Search

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. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the diagnostic performance of minimum apparent diffusion coefficient (mini-ADC) for predicting lymphovascular invasion (LVI) in invasive cervical cancer.Materials and Methods: Ninety-six patients with pathologically confirmed invasive cervical cancer (CC) underwent conventional preoperative magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) on a 3.0T MRI system. Tumor ADC, mini-ADC and mini-ADC ratio (mini-ADC value / tumor ADC value) were obtained and compared between LVI-positive and LVI-negative invasive CC, and correlation between LVI status and Ki-67, p16, p63, and clinical prognostic factors were analyzed. ADC thresholds and diagnostic performance were determined by receiver operating characteristic (ROC) analysis.Results: Tumor ADC showed no significant difference (P = 0.300) between LVI-positive invasive CC (n = 27) and LVI-negative invasive CC (n = 69); the mini-ADC and mini-ADC ratio were significantly lower in LVI-positive invasive CC than in LVI-negative invasive CC ([0.712 ± 0.078 × 10-3 mm2 /s] vs. [0.867 ± 0.099 × 10-3 mm2 /s], P < 0.001; and [0.772 ± 0.062] vs. [0.917 ± 0.052], P < 0.001, respectively). ROC curve analysis yielded a cutoff mini-ADC value of 0.837 in the differentiation of LVI-positive and LVI-negative invasive CC, with a sensitivity of 65%, specificity of 100%, and area under the curve (AUC) of 0.885; a cutoff mini-ADC ratio of 0.875 with a sensitivity of 78%, specificity of 100%, AUC of 0.970, positive predictive value of 100%, and negative predictive value of 64%. There was a positive correlation between LVI status and Ki-67 (r = 0.241, P = 0.014) and a negative correlation between mini-ADC and LVI status (r = -0.582, P < 0.001); mini-ADC and Ki-67 (r = -0.587, P < 0.001).Conclusion: Mini-ADC value appears to be a simple and effective tool for the prediction of LVI status in invasive CC, and the mini-ADC ratio may be the best parameter in discriminating between LVI-positive and LVI-negative invasive CC.Level Of Evidence: 1 Technical Efficacy: Stage 4 J. MAGN. RESON. IMAGING 2017;45:1771-1779. [ABSTRACT FROM AUTHOR]