Longitudinal Magnetic Resonance Imaging Evaluation of Craniofacial Muscle Changes Following Radiotherapy in Nasopharyngeal Carcinoma

Öz

Aim: Nasopharyngeal carcinoma (NPC) is a radiosensitive head and neck malignancy typically arising in the Rosenmüller fossa. Radiotherapy (RT), while effective, is associated with adverse effects such as dysphagia and muscle atrophy. While pharyngeal constrictors have been extensively studied, the impact of RT on masticatory and suprahyoid muscles remains underexplored. This study aimed to quantitatively assess MRI-based changes in the thickness of masticatory and suprahyoid muscles in NPC patients before and 18–24 months after RT and to compare these findings with healthy controls. Material and Methods: MRI data from 31 NPC patients and 50 healthy controls were retrospectively analyzed. Muscle thickness was measured bilaterally on standardized T1- and T2-weighted sequences for the masseter, medial/lateral pterygoid, temporalis, geniohyoid, mylohyoid, digastric (anterior belly), and genioglossus muscles. Statistical analyses included paired and independent t-tests, ANOVA, and Chi-square tests (Python v3.11; p < 0.05). Results: Pre-RT patients showed significantly reduced left masseter thickness compared to controls (p = 0.0022). Post-RT, the masseter and medial pterygoid muscles demonstrated up to 30.61% atrophy (p < 0.00001). Minor, non-significant increases were seen in the lateral pterygoid and digastric muscles. Right-sided tumors showed higher ipsilateral muscle thickness. Genioglossus hypertrophy was observed in bilateral cases. Males had thicker muscles than females, and muscle thickness declined with age. Conclusion: RT leads to significant atrophy in key masticatory muscles in NPC patients. Muscle asymmetry may precede treatment and reflect tumor laterality. MRI-based assessment offers valuable insights.

Anahtar Kelimeler

• radiotherapy
• magnetic resonance imaging
• head and neck cancers
• nasopharyngeal carcinoma

Nazofaringeal Karsinomda Radyoterapi Sonrasi Kraniyofasiyal Kas Değişikliklerinin Longitudinal Manyetik Rezonans Görüntüleme Değerlendirmesi

Öz

Amaç: Nazofaringeal karsinom (NFK), genellikle Rosenmüller fossa’da gelişen, radyosensitif bir baş-boyun malignitesidir. Radyoterapi (RT) etkin bir tedavi yöntemi olmasına rağmen, disfaji ve kas atrofisi gibi olumsuz etkilere yol açabilir. Yutak konstriktör kasları üzerine birçok çalışma yapılmış olmasına rağmen, çiğneme ve suprahyoid kaslar üzerine RT’nin etkisi yeterince araştırılmamıştır. Bu çalışmanın amacı, NFK hastalarında RT öncesi ve sonrası (18–24 ay) çiğneme ve suprahyoid kas kalınlığındaki değişiklikleri manyetik rezonans görüntüleme (MRG) ile kantitatif olarak değerlendirmek ve bulguları sağlıklı bireylerle karşılaştırmaktır. Gereç ve Yöntemler: Otuz bir NFK hastası ve 50 sağlıklı bireye ait MRG verileri retrospektif olarak analiz edildi. Masseter, medial/lateral pterygoid, temporalis, geniohyoid, mylohyoid, digastrik (ön karın) ve genioglossus kaslarının kalınlıkları, standart T1- ve T2-ağırlıklı sekanslar üzerinde bilateral olarak ölçüldü. İstatistiksel analizler için eşleştirilmiş ve bağımsız t-testleri, ANOVA ve Ki-kare testleri uygulandı (Python v3.11; p < 0.05). Bulgular: RT öncesi hastalarda, sol masseter kası kalınlığı sağlıklı kontrollere göre anlamlı olarak daha düşüktü (p = 0.0022). RT sonrasında, masseter ve medial pterygoid kaslarında %30,61’e varan atrofi gözlendi (p < 0.00001). Lateral pterygoid ve digastrik kaslarda küçük fakat anlamlı olmayan artışlar izlendi. Sağ taraflı tümörlerde ipsilateral kas kalınlığı daha fazlaydı. Bilateral tümör olgularında genioglossus hipertrofisi saptandı. Erkeklerde kaslar kadınlara göre daha kalındı ve yaş ilerledikçe kas kalınlığında azalma gözlendi. Sonuç: Radyoterapi, NFK hastalarında önemli çiğneme kası atrofisine neden olmaktadır. Kas asimetrisi tedavi öncesinde de mevcut olabilir ve tümör tarafını yansıtabilir. MRG tabanlı değerlendirme değerli bilgiler sunmaktadır.

Anahtar Kelimeler

• radyoterapi
• manyetik rezonans görüntüleme
• baş ve boyun kanserleri
• nazofaringeal karsinom

Kaynakça

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