Predictive markers for head and neck cancer treatment response: T1rho imaging in nasopharyngeal carcinoma

Abstract Objectives To investigate the potential of T1rho, a new quantitative imaging sequence for cancer, for pre and early intra-treatment prediction of treatment response in nasopharyngeal carcinoma (NPC) and compare the results with those of diffusion-weighted imaging (DWI). Materials and methods T1rho and DWI imaging of primary NPCs were performed pre- and early intra-treatment in 41 prospectively recruited patients. The mean preT1rho, preADC, intraT1rho, intraADC, and % changes in T1rho (ΔT1rho%) and ADC (ΔADC%) were compared between residual and non-residual groups based on biopsy in all patients after chemoradiotherapy (CRT) with ( n = 29) or without ( n = 12) induction chemotherapy (IC), and between responders and non-responders to IC in the subgroup who received IC, using Mann–Whitney U -test. A p -value of < 0.05 indicated statistical significance. Results Significant early intra-treatment changes in mean T1rho ( p = 0.049) and mean ADC ( p < 0.01) were detected (using paired t -test), most showing a decrease in T1rho (63.4%) and an increase in ADC (95.1%). Responders to IC ( n = 17), compared to non-responders ( n = 12), showed higher preT1rho (64.0 ms vs 66.5 ms) and a greater decrease in ΔT1rho% (− 7.5% vs 1.3%) ( p < 0.05). The non-residual group after CRT ( n = 35), compared to the residual group ( n = 6), showed higher intraADC (0.96 vs 1.09 × 10 −3 mm 2 /s) and greater increase in ΔADC% (11.7% vs 27.0%) ( p = 0.02). Conclusion Early intra-treatment changes are detectable on T1rho and show potential to predict tumour shrinkage after IC. T1rho may be complementary to DWI, which, unlike T1rho, did not predict response to IC but did predict non-residual disease after CRT. Clinical relevance statement T1rho has the potential to complement DWI in the prediction of treatment response. Unlike DWI, it predicted shrinkage of the primary NPC after IC but not residual disease after CRT. Key Points Changes in T1rho were detected early during cancer treatment for NPC . Pre-treatment and early intra-treatment change in T1rho predicted response to IC, but not residual disease after CRT . T1rho can be used to complement DWI with DWI predicting residual disease after CRT .