The Quantification of Radiation Fibrosis Using Clinically Indicated Magnetic Resonance Imaging for Head and Neck Cancer Patients

Zhiyao Che ^1,2,3,4, Aamir Suhail ^5,6,7, Nicolin Hainc ^5,8

¹Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
²Department of Speech-Language Pathology, University of Torontto, Toronto, ON, Canada.
³The Swallowing Lab, University of Toronto, Swallowing Lab 160-500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
⁴Krembil Research Institute, University Health Network, Toronto, ON, Canada.
⁵Medical Imaging, University Health Network, Toronto, ON, Canada.
⁶Diagnostic Imaging, Nova Scotia Health, Dartmouth, NS, Canada.
⁷Radiology, Dalhousie University, Halifax, NS, Canada.
⁸Neuroradiology, University Hospital of Zurich, Zurich, Switzerland.
⁹Biostatistics, University of Toronto, Toronto, ON, Canada.
¹⁰Biostatistics, University Health Network, Toronto, ON, Canada.
¹¹Otolaryngology-Head & Neck Surgery, University Health Network, Toronto, ON, Canada.
¹²Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
¹³Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
¹⁴Radiation Oncology, University of Toronto, Toronto, ON, Canada.
¹⁵Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. rosemary.martino@utoronto.ca.
¹⁶Department of Speech-Language Pathology, University of Torontto, Toronto, ON, Canada. rosemary.martino@utoronto.ca.
¹⁷The Swallowing Lab, University of Toronto, Swallowing Lab 160-500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada. rosemary.martino@utoronto.ca.
¹⁸Krembil Research Institute, University Health Network, Toronto, ON, Canada. rosemary.martino@utoronto.ca.
¹⁹Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada. rosemary.martino@utoronto.ca.

⁰Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.

Dysphagia +

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March 27, 2024

View abstract on PubMed

Summary

This study developed a reliable method using MRI to measure fibrosis in head and neck cancer patients, finding increased fibrosis correlates with swallowing difficulties. This offers a new way to detect fibrosis and dysphagia early.

Area Of Science

Medical Imaging
Oncology
Gastroenterology

Background

Head and neck cancer (HNC) patients treated with radiation therapy (RT) often experience fibrosis in swallowing muscles.
Currently, objective methods to quantify this fibrosis and its impact on swallowing are lacking.
This study addresses the need for reliable measurement of fibrosis in HNC patients.

Purpose Of The Study

To determine if clinical magnetic resonance imaging (MRI) can reliably measure fibrosis volume in the pharyngeal musculature of HNC patients post-RT.
To assess the potential of MRI to track changes in fibrosis over time.
To correlate fibrosis volume with swallowing impairment.

Main Methods

Developed and psychometrically tested a method for quantifying fibrosis volume using clinical MRI scans.
Two neuroradiologists independently contoured fibrosis volume, with reliability assessed by Intraclass Correlation Coefficient (ICC).
Two speech-language pathologists rated swallowing impairment from videofluoroscopic swallow (VFS) studies; MRI and VFS scores were correlated.

Main Results

Initial inter-rater reliability for fibrosis volume was low but improved to sufficient levels (ICC = 0.95) after consensus meetings.
Fibrosis volume significantly increased from 3 to 12 months post-RT (p=0.006).
Pharyngeal impairment also worsened over time (p=0.003) and moderately correlated with fibrosis volume at 3 and 12 months (r=0.49, r=0.59).

Conclusions

A reliable method to measure fibrosis volume in the swallowing musculature using clinical MRI was established.
Increased fibrosis volume was significantly associated with worse swallowing function in HNC patients.
This MRI-based method provides a pragmatic approach for early detection of fibrosis and dysphagia.

Keywords:

Dysphagia Magnetic Resonance Imaging Radiation Fibrosis Reliability Videofluoroscopy

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