Quantitative Ultrasonic Nakagami Imaging of Neck Fibrosis After Head and Neck Radiation Therapy.

PURPOSE To investigate the feasibility of ultrasound Nakagami imaging to quantitatively assess radiation-induced neck fibrosis, a common sequela of radiation therapy (RT) to the head and neck. METHODS AND MATERIALS In a pilot study, 40 study participants were enrolled and classified into 3 subgroups: (1) a control group of 12 healthy volunteers; (2) an asymptomatic group of 11 patients who had received intensity modulated RT for head and neck cancer and had experienced no neck fibrosis; and (3) a symptomatic group of 17 post-RT patients with neck fibrosis. Each study participant underwent 1 ultrasound study in which scans were performed in the longitudinal orientation of the bilateral neck. Three Nakagami parameters were calculated to quantify radiation-induced tissue injury: Nakagami probability distribution function, shape, and scaling parameters. Physician-based assessments of the neck fibrosis were performed according to the Radiation Therapy Oncology Group late morbidity scoring scheme, and patient-based fibrosis assessments were rated based on symptoms such as pain and stiffness. RESULTS Major discrepancies existed between physician-based and patient-based assessments of radiation-induced fibrosis. Significant differences in all Nakagami parameters were observed between the control group and 2 post-RT groups. Moreover, significant differences in Nakagami shape and scaling parameters were observed among asymptomatic and symptomatic groups. Compared with the control group, the average Nakagami shape parameter value increased by 32.1% (P<.001), and the average Nakagami scaling parameter increased by 55.7% (P<.001) for the asymptomatic group, whereas the Nakagami shape parameter increased by 74.1% (P<.001) and the Nakagami scaling parameter increased by 83.5% (P<.001) for the symptomatic group. CONCLUSIONS Ultrasonic Nakagami imaging is a potential quantitative tool to characterize radiation-induced asymptomatic and symptomatic neck fibrosis.

[1]  Xiaofeng Yang,et al.  Ultrasonic Nakagami-parameter characterization of parotid-gland injury following head-and-neck radiotherapy: a feasibility study of late toxicity. , 2014, Medical physics.

[2]  Chih-Kuang Yeh,et al.  Ultrasonic Nakagami imaging: a strategy to visualize the scatterer properties of benign and malignant breast tumors. , 2010, Ultrasound in medicine & biology.

[3]  Yongping Zheng,et al.  Quantitative measurement of post‐irradiation neck fibrosis based on the young modulus , 2002, Cancer.

[4]  P. Shankar.  Ultrasonic tissue characterization using a generalized Nakagami model , 2001, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[5]  S. Bentzen.  Preventing or reducing late side effects of radiation therapy: radiobiology meets molecular pathology , 2006, Nature Reviews Cancer.

[6]  S. Dische,et al.  Morbidity Related to Axillary Irradiation in the Treatment of Breast Cancer , 2000, Acta oncologica.

[7]  Chien-Cheng Chang,et al.  Imaging local scatterer concentrations by the Nakagami statistical model. , 2007, Ultrasound in medicine & biology.

[8]  H. Thames,et al.  Latent-time estimation for late cutaneous and subcutaneous radiation reactions in a single-follow-up clinical study. , 1989, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[9]  J. Overgaard,et al.  Late treatment-related morbidity in breast cancer patients randomized to postmastectomy radiotherapy and systemic treatment versus systemic treatment alone. , 1999, Acta oncologica.

[10]  Chien-Cheng Chang,et al.  Using ultrasound Nakagami imaging to assess liver fibrosis in rats. , 2012, Ultrasonics.

[11]  J. Lefaix,et al.  Current management for late normal tissue injury: radiation-induced fibrosis and necrosis. , 2007, Seminars in radiation oncology.

[12]  W. Small,et al.  Radiation toxicity : a practical guide , 2006 .

[13]  Xiaofeng Yang,et al.  Ultrasound histogram assessment of parotid gland injury following head-and-neck radiotherapy: a feasibility study. , 2012, Ultrasound in medicine & biology.

[14]  Hans Svensson,et al.  Dose response and latency for radiation-induced fibrosis, edema, and neuropathy in breast cancer patients. , 2002, International journal of radiation oncology, biology, physics.

[15]  C. Denton,et al.  Non-invasive measurement of biomechanical skin properties in systemic sclerosis , 2002, Annals of the rheumatic diseases.

[16]  R. F. Wagner,et al.  Statistical properties of radio-frequency and envelope-detected signals with applications to medical ultrasound. , 1987, Journal of the Optical Society of America. A, Optics and image science.

[17]  Robert Jeraj,et al.  Imaging for assessment of radiation-induced normal tissue effects. , 2010, International journal of radiation oncology, biology, physics.

[18]  S. Bentzen,et al.  Clinical radiobiology and normal-tissue morbidity after breast cancer treatment , 1994 .

[19]  Y. Zheng,et al.  Assessment of neck tissue fibrosis using an ultrasound palpation system: A feasibility study , 2006, Medical and Biological Engineering and Computing.

[20]  T. Pajak,et al.  Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) , 1995, International journal of radiation oncology, biology, physics.

[21]  Chien-Cheng Chang,et al.  Strain-compounding technique with ultrasound Nakagami imaging for distinguishing between benign and malignant breast tumors. , 2012, Medical physics.

[22]  Chih-Kuang Yeh,et al.  Classification of Benign and Malignant Breast Tumors by Ultrasound B-scan and Nakagami-based Images , 2010 .

[23]  A. Davis,et al.  Measuring postirradiation subcutaneous soft-tissue fibrosis: state-of-the-art and future directions. , 2003, Seminars in radiation oncology.

[24]  M. Parmar,et al.  A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer , 1998 .

[25]  H. Thames,et al.  Fractionation sensitivity of a functional endpoint: impaired shoulder movement after post-mastectomy radiotherapy. , 1989, International journal of radiation oncology, biology, physics.

[26]  J. Overgaard,et al.  Late Treatment-Related Morbidity in Breast Cancer Patients Randomized to Postmastectomy Radiotherapy and Systemic Treatment Versus Systemic Treatment Alone , 2000 .