Abstract
Objective
To investigate the prediction of response to concurrent chemoradiotherapy (CCRT) through a combination of pretreatment multi-parametric magnetic resonance imaging (MRI) with clinical prognostic factors (CPF) in cervical cancer patients.
Methods
Sixty-five patients underwent conventional MRI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) before CCRT. The patients were divided into non- and residual tumour groups according to post-treatment MRI. Pretreatment MRI parameters and CPF between the two groups were compared and prognostic factors, optimal thresholds, and predictive performance for post-treatment residual tumour occurrence were estimated.
Results
The residual group showed a lower maximum slope of increase (MSIL) and signal enhancement ratio (SERL) in low-perfusion subregions, a higher apparent diffusion coefficient (ADC) value, and a higher stage than the non-residual tumour group (p < 0.001, p = 0.003, p < 0.001, and p < 0.001, respectively). MSIL and ADC were independent prognostic factors. The combination of both measures improved the diagnostic performance compared with individual MRI parameters. A further combination of these two factors with CPF exhibited the highest predictive performance.
Conclusions
Pretreatment MSIL and ADC were independent prognostic factors for cervical cancer. The predictive capacity of multi-parametric MRI was superior to individual MRI parameters. The combination of multi-parametric MRI with CPF further improved the predictive performance.
Key points
• Pretreatment MSI L and ADC were independent prognostic factors for post-treatment residual tumours.
• The residual groups showed lower MSI L , higher ADC and higher stage.
• The predictive capacity of multi-parametric MRI was superior to individual MRI parameters.
• The combination of multi-parametric MRI with CPF exhibited the highest predictive performance.
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Abbreviations
- MRI:
-
magnetic resonance imaging
- DWI:
-
diffusion-weighted imaging
- ADC:
-
apparent diffusion coefficient
- DCE-MRI:
-
dynamic contrast-enhanced MRI
- MSI:
-
maximum slope of increase
- SER:
-
signal enhancement ratio
- ROI:
-
region of interest
- CPF:
-
clinical prognostic factor
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The scientific guarantor of this publication is Jin Wei Qiang.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Funding
This study has received funding by National Natural Science Foundation of China (No.81471628); Shanghai Municipal Commission of Health and Family Planning, China (No.2013SY075 and No. ZK2015A05).
Statistics and biometry
No complex statistical methods were necessary for this paper.
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Institutional Review Board approval was obtained.
Informed consent
Written informed consent was obtained from all patients in this study.
Methodology
• prospective
• diagnostic or prognostic study
• performed at one institution.
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Yang, W., Qiang, J.W., Tian, H.P. et al. Multi-parametric MRI in cervical cancer: early prediction of response to concurrent chemoradiotherapy in combination with clinical prognostic factors. Eur Radiol 28, 437–445 (2018). https://doi.org/10.1007/s00330-017-4989-3
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DOI: https://doi.org/10.1007/s00330-017-4989-3