Abstract
BackgroundIntravoxel incoherent motion (IVIM) MR imaging has been applied in researches of various diseases, however its potential in cervical cancer patients has not been fully explored. The purpose of this study was to investigate the feasibility of IVIM MR imaging to monitor early treatment response in patients receiving concurrent chemo-radiotherapy (CCRT) for advanced cervical cancers.MethodsTwenty-one patients receiving CCRT for advanced cervical cancer were prospectively enrolled. MR examinations including IVIM imaging (with 14 b values, 0 ~ 1000 s/mm2) were performed at 4 time points: 1-week prior to, 2-week and 4-week during, as well as immediately post CCRT (within 1 week). The apparent diffusion coefficient (ADC) maps were derived from the mono-exponential model, while the diffusion coefficient (D), perfusion fraction (f) and pseudo-diffusion coefficient (D*) maps were calculated from the bi-exponential model. Dynamic changes of ADC, D, f and D* in cervical cancers were investigated as early surrogate markers for treatment response.ResultsADC and D values increased throughout the CCRT course. Both f and D* increased in the first 2 to 3 weeks of CCRT and started to decrease around 4 weeks of CCRT. Significant increase of f value was observed from prior to CCRT (f1 = 0.12 ± 0.52) to two-week during CCRT (f2 = 0.20 ± 0.90, p = 0.002).ConclusionsIVIM MR imaging has the potential in monitoring early tumor response induced by CCRT in patients with cervical cancers.
Highlights
Intravoxel incoherent motion (IVIM) MR imaging has been applied in researches of various diseases, its potential in cervical cancer patients has not been fully explored
This study further demonstrated that tumor with low pretreatment apparent diffusion coefficient (ADC) values tended to respond better to concurrent chemo-radiotherapy (CCRT) than those with high baseline ADC values
The study inclusion criteria were: 1) women with advanced cervical cancers (i.e., clinically staged IIB to IVA based on the International Federation of Gynecology and Obstetrics (FIGO) classification) diagnosed with biopsies, 2) age older than 18 years, and 3) no prior history of cervical cancer treatment
Summary
Intravoxel incoherent motion (IVIM) MR imaging has been applied in researches of various diseases, its potential in cervical cancer patients has not been fully explored. The purpose of this study was to investigate the feasibility of IVIM MR imaging to monitor early treatment response in patients receiving concurrent chemo-radiotherapy (CCRT) for advanced cervical cancers. Primary treatment selection is guided by tumor stage [2]. For those who are diagnosed at the locally advanced stage, concurrent chemo-radiotherapy (CCRT) is currently the standard care [3, 4]. A number of studies have established MRI as the most effective imaging modality for the diagnosis of the cervical cancers as well as the assessment of tumor response to therapy [6, 7]. Conventional T1-weighted and T2-weighted MRIs offer anatomical information such as tumor size, while newer sequences such as perfusion-weighted (PW), diffusionweighted (DW) MRIs and MR spectroscopy (MRS) have demonstrated potential as early predictors by offering a
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