Application of Diffusion Kurtosis Imaging in Evaluating Acute Xerostomia in Nasopharyngeal Carcinoma Treated With Induction Chemotherapy Plus Concurrent Chemoradiotherapy

Da-Wei Zhao; Xue-Mei Fang; Shu-Han Zhou; Yan-Rong Luo; Jian Wei; Kun Liu; Ling-Ling Meng; Gang Liu; Jin-Feng Li; Xiao Zang; Meng Li; Xiao-Fei Qiang; Hua-Yong Jiang; Wen-Jun Fan; Xin-Xin Zhang; Lin Ma

doi:10.3389/fonc.2022.870315

Application of Diffusion Kurtosis Imaging in Evaluating Acute Xerostomia in Nasopharyngeal Carcinoma Treated With Induction Chemotherapy Plus Concurrent Chemoradiotherapy

Front Oncol. 2022 May 19:12:870315. doi: 10.3389/fonc.2022.870315. eCollection 2022.

Authors

Da-Wei Zhao^{1

2

3}, Xue-Mei Fang^{3

4}, Shu-Han Zhou⁵, Yan-Rong Luo³, Jian Wei⁶, Kun Liu⁶, Ling-Ling Meng³, Gang Liu⁷, Jin-Feng Li⁷, Xiao Zang⁷, Meng Li⁷, Xiao-Fei Qiang^{7

8}, Hua-Yong Jiang^{7

9}, Wen-Jun Fan^{10

11}, Xin-Xin Zhang⁶, Lin Ma^{3

9}

Affiliations

¹ Medical School of Chinese PLA, Beijing, China.
² Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China.
³ Department of Radiation Oncology, First Medical Center of PLA General Hospital, Beijing, China.
⁴ Department of Ultrasound, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China.
⁵ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
⁶ Department of Otolaryngology, First Medical Center of PLA General Hospital, Beijing, China.
⁷ Department of Radiology, First Medical Center of PLA General Hospital, Beijing, China.
⁸ Department of Radiology, Helicopter Detachment of the Second Mobile Corps of the Armed Police, Chengdu, China.
⁹ Department of Radiation Oncology, Fifth Medical Center of the PLA General Hospital, Beijing, China.
¹⁰ Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.
¹¹ Armed Police Forces Corps Hospital of Henan Province, Zhengzhou, China.

Abstract

Purpose: The aim of this study was to identify the efficacy of diffusion kurtosis imaging (DKI) in tracking and monitoring the dynamic change of parotid glands (PGs), submandibular glands (SMGs), sublingual glands (SLGs), and acute xerostomia in nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT).

Methods: The prospective study recruited 42 participants treated with IC+CCRT. All patients underwent DKI scanning six times: before IC, before RT, in the middle of the RT course, immediately after RT, and 1 and 3 months post-RT. Mean diffusion coefficient (MD) and mean kurtosis (MK) of PG, SMG, SLG, saliva flow rate measured under resting (uSFR) and stimulated condition (sSFR), and xerostomia questionnaire (XQ) scores were recorded.

Results: At each time point, sSFR was significantly higher than uSFR (p < 0.05 for all). MD of the salivary glands and XQ scores increased over time while MK, uSFR, and sSFR decreased. After IC, the significant differences were detected in MD and MK of bilateral SMG and MK of the left SLG (p < 0.05 for all), but not in MD and MK of PG, uSFR, sSFR, and XQ scores. After RT, sSFR at 1m-RT decreased significantly (p = 0.03) while no significant differences were detected in uSFR and XQ scores. Moderate-strong correlations were detected in ΔMD-PG-R%, ΔMK-PG-R%, ΔMD-PG-L%, ΔMK-PG-L%, ΔMD-SMG-R%, ΔMK-SMG-R%, ΔMD-SMG-L%, ΔMK-SMG-L%, and ΔMD-SLG-R%, with correlation coefficients (p < 0.05 for all) ranging from 0.401 to 0.714. ΔuSFR% was correlated with ΔMD-SMG% (p = 0.01, r = -0.39), ΔMD-SLG% (p < 0.001, r = -0.532), and ΔMK-SMG% (p < 0.001, r = -0.493). ΔsSFR% correlated with ΔMD-PG% (p = 0.001, r = -0.509), ΔMD-SMG% (p = 0.015, r = -0.221), and ΔMK-PG% (p < 0.001, r = 0.524). ΔXQ% was only correlated with ΔMK-PG% (p = 0.004, r = 0.433).

Conclusion: DKI is a promising tool for tracking and monitoring the acute damage of PG, SMG, and SLG induced by IC+CCRT in NPC patients.

Keywords: diffusion kurtosis imaging; parotid gland; radiation; sublingual gland; submandibular gland; xerostomia.