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Treatment response evaluation using the mean apparent diffusion coefficient in cervical cancer patients treated with definitive chemoradiotherapy
Author(s) -
Onal Cem,
Erbay Gurcan,
Guler Ozan C.
Publication year - 2016
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.25215
Subject(s) - medicine , effective diffusion coefficient , cervical cancer , magnetic resonance imaging , nuclear medicine , chemoradiotherapy , diffusion mri , lymph node , cancer , radiology
Purpose To investigate the pre‐ and posttreatment mean apparent diffusion coefficient (ADC mean ) of cervical cancer tumors treated with definitive chemoradiotherapy (CRT) and evaluate their correlation with recurrence and survival rates. Materials and Methods Forty‐four patients with cervical squamous cell carcinoma were retrospectively evaluated. All patients underwent multiparametric 1.5T magnetic resonance imaging (MRI) including T 2 ‐weighted, fat‐saturated T 2 ‐weighted, dynamic contrast‐enhanced (DCE), and diffusion‐weighted imaging (DWI) sequences before and after treatment. Posttreatment MR images were acquired within a median of 3.2 months (range, 2.8–4.1 months) after completing CRT. We assessed the impact of primary tumor pre‐ and posttreatment ADC values on prognostic factors and treatment outcomes. Results The pre‐ and posttreatment ADC mean values were 0.882 ± 0.096 × 10 −3 mm 2 /sec and 1.159 ± 0.168 × 10 −3 mm 2 /sec, respectively, and the difference was statistically significant ( P < 0.001). The median percent ADC change was 33.7% (range, 5.0–70.0%). Patients with disease recurrence had lower ADC values, both pretreatment (0.822 ± 0.096 × 10 −3 mm 2 /sec vs. 0.936 ± 0.058 × 10 −3 mm 2 /sec; P < 0.001) and posttreatment (1.060 ± 0.116 × 10 −3 mm 2 /sec vs. 1.248 ± 0.160 × 10 −3 mm 2 /sec; P < 0.001). The ADC change was lower in patients with recurrence (25.7% ± 13.0% vs. 42.8% ± 15.7; P < 0.001) than in patients without recurrence. In multivariate analysis, pelvic lymph node metastasis and pretreatment ADC mean were prognostic factors for overall survival (OS) and disease‐free survival (DFS). ADC change between pre‐ and posttreatment DW‐MRI was a prognostic factor for OS. Conclusion DWI parameters, measured before and after treatment, may be useful prognostic biomarkers for tumor burden, recurrence, and survival in cervical cancer patients treated with CRT. The primary tumor pretreatment ADC mean is an independent prognostic factor for DFS and OS. J. MAGN. RESON. IMAGING 2016;44:1010–1019.