Predicting chemoradiotherapy response of nasopharyngeal carcinoma using texture features based on intravoxel incoherent motion diffusion-weighted imaging

Abstract

The aim of the study was to investigative the utility of gray-level co-occurrence matrix (GLCM) texture analysis based on intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for predicting the early response to chemoradiotherapy for nasopharyngeal carcinoma (NPC).Baseline IVIM-DWI was performed on 81 patients with NPC receiving chemoradiotherapy in a prospective nested case-control study. The patients were categorized into the residue (n = 11) and nonresidue (n = 70) groups, according to whether there was local residual lesion or not at the end of chemoradiotherapy. The pretreatment tumor volume and the values of IVIM-DWI parameters (apparent diffusion coefficient [ADC], D, D, and f) and GLCM features based on IVIM-DWI were compared between the 2 groups. Receiver operating characteristic (ROC) curves in univariate and multivariate logistic regression analysis were generated to determine significant indicator of treatment response.The nonresidue group had lower tumor volume, ADC, D, CorrelatADC, CorrelatD, InvDfMomADC, InvDfMomD and InvDfMomD values, together with higher ContrastD, Contrastf, SumAvergADC, SumAvergD, and SumAvergD values, than the residue group (all P < .05). Based on ROC curve in univariate analysis, the area under the curve (AUC) values for individual GLCM features in the prediction of the treatment response ranged from 0.635 to 0.879, with sensitivities from 54.55% to 100.00% and specificities from 52.86% to 85.71%. Multivariate logistic regression analysis demonstrated D (P = .026), InvDfMomADC (P = .033) and SumAvergD (P = .015) as the independent predictors for identifying NPC without residue, with an AUC value of 0.977, a sensitivity of 90.91% and a specificity of 95.71%.Pretreatment GLCM features based on IVIM-DWI, especially on the diffusion-related maps, may have the potential to predict the early response to chemoradiotherapy for NPC.

Figure 1

Study flow diagram in this study.

Figure 2

Examples of baseline intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) maps, VOI for texture features extraction, and pre- and posttherapy T2WI images for nasopharyngeal carcinoma. The upper 2 rows show images from a patient (case A) in the nonresidue group, whereas the lower 2 rows exhibit images from a patient (case B) in the residue group. For case A, the primary lesion disappeared at the end of chemoradiotherapy, its baseline Contrast_D, Contrast_f, Correlat_ADC, Correlat_D, DifVarnc_ADC, DifVarnc_D, InvDfMom_ADC, InvDfMom_D, InvDfMom_D^∗, SumAverg_ADC, SumAverg_D, and SumAverg_D^∗ values were 63.738, 56.015, 0.711, 0.698, 34.892, 34.361, 0.245, 0.257, 0.328, 62.340, 63.267, and 60.157, respectively. For case B, the nasopharyngeal tumor demonstrated residue at the end of chemoradiotherapy, its baseline Contrast_D, Contrast_f, Correlat_ADC, Correlat_D, DifVarnc_ADC, DifVarnc_D, InvDfMom_ADC, InvDfMom_D, InvDfMom_D^∗, SumAverg_ADC, SumAverg_D, and SumAverg_D^∗ values were 52.135, 45.632, 0.773, 0.784, 26.876, 25.178, 0.401, 0.423, 0.387, 45.867, 49.376, and 48.763, respectively. ADC = apparent diffusion coefficient, D^∗ = pseudo-diffusion coefficient, D = true-diffusion coefficient, f = perfusion fraction, IVIM-DWI = intravoxel incoherent motion diffusion-weighted imaging, post-T2WI = posttreatment T2-weighted imaging, pre-T2WI = pretreatment T2-weighted imaging, VOI = volume of interest.