Apparent diffusion coefficient histogram shape analysis for monitoring early response in patients with advanced cervical cancers undergoing concurrent chemo-radiotherapy.

Jie Meng,Jian He,Huanhuan Wang,Baorui Liu,Yun Ge,Song Liu,Xiaofeng Yang,Lijing Zhu,Yue Guan,Jing Yan,Zhengyang Zhou,Li Zhu

doi:10.1186/s13014-016-0715-6

Abstract

BackgroundTo explore the role of apparent diffusion coefficient (ADC) histogram shape related parameters in early assessment of treatment response during the concurrent chemo-radiotherapy (CCRT) course of advanced cervical cancers.MethodsThis prospective study was approved by the local ethics committee and informed consent was obtained from all patients. Thirty-two patients with advanced cervical squamous cell carcinomas underwent diffusion weighted magnetic resonance imaging (b values, 0 and 800 s/mm2) before CCRT, at the end of 2nd and 4th week during CCRT and immediately after CCRT completion. Whole lesion ADC histogram analysis generated several histogram shape related parameters including skewness, kurtosis, s-sDav, width, standard deviation, as well as first-order entropy and second-order entropies. The averaged ADC histograms of 32 patients were generated to visually observe dynamic changes of the histogram shape following CCRT.ResultsAll parameters except width and standard deviation showed significant changes during CCRT (all P < 0.05), and their variation trends fell into four different patterns. Skewness and kurtosis both showed high early decline rate (43.10 %, 48.29 %) at the end of 2nd week of CCRT. All entropies kept decreasing significantly since 2 weeks after CCRT initiated. The shape of averaged ADC histogram also changed obviously following CCRT.ConclusionsADC histogram shape analysis held the potential in monitoring early tumor response in patients with advanced cervical cancers undergoing CCRT.

Highlights

To explore the role of apparent diffusion coefficient (ADC) histogram shape related parameters in early assessment of treatment response during the concurrent chemo-radiotherapy (CCRT) course of advanced cervical cancers
Several studies have shown that ADC histogram analysis was useful in characterizing cervical cancer and normal cervix, distinguishing between well or moderately and poorly differentiated cervical cancers and identifying squamous cell carcinoma from adenocarcinoma of the cervix [4,5,6,7]
The inclusion criteria consisted of: (a) women aged over 18 years with biopsyproven cervical cancer and clinically diagnosed as advanced cervical cancer (staged IIB to IVA based on the International Federation of Gynecology and Obstetrics (FIGO) classification), (b) no previous treatment for cervical cancer before the first magnetic resonance (MR) examination, (c) being scheduled to receive CCRT in our hospital, (d) finishing the follow-up MR examinations on time

Summary

Introduction

To explore the role of apparent diffusion coefficient (ADC) histogram shape related parameters in early assessment of treatment response during the concurrent chemo-radiotherapy (CCRT) course of advanced cervical cancers. Concurrent chemo-radiotherapy (CCRT) remains the standard treatment protocol for advanced cervical cancers [1]. The conventional method to assess tumor response is to observe the changes in tumor size using computed tomography (CT) or magnetic resonance (MR) imaging. Those morphologic alterations significantly lag behind the biological and molecular changes that occur early in responders [2]. Apparent diffusion coefficient (ADC) histogram analysis can evaluate microstructural heterogeneity within the whole tumor [3]. Several studies have shown that ADC histogram analysis was useful in characterizing cervical cancer and normal cervix, distinguishing between well or moderately and poorly differentiated cervical cancers and identifying squamous cell carcinoma from adenocarcinoma of the cervix [4,5,6,7]

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