TY - JOUR
T1 - Apparent diffusion coefficient agreement and reliability using different region of interest methods for the evaluation of head and neck cancer post chemo-radiotherapy
AU - Anjari, Mustafa
AU - Guha, Amrita
AU - Burd, Christian
AU - Varela, Marta
AU - Goh, Vicky
AU - Connor, Steve
N1 - Funding Information:
This study was supported by grants from Guy’s and St Thomas’ Hospital Charity (ref EFT130501) and the Royal College of Radiologists: Kodak Radiology Fund Research Bursary.
Publisher Copyright:
© 2021 The Authors. Published by the British Institute of Radiolog
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Objectives: Post chemoradiotherapy (CRT) interval changes in apparent diffusion coefficient (ADC) have prognostic value in head and neck squamous cell cancer (HNSCC). The impact of using different region of interest (ROI) methods on interobserver agreement and their ability to reliably detect the changes in the ADC values was assessed. Methods: Following ethical approval, 25 patients (mean age 59.5 years, 21 male) with stage 3–4 HNSCC undergoing CRT were recruited for this prospective cohort study. Diffusion weighted MRI (DW-MRI) was performed pre-treatment and at 6 and 12 weeks following CRT. Two radiologists independently delineated ROIs using whole volume (ROI
v), largest area (ROI
a) or representative area (ROI
r) methods at primary tumour (n = 22) and largest nodal (n = 24) locations and recorded the ADC
mean. When no clear focus of increased DWI signal was evident at follow-up, a standardised ROI was placed (non-measurable or NM). Bland-Altman plots and interclass correlation coefficient (ICC) were assessed. Paired t-tests evaluated interval changes in pre- and post-treatment ADC
mean at each location, which were compared to the smallest detectable difference (SDD). Results: Excellent agreement was obtained for all ROI methods at pre-treatment (ICC 0.94–0.98) and 6-week post-treatment (ICC 0.94–0.98). At 12-week post-treatment, agreement was excellent (ICC 0.91–0.94) apart from ROI
r (ICC 0.86) and the NM nodal disease (ICC 0.87). There were significant interval increases in ADC
mean between pre-treatment and post-treatment studies, which were greater than the SDD for all ROIs. Conclusions: ADC
mean values can be reproducibly obtained in HNSCC using the different ROI techniques on pre- and post-CRT MRI, and this reliably detects the interval changes.
AB - Objectives: Post chemoradiotherapy (CRT) interval changes in apparent diffusion coefficient (ADC) have prognostic value in head and neck squamous cell cancer (HNSCC). The impact of using different region of interest (ROI) methods on interobserver agreement and their ability to reliably detect the changes in the ADC values was assessed. Methods: Following ethical approval, 25 patients (mean age 59.5 years, 21 male) with stage 3–4 HNSCC undergoing CRT were recruited for this prospective cohort study. Diffusion weighted MRI (DW-MRI) was performed pre-treatment and at 6 and 12 weeks following CRT. Two radiologists independently delineated ROIs using whole volume (ROI
v), largest area (ROI
a) or representative area (ROI
r) methods at primary tumour (n = 22) and largest nodal (n = 24) locations and recorded the ADC
mean. When no clear focus of increased DWI signal was evident at follow-up, a standardised ROI was placed (non-measurable or NM). Bland-Altman plots and interclass correlation coefficient (ICC) were assessed. Paired t-tests evaluated interval changes in pre- and post-treatment ADC
mean at each location, which were compared to the smallest detectable difference (SDD). Results: Excellent agreement was obtained for all ROI methods at pre-treatment (ICC 0.94–0.98) and 6-week post-treatment (ICC 0.94–0.98). At 12-week post-treatment, agreement was excellent (ICC 0.91–0.94) apart from ROI
r (ICC 0.86) and the NM nodal disease (ICC 0.87). There were significant interval increases in ADC
mean between pre-treatment and post-treatment studies, which were greater than the SDD for all ROIs. Conclusions: ADC
mean values can be reproducibly obtained in HNSCC using the different ROI techniques on pre- and post-CRT MRI, and this reliably detects the interval changes.
UR - http://www.scopus.com/inward/record.url?scp=85115775937&partnerID=8YFLogxK
U2 - 10.1259/dmfr.20200579
DO - 10.1259/dmfr.20200579
M3 - Article
SN - 0250-832X
VL - 50
JO - DENTOMAXILLOFACIAL RADIOLOGY
JF - DENTOMAXILLOFACIAL RADIOLOGY
IS - 7
M1 - 20200579
ER -
