable information when performing head and neck imaging. This information can be used to detect the presence or absence of pathology, refine differential diagnosis, determine the location for biopsy, assess response to treatment, and prognosticate outcomes. For example, when certain technical factors are taken into consideration, diffusion techniques prove indispensable in assessing for residual cholesteatoma following middle ear surgery. In other scenarios, pretreatment apparent diffusion coefficient values may assist in prognosticating outcomes in laryngeal cancer and likelihood of response to radiation therapy. As diffusion techniques continue to advance, so too will its clinical utility.
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Affiliation(s)
- Felix Boucher
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 East Medical Center Drive, B1D502, Ann Arbor 48109-5030, USA
| | - Eric Liao
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 East Medical Center Drive, Taubman Center B1-132, Ann Arbor 48109-5030, USA
| | - Ashok Srinivasan
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 East Medical Center Drive, B2A209, Ann Arbor 48109-5030, USA.
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Johnson M, Sreela LS, Mathew P, Prasad TS. Actual applications of magnetic resonance imaging in dentomaxillofacial region. Oral Radiol 2021; 38:17-28. [PMID: 33635492 DOI: 10.1007/s11282-021-00521-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/13/2021] [Indexed: 11/24/2022]
Abstract
Magnetic resonance imaging (MRI) is a versatile imaging modality utilized in various medical fields. Specifically used for evaluation of soft tissues, with non-ionizing radiation and multiplanar sections that has provided great guidance to diagnosis. Nowadays, use of MRI in dental practice is becoming more pervasive, especially for the evaluation of head-and-neck cancer, detection of salivary gland lesions, lymphadenopathy, and temporomandibular joint disorders. Understanding the basic principles, its recent advances, and multiple applications in dentomaxillofacial region helps significantly in the diagnostic decision making. In this article, the principle of MRI and its recent advances are reviewed, with further discussion on the appearance of various maxillofacial pathosis.
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Affiliation(s)
- Migi Johnson
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Gandhinagar, Kottayam, 686008, Kerala, India.
| | - L S Sreela
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Gandhinagar, Kottayam, 686008, Kerala, India
| | - Philips Mathew
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Gandhinagar, Kottayam, 686008, Kerala, India
| | - Twinkle S Prasad
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Gandhinagar, Kottayam, 686008, Kerala, India
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Fan WJ, Teng F, Liu G, Zhao DW, Li JF, Luo YR, Zhang XX, Ma L, Guan J. Diffusion weighted imaging in submandibular gland sparing helical tomotherapy for nasopharyngeal carcinoma. Radiother Oncol 2021; 157:247-254. [PMID: 33587972 DOI: 10.1016/j.radonc.2021.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To verify clinical significance of submandibular gland (SMG)-sparing during helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC) from the perspective of imaging by using diffusion weighted imaging (DWI). MATERIALS AND METHODS In this prospective study, 60 NPC patients scheduled for radical SMG-sparing HT were enrolled. All patients underwent DWI examinations prior to HT (pre-HT) and 1, 3, 6, 9, 12 months post HT. Mean apparent diffusion coefficient (ADC) values of bilateral parotid glands (PGs) and submandibular glands (SMGs) were measured. Differences of ADC and changes of ADC pre and pro HT (ΔADC) among SMG-spared, SMG-unspared and PGs were compared and the associations betweenΔADC and variations of patient-rated xerostomia questionnaire summary scores (XQ-sum) were further tested. RESULTS ADCpost-HT and ΔADCpost-HT of SMG-spared were both much lower than of SMG-unspared and a strong dose-response relationship was detected between mean radiation dose and ΔADC of SMGs. Dynamic change trends of PGs, SMG-spared and SMG-unspared were similar, with initial increase at 1 m-post-HT followed by little change at 3 m-post-HT and then gradual decrease over time. But for SMG-unspared, there was no obvious change of ADC from 6 m-post-HT to 12 m-post-HT. The dynamic change trend of XQ-sum was nearly in line with that of ADC on the whole. And a positive correlation between mean ΔADC1m-post-HT of bilateral SMGs and variation of XQ-sum1m-post-HT in patients with bSMG-unspared were found (r = 0.693, P < 0.001). Multivariate stepwise regression analysis showed that whether spared SMG or not was the only independent predictor correlated to XQ-sumpost-HT at each follow-up timepoint. CONCLUSION SMG-sparing technique could significantly improve subjective xerostomia post HT in NPC patients from the perspective of imaging.
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Affiliation(s)
- Wen-Jun Fan
- Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China; Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China; Armed Police Corps Hospital of Henan Province, Zhengzhou, China
| | - Feng Teng
- Department of Radiation Oncology, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Gang Liu
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Da-Wei Zhao
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China; Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Jin-Feng Li
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan-Rong Luo
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin-Xin Zhang
- Department of Otolaryngology, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Lin Ma
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Jian Guan
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Diffusion-weighted imaging as a follow-up modality for evaluation of major salivary gland function in nasopharyngeal carcinoma patients: a preliminary study. Strahlenther Onkol 2020; 196:530-541. [PMID: 32025803 PMCID: PMC7248033 DOI: 10.1007/s00066-020-01580-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/07/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the value of diffusion-weighted imaging (DWI) in assessing dynamic changes of major salivary gland function during follow-up post radiotherapy (RT) in nasopharyngeal carcinoma (NPC) patients. MATERIALS AND METHODS 31 consecutive patients with pathologically confirmed NPC scheduled for RT underwent six routine follow-up MRI examinations including DWI sequence prior to (pre-RT) and 1, 3, 6, 9, and 12 months post RT. Mean apparent diffusion coefficient (ADC) values of bilateral parotid glands (PGs) and submandibular glands (SMGs) were measured. Objective measurement of salivary flow rate (SFR) under unstimulated (uSFR) and stimulated conditions (sSFR) as well as subjective xerostomia assessment according to a patient-rated questionnaire were conducted before each MRI. Variance analysis was used to evaluate dynamic changes of ADC, SFR and xerostomia questionnaire summary scores (XQ-sum) at different timepoints and the correlation between ADC and XQ-sum. Pearson's correlation test was used to evaluate the correlations between pre- and post-RT changes of ADC (ΔADC) and SFR (ΔSFR) or mean RT dose. RESULTS At each timepoint, ADCs of PGs were significantly lower than of SMGs, uSFR was significantly lower than sSFR. For both PGs and SMGs, ADCpost-RT were all higher than ADCpre-RT, with significant differences. ADC1m-post-RT initially increased and changed little to ADC3m-post-RT, ADC6m-post-RT, ADC9m-post-RT, and ADC12m-post-RT, then gradually declined over time. The dynamic change trends of SFR were negatively paralleled to those of ADC, while that of XQ-sum was similar. Dose-response relationships were detected between salivary gland mean RT dose and ΔADC. In PGs, negative correlations between ΔsSFR9m-post-RT and ΔADC9m-post-RT, and ΔsSFR12m-post-RT and ΔADC12m-post-RT were detected. In SMGs, negative correlations between ΔsSFR12m-post-RT and ΔADC12m-post-RT, and ΔuSFR12m-post-RT and ΔADC12m-post-RT were also detected. The ADCs of patients with severe subjective xerostomia were significantly higher, while patients with moderate subjective xerostomia presented a tendency toward higher ADCs compared to those with mild xerostomia from 6 to 12 months post RT. CONCLUSION As part of routine follow-up MRI in NPC patients, DWI might be a promising modality for follow-up assessing the dynamic changes of major salivary gland function and might be more powerful in the late post-RT period.
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Abstract
Summary
Saliva as a microfluidic system offers numerous advantages for both general and oral health diagnostic and therapeutic procedures since its assembly is quick, stress-free, inexpensive and non-invasive. Moreover, saliva is frequently referred to as a mirror of the body due to the fact that it can reflect the physiological and pathological state of the body. More than a decade ago the term “Salivaomics” has been introduced with the aim of emphasizing the development of research, knowledge and applications of five salivary constituents: proteome, transcriptome, micro-RNA, metabolome, and microbiome. Contemporary oral health care delivery in pediatric and special care dentistry is focused toward the development of new diagnostic and therapeutical procedures that are essentially noninvasive due to common issue of intolerability to invasive procedures among these patients, with the possibility of increasing participation rates. Besides the criteria of being easily and non-invasive collected, there are additional standards that should be met before routine application in everyday clinical practice; the existence of specific biomarkers for a disease, and ability of having its biomarkers detected using present-day equipment. For example, there are recent suggestions that a salivary RNA panel could objectively differentiate children with autism spectrum disorder from their neurotypical peers. In addition, due to the ease of the administration, the oral cavity is an attractive site for the drug delivery systems development because through this route it is possible to realize mucosal and transmucosal, systemic effect. All these contemporary advances extended the salivary diagnostic approach from the oral to general health pointing towards a promising future of salivary diagnostics for personalized medicine devices.
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Stieb S, Kiser K, van Dijk L, Livingstone NR, Elhalawani H, Elgohari B, McDonald B, Ventura J, Mohamed ASR, Fuller CD. Imaging for Response Assessment in Radiation Oncology: Current and Emerging Techniques. Hematol Oncol Clin North Am 2019; 34:293-306. [PMID: 31739950 DOI: 10.1016/j.hoc.2019.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Imaging in radiation oncology is essential for the evaluation of treatment response in tumors and organs at risk. This influences further treatment decisions and could possibly be used to adapt therapy. This review article focuses on the currently used imaging modalities for response assessment in radiation oncology and gives an overview of new and promising techniques within this field.
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Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Kendall Kiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Lisanne van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Nadia Roxanne Livingstone
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Baher Elgohari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Juan Ventura
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Abdallah Sherif Radwan Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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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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