1. Clinical Research Experiment Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
2. Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
#These authors contributed equally to this work.
Objective: This study aimed to evaluate the feasibility of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the diagnosis of skull-base invasion (SBI) in nasopharyngeal carcinoma (NPC).
Materials and methods: A total of 50 patients pathologically diagnosed with NPC and a group of 40 controls comprised of those with either normal nasopharynx or patients with nasopharyngitis underwent conventional MRI and IVIM-DWI scans with 3 different groups of b values. Among the 50 patients, 36 patients diagnosed with SBI in NPC were included in the case group according to SBI criteria. All subjects (including those in the control group and case group) were divided into the b1, b2, and b3 groups based on their b values. The pure diffusion coefficient (D), perfusion-related incoherent microcirculation (D*), and microvascular volume fraction (f) values obtained in each measurement area of each group were tested for variance. Next,2 groups of b-value parameters with statistically significant data in the 3 groups were randomly selected for use in both the control group and the case group. A t-test was performed on the D, D*, and f values obtained by measuring each area of the skull base, and the area under the curve (AUC) of the receiver operating characteristic (ROC) was used to evaluate the diagnostic efficacy of the D, D*, and f values.
Results: There was no statistical significance among the D, D*, and f values of the b1 and b3 groups (P>0.05), and the differences in parameters between the b1 and b2 groups were statistically significant(P < 0.05),and the differences in parameters between the b3 and b2 groups were also statistically significant(P < 0.05).The f value of the case group, which was obtained using the b1 and b2 parameters in each area of the skull base, was lower than that of the control group (P <0.05).The D, D*, and f values of the case group obtained by the b1 and b2 parameters in the pars petrosa of the temporal bone (including the foramen lacerum) were lower than those of the control group (P<0.05).When the parameters of the b1 group were used in the corpus of sphenoid bone (including the foramen ovale), the D, D*, and f values of the control group and the case group were compared, yielding a statistically significant difference (P<0.05).When the parameters of the b1 group were used, the diagnostic efficacy of the f value in each area of the skull base was the highest (AUC=0.908-0.991), followed by the D* value (AUC=0.624-0.692).
Conclusion: When the number of b values <200 s/mm2 in IVIM-DWI accounts for more than half of the selected b values, IVIM-DWI is highly stable for the diagnosis of SBI in NPC. The D, D*, and f values of the bone and muscle areas of the skull base in patients with SBI of NPC showed a downward trend, and the f value had the best diagnostic performance, followed by the D* value, while the D value had the worst. Thus, IVIM-DWI can be used as a noninvasive method in the diagnosis of SBI in NPC.
Keywords: Nasopharyngeal carcinoma (NPC), skull-base invasion (SBI), intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), magnetic resonance imaging (MRI)