Korean J Radiol.  2018 Aug;19(4):758-766. 10.3348/kjr.2018.19.4.758.

Evaluation of Salivary Gland Function Using Diffusion-Weighted Magnetic Resonance Imaging for Follow-Up of Radiation-Induced Xerostomia

• Zhang Y
• Ou D
• Gu Y
• He X
• Peng W

• KMID: 2413705
• DOI: http://doi.org/10.3348/kjr.2018.19.4.758

Abstract

OBJECTIVE
To investigate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) as a noninvasive tool to assess salivary gland function for follow-up of patients with radiation-induced xerostomia.
MATERIALS AND METHODS
This study included 23 patients with nasopharyngeal carcinoma who had been treated with parotid-sparing radiotherapy (RT). Salivary function was assessed by DW-MRI pre-treatment and one week and one year post-RT, respectively. The maximum apparent diffusion coefficient (ADC) of parotid glands (pADCmax) and the time to peak ADC of parotid glands (pTmax) during stimulation were obtained. Multivariate analysis was used to analyze factors correlated with the severity of radiation-induced xerostomia.
RESULTS
The ADCs of parotid and submandibular glands (1.26 ± 0.10 × 10−3 mm2/s and 1.32 ± 0.07 × 10−3 mm2/s pre-RT, respectively) both showed an increase in all patients at one week post-RT (1.75 ± 0.16 × 10−3 mm2/s, p < 0.001 and 1.70 ± 0.16 × 10−3 mm2/s, p < 0.001, respectively), followed by a decrease in parotid glands at one year post-RT(1.57 ± 0.15 × 10−3 mm2/s, p < 0.001) but not in submandibular glands (1.69 ± 0.18 × 10−3 mm2/s, p = 0.581). An improvement in xerostomia was found in 13 patients at one year post-RT. Multivariate analysis revealed 4 significant predictors for the improvement of xerostomia, including dose to parotid glands (p = 0.009, odds ratio [OR] = 0.639), the ADC of submandibular glands (p = 0.013, OR = 3.295), pADCmax (p = 0.024, OR = 0.474), and pTmax (p = 0.017, OR = 0.729) at one week post-RT.
CONCLUSION
The ADC value is a sensitive indicator for salivary gland dysfunction. DW-MRI is potentially useful for noninvasively predicting the severity of radiation-induced xerostomia.

Keyword

Salivary glands; Diffusion-weighted imaging; Magnetic resonance; Xerostomia; Radiotherapy; Head and neck cancer; Functional imaging

MeSH Terms

Diffusion
Follow-Up Studies*
Head and Neck Neoplasms
Humans
Magnetic Resonance Imaging*
Multivariate Analysis
Odds Ratio
Parotid Gland
Radiotherapy
Salivary Glands*
Submandibular Gland
Xerostomia*

Figure

• 

  Fig. 1 55-year-old male patient with nasopharyngeal carcinoma before RT.Axial T2-weighted images and corresponding diffusion-weighted images of parotid (A, B) and submandibular glands (C, D) were obtained. Regions of interest were manually drawn in reference to T2-weighted images, including as much of gland parenchyma as possible. RT = radiotherapy

• 

  Fig. 2 Box plots show different ADC levels of salivary glands in all patients before and after RT.Mean and median are given by dotted and solid lines, respectively (dotted lines, means; solid lines, medians; boundaries of boxes, 25%/75% quintiles; error bars, 10%/90% quintiles; data points, outliers). Graph shows that ADC values of salivary glands increase after RT (p < 0.001). Compared with 1 week post-RT, pADC and pADCmax both decreased at 1 year post-RT (p < 0.001), but sADC shows no significant change (p = 0.581). ADC = apparent diffusion coefficient, pADC = ADC of parotid glands at rest, pADCmax = maximum ADC of parotid glands, sADC = ADC of submandibular glands at rest

• 

  Fig. 3 Bar charts show mean values and 95% of confidence intervals of pTmax after stimulation in patients with different grades of late xerostomia.Only at 1 week post-RT, two groups show significant differences (p = 0.019). pTmax = Time to peak ADC of parotid glands

• 

  Fig. 4 Box plots show different ADC levels of salivary glands at 1 week post-RT in patients with different grades of late xerostomia.Mean and median are given by dotted and solid lines, respectively (dotted lines, means; solid lines, medians; boundaries of boxes, 25%/75% quintiles; error bars, 10%/90% quintiles; data points, outliers). Graph shows that sADC is higher in patients with Grade 1 xerostomia than those with Grade 2 (p = 0.013).

• 

  Fig. 5 ADC changes of parotid glands.Line graphs indicate ADC changes of parotid glands after stimulation at 1 week post-RT in 55-year-old male patient (patient 1) who experienced Grade 2 xerostomia both at 1 week and 1 year post-RT and 56-year-old female patient (patient 2) who had improvement in xerostomia late after RT. pADCmax were lower and pTmax were shorter in patient 2 than in patient 1. sADC were higher in patient 2 (R = 1.81 × 10−3 mm2/s, L = 1.74 × 10−3 mm2/s, not shown) than in patient 1 at 1 week post-RT (R = 1.58 × 10−3 mm2/s, L = 1.60 × 10−3 mm2/s). L = left, R = right

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