Research Papers:

Apparent diffusion coefficient histogram analysis can evaluate radiation-induced parotid damage and predict late xerostomia degree in nasopharyngeal carcinoma

Nan Zhou, Tingting Guo, Huanhuan Zheng, Xia Pan, Chen Chu, Xin Dou, Ming Li, Song Liu, Lijing Zhu, Baorui Liu, Weibo Chen, Jian He, Jing Yan, Zhengyang Zhou _ and Xiaofeng Yang

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Oncotarget. 2017; 8:70226-70238. https://doi.org/10.18632/oncotarget.19602

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Nan Zhou1,*, Tingting Guo2,*, Huanhuan Zheng1, Xia Pan1, Chen Chu1, Xin Dou1, Ming Li1, Song Liu1, Lijing Zhu3, Baorui Liu3, Weibo Chen4, Jian He1, Jing Yan3, Zhengyang Zhou1 and Xiaofeng Yang5

1Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China

2Department of Radiology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, China

3The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China

4Philips Healthcare, Shanghai 200233, China

5Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA

*These authors have contributed equally to this work

Correspondence to:

Zhengyang Zhou, email: [email protected]

Jian He, email: [email protected]

Jing Yan email: [email protected]

Keywords: apparent diffusion coefficient, histogram analysis, radiotherapy, parotid glands, nasopharyngeal carcinoma

Received: March 23, 2017     Accepted: June 27, 2017     Published: July 26, 2017


We investigated apparent diffusion coefficient (ADC) histogram analysis to evaluate radiation-induced parotid damage and predict xerostomia degrees in nasopharyngeal carcinoma (NPC) patients receiving radiotherapy. The imaging of bilateral parotid glands in NPC patients was conducted 2 weeks before radiotherapy (time point 1), one month after radiotherapy (time point 2), and four months after radiotherapy (time point 3). From time point 1 to 2, parotid volume, skewness, and kurtosis decreased (P < 0.001, = 0.001, and < 0.001, respectively), but all other ADC histogram parameters increased (all P < 0.001, except P = 0.006 for standard deviation [SD]). From time point 2 to 3, parotid volume continued to decrease (P = 0.022), and SD, 75th and 90th percentiles continued to increase (P = 0.024, 0.010, and 0.006, respectively). Early change rates of parotid ADCmean, ADCmin, kurtosis, and 25th, 50th, 75th, 90th percentiles (from time point 1 to 2) correlated with late parotid atrophy rate (from time point 1 to 3) (all P < 0.05). Multiple linear regression analysis revealed correlations among parotid volume, time point, and ADC histogram parameters. Early mean change rates for bilateral parotid SD and ADCmax could predict late xerostomia degrees at seven months after radiotherapy (three months after time point 3) with AUC of 0.781 and 0.818 (P = 0.014, 0.005, respectively). ADC histogram parameters were reproducible (intraclass correlation coefficient, 0.830 - 0.999). ADC histogram analysis could be used to evaluate radiation-induced parotid damage noninvasively, and predict late xerostomia degrees of NPC patients treated with radiotherapy.

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