TY - JOUR
T1 - Quantitative Dynamic Contrast-Enhanced MRI Identifies Radiation-Induced Vascular Damage in Patients With Advanced Osteoradionecrosis
T2 - Results of a Prospective Study
AU - Joint Head and Neck Radiation Therapy-MRI Development Cooperative
AU - Mohamed, Abdallah S.R.
AU - He, Renjie
AU - Ding, Yao
AU - Wang, Jihong
AU - Fahim, Joly
AU - Elgohari, Baher
AU - Elhalawani, Hesham
AU - Kim, Andrew D.
AU - Ahmed, Hoda
AU - Garcia, Jose A.
AU - Johnson, Jason M.
AU - Stafford, R. Jason
AU - Bankson, James A.
AU - Chambers, Mark S.
AU - Sandulache, Vlad C.
AU - Fuller, Clifton D.
AU - Lai, Stephen Y.
N1 - Funding Information:
Research reported in this publication was supported by the National Institutes of Health (NIH)/National Institute of Dental and Craniofacial Research (1R01DE025248-01/R56DE025248-01). A.S.R.M., C.D.F., and S.Y.L. receive funding support from the NIH/NCI Early Phase Clinical Trials in Imaging and Image Guided Interventions Program (1R01CA218148-01). C.D.F. has received federal grant and salary support from the NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50CA097007-10) and Pau l Calabresi Clinical Oncology Program Award (K12 CA088084-06); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825-01); and the Cancer center Support Grant Radiation Oncology/Cancer Imaging Program Seed Grant (5P30CA016672). Disclosures: C.D. Fuller receives industry grant support and speaker travel funding from Elekta and is a Sabin Family Foundation Fellow.
Funding Information:
Disclosures: C.D. Fuller receives industry grant support and speaker travel funding from Elekta and is a Sabin Family Foundation Fellow.
Funding Information:
Research reported in this publication was supported by the National Institutes of Health (NIH)/ National Institute of Dental and Craniofacial Research ( 1R01DE025248-01 / R56DE025248-01 ). A.S.R.M., C.D.F., and S.Y.L. receive funding support from the NIH / NCI Early Phase Clinical Trials in Imaging and Image Guided Interventions Program ( 1R01CA218148-01 ). C.D.F. has received federal grant and salary support from the NIH / NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award ( P50CA097007-10 ) and Pau l Calabresi Clinical Oncology Program Award (K12 CA088084-06); a National Science Foundation (NSF), Division of Mathematical Sciences , Joint NIH/ NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679 ); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award ( 1R01CA214825-01 ); and the Cancer center Support Grant Radiation Oncology / Cancer Imaging Program Seed Grant ( 5P30CA016672 ).
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Purpose: We aim to characterize the quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters associated with advanced mandibular osteoradionecrosis (ORN) compared with the contralateral normal mandible. Methods and Materials: Patients with a diagnosis of advanced ORN after curative-intent radiation treatment of head and neck cancer were prospectively enrolled after institutional review board approval and study-specific informed consent were obtained. Quantitative maps generated with the Tofts and extended Tofts pharmacokinetic models were used for analysis. Manual segmentation of advanced ORN 3-dimensional volume was done using anatomic sequences to create ORN volumes of interest (VOIs). Subsequently, normal mandibular VOIs were segmented on the contralateral healthy mandible of similar volume and anatomic location to create control VOIs. Finally, anatomic sequences were coregistered to DCE sequences, and contours were propagated to the respective parameter maps. Results: Thirty patients were included. The median time to ORN diagnosis after completion of IMRT was 38 months (range, 6-184 months), whereas median time to ORN progression to advanced grade after initial diagnosis was 5.6 months (range, 0-128 months). There were statistically significant higher Ktrans and Ve in ORN-VOIs compared with controls (0.23 vs 0.07 min−1, and 0.34 vs 0.15; P < .0001 for both). The average relative increase of Ktrans in ORN-VOIs was 3.2-fold higher than healthy mandibular control VOIs. Moreover, the corresponding rise of Ve in ORN-VOIs was 2.7-fold higher than in the controls. Using combined Ktrans and Ve parameters, 27 patients (90%) had at least a 200% increase of either of the studied parameters in the ORN-VOIs compared with their healthy mandible VOIs. Conclusions: Our results confirm that there is a quantitatively significant higher degree of leakiness in the mandibular vasculature as measured using DCE-MRI parameters of areas with advanced ORN versus healthy mandible.
AB - Purpose: We aim to characterize the quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters associated with advanced mandibular osteoradionecrosis (ORN) compared with the contralateral normal mandible. Methods and Materials: Patients with a diagnosis of advanced ORN after curative-intent radiation treatment of head and neck cancer were prospectively enrolled after institutional review board approval and study-specific informed consent were obtained. Quantitative maps generated with the Tofts and extended Tofts pharmacokinetic models were used for analysis. Manual segmentation of advanced ORN 3-dimensional volume was done using anatomic sequences to create ORN volumes of interest (VOIs). Subsequently, normal mandibular VOIs were segmented on the contralateral healthy mandible of similar volume and anatomic location to create control VOIs. Finally, anatomic sequences were coregistered to DCE sequences, and contours were propagated to the respective parameter maps. Results: Thirty patients were included. The median time to ORN diagnosis after completion of IMRT was 38 months (range, 6-184 months), whereas median time to ORN progression to advanced grade after initial diagnosis was 5.6 months (range, 0-128 months). There were statistically significant higher Ktrans and Ve in ORN-VOIs compared with controls (0.23 vs 0.07 min−1, and 0.34 vs 0.15; P < .0001 for both). The average relative increase of Ktrans in ORN-VOIs was 3.2-fold higher than healthy mandibular control VOIs. Moreover, the corresponding rise of Ve in ORN-VOIs was 2.7-fold higher than in the controls. Using combined Ktrans and Ve parameters, 27 patients (90%) had at least a 200% increase of either of the studied parameters in the ORN-VOIs compared with their healthy mandible VOIs. Conclusions: Our results confirm that there is a quantitatively significant higher degree of leakiness in the mandibular vasculature as measured using DCE-MRI parameters of areas with advanced ORN versus healthy mandible.
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U2 - 10.1016/j.ijrobp.2020.07.029
DO - 10.1016/j.ijrobp.2020.07.029
M3 - Article
C2 - 32712257
AN - SCOPUS:85089585611
SN - 0360-3016
VL - 108
SP - 1319
EP - 1328
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -