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

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

Da-Wei Zhao  1   2   3 , Xue-Mei Fang  3   4 , Shu-Han Zhou  5 , Yan-Rong Luo  3 , Jian Wei  6 , Kun Liu  6 , Ling-Ling Meng  3 , Gang Liu  7 , Jin-Feng Li  7 , Xiao Zang  7 , Meng Li  7 , Xiao-Fei Qiang  7   8 , Hua-Yong Jiang  7   9 , Wen-Jun Fan  10   11 , Xin-Xin Zhang  6 , Lin Ma  3   9
Affiliations

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

Da-Wei Zhao et al. Front Oncol. .

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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Illustrations of the region of interest of the right parotid gland (PG), sublingual gland (SLG), and submandibular gland (SMG) (yellow solid arrow). DKI, diffusion kurtosis imaging; MD, mean diffusion; MK, mean kurtosis.
Figure 2
Figure 2
(A) denotes comparisons of MD between the left and the right side of the major salivary glands, and between ipsilateral PG, SMG, and SLG; (B) denotes comparisons of MK between the left and the right side of the major salivary glands, and between ipsilateral PG, SMG, and SLG. Abbreviations are referred to in Table 2.
Figure 3
Figure 3
The comparisons of uSFR and sSFR at pre-IC, pre-RT, mid-RT, post-RT, 1m-RT, and 3m-RT denote that sSFR was significantly higher than uSFR at each time point. Abbreviations are referred to in Table 2.
Figure 4
Figure 4
(A–I) The pairwise comparisons of MD and MK of left PG, SMG, SLG, and uSFR, sSFR, and XQ between different time points; p < 0.05 denotes significant differences between two time points linked together. Abbreviations are referred to in Table 2.
Figure 5
Figure 5
Scatter dot plots of the change ratio of MD and MK versus dose of bilateral PGs, SMGs, and SLGs. Abbreviations are referred to in Table 2.
Figure 6
Figure 6
(A) Heatmap of the correlation coefficients between the change ratio of DKI metrics (MD and MK) from pre-RT to post-RT and dose of bilateral salivary glands. (B) Heatmap of the correlation coefficients between the change ratio of DKI metrics (MD and MK) of the salivary glands and the change ratio of uSFR, sSFR, and XQ scores from pre-RT to post-RT. Abbreviations are referred to in Table 2.
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