Dual-Energy Computed Tomography Quantitative Parameter Analysis of Nasopharyngeal Carcinoma Cervical Lymph Node Characteristics and Prediction of Radiotherapy Sensitivity: A Prospective Study

Abstract

Background and purpose: Treatment efficacy may differ among patients with nasopharyngeal carcinoma (NPC) at a similar tumor–node–metastasis stage. Moreover, end-of-treatment tumor regression is a reliable indicator of treatment sensitivity. This study aimed to investigate whether quantitative dual-energy computer tomography (DECT) parameters can predict the sensitivity of neck-lymph node radiotherapy in patients with NPC.

Materials and methods: Overall, 549 lymph nodes were collected from 98 patients with NPC who underwent pretreatment DECT between September 2021 and December 2022. The patients were divided into complete response (CR) and partial response (PR) groups. Clinical characteristics and quantitative DECT parameters were compared between the groups, and the optimal predictive ability of each parameter was determined using the receiver operating characteristic (ROC) analysis. A nomogram prediction model was constructed and validated using univariate and binary logistic regression analyses.

Results: The DECT parameters were higher in the CR group than in the PR group. Iodine concentration (IC), normalized IC, Mix-0.6, spectral Hounsfield unit curve slope, effective atomic number, and virtual monoenergetic images were significantly different between the groups. The area under the ROC curve (AUC) of the DECT parameters was 0.637–0.71 (P <0.001). The AUC value of the constructed model was 0.813, with a sensitivity and specificity of 85.56% and 81.25%, respectively.

Conclusion: Quantitative DECT parameters can potentially predict the sensitivity of radiotherapy to NPC. Therefore, DECT parameters and NPC clinical features can be combined to construct a nomogram with high predictive power and used as a clinical analytical tool.

Note:
Funding declaration: This work was supported by grants from the National Natural Science Foundation of China (No. 82272736,81460460,81760542) , The Research Foundation of the Science and Technology Department of Guangxi Province, China (grant No. 2023GXNSFDA026009, 2016 GXNSFAA380252, 2018AB61001 and 2014GXNSFBA118114), the Research Foundation of the Health Department of Guangxi Province, China (No.S2018087), Guangxi Medical University Training Program for Distinguished Young Scholars (2017), Medical Excellence Award Funded by the Creative Research Development Grant from the First Affiliated Hospital of Guangxi Medical University (2016). Guangxi Medical High-level Talents Training Program. The central government guide local science and technology development projects (ZY18057006).

Conflict of Interests: The authors have no conflicts of interest.

Ethical Approval: Approved by the Medical Ethics Committee of the First Affiliated Hospital of Guangxi Medical University. All patients signed an informed consent form after receiving a detailed explanation of the research.

Keywords: dual-energy CT, nasopharyngeal carcinoma, lymph nodes, radiotherapy sensitivity