以全體積體素內不同調運動參數評估頭頸癌病人與健康者咬肌之間的變化

Evaluation of changes in masseter muscle between patients with head and neck cancer and healthy subjects with whole volume intravoxel incoherent motion parameters.

林家維(Chia-Wei Lin)

指導教授 ： 蔡炳煇

中山醫學大學/醫學科技學院/醫學影像暨放射科學系/碩士(2022年)

https://doi.org/10.6834/csmu202200160

摘要

目的：
本研究的目的是，比較健康對照組的咬肌與頭頸癌(HNC)病人腫瘤側及健康側咬肌的IVIM 參數，並同時採集咬肌的體積，以評估HNC 腫瘤對咬肌灌注、擴散及體積的影響。

材料與方法：
　　共納入71位受試者，其中16位為健康對照組(13名男性，3名女性)，平均年齡57±12歲；55位HNC病人(52名男性，3名女性)，平均年齡58±10歲。受試者咬肌分為健康對照組，HNC病人腫瘤側及HNC病人健康側。以T1加權影像為參考，在受試者的所有b0影像上圈選全體積咬肌，圈選後的ROI包含了IVIM參數值(D, 純擴散係數；f, 灌注分數；D*, 偽擴散係數)以及面積。計算所有ROI內IVIM參數的平均值以及體積，用來分析其在健康對照組兩側咬肌以及三組間的差異。本研究使用SPSS(IBM Statistics 20)進行統計分析，p值小於0.05被認為是具有統計學差異。

結果：
　　健康對照組的左右側咬肌的D、D*、f及總體積都沒有顯著差異(p=0.305, 0.696, 0.780, 1.000)，說明兩側不存在會對本研究造成影響的差異。f值和總體積的Kruskal-Wallis U test有顯著差異(p=0.011, <0.001)，並在進行事後多重比較分析後，發現健康對照組的f值和總體積分別與HNC病人健康側(p=0.014, <0.001)及HNC病人腫瘤側(p=0.027, 0.007)的咬肌都有顯著差異。雖然D值存在上升，D*值有下降的趨勢，但在三組間並沒有顯著差異。

結論：
　　本研究的初步結果說明了，腫瘤會導致HNC病人兩側咬肌的f值上升而總體積下降。而D和D*分別有上升及下降的趨勢，但並沒有顯著的差異。

關鍵字

體素內不同調運動 ； 頭頸癌 ； 咬肌 ； 灌注 ； 擴散

並列摘要

Purpose：
This study aims to compare the IVIM parameters and volume of masseter muscle(MM) between groups of normal controls(NC), HNC patients’ tumor side and HNC patients’ normal side. Through IVIM parameters and volume of MM, the effect of HNC tumors on the perfusion, diffusion, and the volume of MM can be accessed.

Materials and Methods：
A total of 71 subjects were finally included, of which 16 were healthy controls (13 males, 3 females), with an average age of 57±12 years; 55 HNC patients (52 males, 3 females), with an average age of 58 ±10 years old. This study will divide the MM into the NC, the healthy side, and the tumor side. T1-weighted images were used as reference, and ROIs were contoured for whole volume of the MM. The contoured ROI includes the IVIM parameters(D, diffusion-coefficient; D* pseudo-diffusion coefficient; f, perfusion fraction) and area. The mean value and volume of IVIM parameters in all ROIs were calculated to analyze their differences in the MM on both sides of the NC and among the three groups. Using SPSS(IBM Statistics 20) for statistical analysis and statistical significance was considered when the p-value was less than 0.05.

Results：
There was no significant difference in D, D*, f and whole volume of the left and right MM in the NC, indicating there was no difference between the two sides that would affect on this study(p=0.305, 0.696, 0.780, 1.000). For the f value and whole volume, the Kruskal-Wallis U test was significantly different among the three groups(p=0.011, <0.001), and after post-hoc multiple comparison analysis, it was found that the MM of the NC were respectively significant different with the HNC patients' normal side(p=0.014, <0.001) and tumor side(p=0.027, 0.007). Although there was an increase in the D value and a decrease current in the D* value, there was no significant difference among the three groups.

Conclusion：
Preliminary results from this study suggest that tumors cause an increase in the f-value of the MM on both sides of the HNC patient and a decrease in the whole volume. While D and D* respectively have an upward and downward trend, but there is no significant difference.

並列關鍵字

IVIM ； HNC ； masseter muscle ； perfusion ； difussion

參考文獻

[1] A.K. Dhull, R. Atri, R. Dhankhar, A.K. Chauhan, V. Kaushal, Major risk factors in head and neck cancer: a retrospective analysis of 12-year experiences, World journal of oncology 9(3) (2018) 80.

[2] Y.C.A. Lee, S. Li, Y. Chen, Q. Li, C.J. Chen, W.L. Hsu, P.J. Lou, C. Zhu, J. Pan, H. Shen, Tobacco smoking, alcohol drinking, betel quid chewing, and the risk of head and neck cancer in an East Asian population, Head neck 41(1) (2019) 92-102.

[3] S.M. Judge, R.L. Nosacka, D. Delitto, M.H. Gerber, M.E. Cameron, J.G. Trevino, A.R. Judge, Skeletal muscle fibrosis in pancreatic cancer patients with respect to survival, JNCI cancer spectrum 2(3) (2018) pky043.

[4] R.L. Nosacka, A.E. Delitto, D. Delitto, R. Patel, S.M. Judge, J.G. Trevino, A.R. Judge, Distinct cachexia profiles in response to human pancreatic tumours in mouse limb and respiratory muscle, Journal of cachexia, sarcopenia and muscle 11(3) (2020) 820-837.

[5] K. Fearon, F. Strasser, S.D. Anker, I. Bosaeus, E. Bruera, R.L. Fainsinger, A. Jatoi, C. Loprinzi, N. MacDonald, G. Mantovani, Definition and classification of cancer cachexia: an international consensus, The lancet oncology 12(5) (2011) 489-495.