A comparative study of functional MRI in predicting response of regional nodes to induction chemotherapy in patients with nasopharyngeal carcinoma

PURPOSE: To identify and compare the value of functional MRI (fMRI) in predicting the early response of metastatic cervical lymph nodes (LNs) to induction chemotherapy (IC) in nasopharyngeal carcinoma (NPC) patients. METHODS: This prospective study collected 94 metastatic LNs from 40 consecutive NPC patients treated with IC from January 2021 to May 2021. Conventional diffusion-weighted imaging, diffusion kurtosis imaging, intravoxel incoherent motion, and dynamic contrast-enhanced magnetic resonance imaging were performed before and after IC. The parameter maps apparent diffusion coefficient (ADC), mean diffusion coefficient (MD), mean kurtosis (MK), D(slow), D(fast), perfusion fraction (PF), K(trans), V(e), and K(ep)) of the metastatic nodes were calculated by the Functool postprocessing software. All LNs were classified as the responding group (RG) and non-responding group (NRG) according to Response Evaluation Criteria in Solid Tumors 1.1. The fMRI parameters were compared before and after IC and between the RG and the NRG. The significant parameters are fitted by logistic regression analysis to produce new predictive factor (PRE)–predicted probabilities. Logistic regression analysis and receiver operating characteristic (ROC) curves were performed to further identify and compare the efficacy of the parameters. RESULTS: After IC, the mean values of ADC, MD, and D(slow) significantly increased, while MK, D(fast), and K(trans) values decreased dramatically, while no significant difference was detected in V(e) and K(ep). Compared with NRG, PF-pre and K(trans)-pre values in the RG were higher statistically. The areas under the ROC for the pretreatment PF, K(trans), and PRE were 0.736, 0.722, and 0.810, respectively, with the optimal cutoff value of 222 × 10(-4), 934 × 10(-3)/min, and 0.6624, respectively. CONCLUSIONS: The pretreatment fMRI parameters PF and K(trans) showed promising potential in predicting the response of the metastatic LNs to IC in NPC patients. CLINICAL TRIAL REGISTRATION: This study was approved by the ethics board of the Chinese PLA General Hospital, and registered on 30 January 2021, in the Chinese Clinical Trial Registry; http://www.chictr.org.cn/showproj.aspx?proj=121198, identifier (ChiCTR2100042863).