The aim of this study was to explore the prognostic value of diffusion-weighted magnetic resonance imaging (DWI) 3D texture features in esophageal squamous cell carcinoma (ESCC) patients undergoing concurrent chemo-radiotherapy (CRT).
We prospectively enrolled 82 cases with ESCC into a cohort study which underwent DWI before CRT. All MR examinations included axial T2WI, T1WI and diffusion-weighted sequences (b = 0, b = 600 s/mm2). Two groups of tumor features were examined: (1) clinical features (eg, TNM stage, age and gender) and demographics; (2) spatial texture features of apparent diffusion coefficient (ADC), which characterize tumor intensity range, spatial patterns and distribution and associated changes resulting from CRT. A reproducible and no redundant feature set was statistically filtered and validated. The prognostic value of each parameter for overall survival was investigated using Kaplan-Meier and Cox regression models for univariate and multivariate analyses, respectively.
Both univariate and multivariate Cox model analyses showed that the radiation dose; IHIST_energy, m_contrast_1, m_clustershade_2, Diff_ClusetrTendency_2, Diff_homogeneity_2, m_lnversevariance_2, high intensity small zone emphasis (HISE) and low intensity large zone emphasis (LILE) associated significantly with survival. Our study showed seven 3D texture parameters extracted from ADC maps could distinguish high, median and low risk groups (Log-rank c2=9.7, P = 0.00773).
The ADC 3D texture features can be useful biomarkers to predict the survival of ESCC patients who received CRT. The combination of DWI texture and conventional prognostic factors can be used to generate robust predictive models for survival rate.
Clinical trial identification
Legal entity responsible for the study
Shandong Cancer Hospital.
Has not received any funding.
All authors have declared no conflicts of interest.