Cervical spine osteoradionecrosis or bone metastasis after radiotherapy for nasopharyngeal carcinoma? The MRI-based radi
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RESEARCH ARTICLE
Open Access
Cervical spine osteoradionecrosis or bone metastasis after radiotherapy for nasopharyngeal carcinoma? The MRI-based radiomics for characterization Xi Zhong1†, Li Li2†, Huali Jiang3†, Jinxue Yin1, Bingui Lu1, Wen Han1, Jiansheng Li1 and Jian Zhang4*
Abstract Background: To develop and validate an MRI-based radiomics nomogram for differentiation of cervical spine ORN from metastasis after radiotherapy (RT) in nasopharyngeal carcinoma (NPC). Methods: A radiomics nomogram was developed in a training set that comprised 46 NPC patients after RT with 95 cervical spine lesions (ORN, n = 51; metastasis, n = 44), and data were gathered from January 2008 to December 2012. 279 radiomics features were extracted from the axial contrast-enhanced T1-weighted image (CE-T1WI). A radiomics signature was created by using the least absolute shrinkage and selection operator (LASSO) algorithm. A nomogram model was developed based on the radiomics scores. The performance of the nomogram was determined in terms of its discrimination, calibration, and clinical utility. An independent validation set contained 25 consecutive patients with 47 lesions (ORN, n = 25; metastasis, n = 22) from January 2013 to December 2015. Results: The radiomics signature that comprised eight selected features was significantly associated with the differentiation of cervical spine ORN and metastasis. The nomogram model demonstrated good calibration and discrimination in the training set [AUC, 0.725; 95% confidence interval (CI), 0.622–0.828] and the validation set (AUC, 0.720; 95% CI, 0.573–0.867). The decision curve analysis indicated that the radiomics nomogram was clinically useful. Conclusions: MRI-based radiomics nomogram shows potential value to differentiate cervical spine ORN from metastasis after RT in NPC. Keywords: Magnetic resonance imaging, Nasopharyngeal carcinoma, Radiotherapy, Osteoradionecrosis, Radiomics
Background Nasopharyngeal carcinoma (NPC) is a unique malignancy with distinct geographic and racial distribution differences. It is particularly prevalent in South-Eastern Asia, Northern Africa, and Southern China [1]. With the application of radiochemotherapy, the local control of * Correspondence: [email protected] † Xi Zhong, Li Li and Huali Jiang contributed equally to this work. 4 Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China Full list of author information is available at the end of the article
NPC has been prominently improved [2]. Osteoradionecrosis (ORN) is a common complication of NPC after radiotherapy (RT), which frequently occurs in the mandible, maxilla, and skull base [3, 4]. Recently, RT induced ORN has been drawn much more attention. However, ORN of the cervical spine only has been described in several case reports and few retrospective studies [5–10]. As the clinical treatment difference between ORN and metastasis, antibiotic administration, sequestrectomy, or hyperbaric oxygen therapy for ORN and RT or che
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