Article Figures & Data
Figures
- Fig 1.
Examples of CT perfusion images for a patient with squamous cell carcinoma of the epiglottis.
A, Regions of interest are drawn within the ipsilateral internal carotid artery (1), internal jugular vein (2), and around the tumor margins (3).
B, Concentration curves of the previously selected regions of interest are plotted with Hounsfield units on the y-axis and time on the x-axis.
C, Corresponding BF map of the neck at the level of the epiglottic tumor.
D, Corresponding BV map of the neck at the level of the epiglottic tumor.
- Fig 2.
The relationship to BV values as a function response, defined as >50% reduction in tumor volume as assessed by endoscopy.
- Fig 3.
The relationship to BF values as a function response, defined as >50% reduction in tumor volume as assessed by endoscopy.
- Fig 4.
The area under the ROC curve for the predictive model.
- Fig 5.
The probability of response to induction chemotherapy as a function of BV.
- Fig 6.
The potential use of the prediction model using the 17 patients in this study in clinical practice.
A, Actual response. In our patient population, all 17 patients underwent induction chemotherapy. Twelve patients responded (+) and received additional chemotherapy and radiation; 5 patients underwent surgery and radiation.
B, Using ≥90% pretest probability as a threshold. In this hypothetical application of the prediction rule, 10 patients would be directed immediately to organ preservation, whereas 7 patients would undergo induction chemotherapy. Of those 7 patients, 2 patients would respond and proceed to organ preservation therapy, and the remaining 5 patients would proceed to surgery and radiation.
C, Using ≥10% pretest probability as a threshold. In this hypothetical application, 2 patients would receive immediate surgery and radiation, whereas 15 would undergo induction chemotherapy. Using this low threshold, 3 patients would not respond to induction chemotherapy with potential delay in more invasive, but appropriate, surgery and radiation therapy.
Tables
- Table 1:
Location, stage of tumor, and the decrease in tumor volume as assessed by endoscopy
Sex Age Tumor Location TMN Stage Endoscopic Response (%) M 40 Buccal mucosa T3 N0 III 20 M 66 Epiglottis T3 N0 III 65 F 80 Oral tongue T3 N0 III 70 F 49 Epiglottis T3 N0 III 100 M 53 Base of tongue T3 N1 III 90 M 53 Base of tongue T3 N1 III 40 M 63 Base of tongue T1 N2c IV 95 F 57 Tonsil T2 N2a IV 70 M 55 Base of tongue T2 N2a IV 100 M 48 Tonsil T2 N2b IV 90 M 48 Tonsil T2 N3 IV 70 F 46 Epiglottis T3 N2b IV 60 M 46 Tonsil T3 N2b IV 100 F 72 Base of tongue T4 N0 IV 50 M 55 Tonsil T4 N2b IV 50 F 53 Base of tongue T4 N2c IV 20 M 58 Base of tongue T4 N2c IV 70 Note:—M indicates male; F, female.
- Table 2:
Means and ranges for the 4 CT perfusion parameters for responders and nonresponders
BF (ml/100 g) BV (ml/100 g) MTT (seconds) CP (ml/100 g/min) Responders Mean 155.9 9.4 6.8 18.8 Range 39.1–361.0 4.6–24.2 2.4–12.6 9.8–27.1 Nonresponders Mean 78.5 4.6 5.4 14.2 Range 54.5–108.5 3.0–5.4 4.4–7.0 10.4–19.1 Note:—BF indicates blood flow; BV, blood volume; MTT, mean transit time; CP, capillary permeability
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