Abstract
ObjectivesTo compare MR imaging with or without DWI and clinical response evaluation (CRE) in the local control evaluation of cervical carcinoma after radiotherapy.MethodsIn a multicentre university setting, we prospectively included 107 patients with primary cervical cancer treated with radiotherapy. Sensitivity and specificity for CRE and MR imaging (with pre-therapy MR imaging as reference) (2 readers) were evaluated using cautious and strict criteria for identifying residual tumour. Nested logistic regression models were constructed for CRE, subsequently adding MR imaging with and without DWI as independent variables, as well as the pre- to post-treatment change in apparent diffusion coefficient (delta ADC).ResultsUsing cautious criteria, CRE and MR imaging with DWI (reader 1/reader 2) have comparable high specificity (83% and 89%/95%, respectively), whereas MR imaging without DWI showed significantly lower specificity (63%/53%) than CRE. Using strict criteria, CRE and MR imaging with DWI both showed very high specificity (99% and 92%/95%, respectively), whereas MR imaging without DWI showed significantly lower specificity (89%/77%) than CRE. All sensitivities were not significantly different. Addition of MR imaging with DWI to CRE has statistically significant incremental value in identifying residual tumour (reader 1: estimate, 1.06; p = 0.001) (reader 2: estimate, 0.62; p = 0.02). Adding the delta ADC did not have significant incremental value in detecting residual tumour.ConclusionsDWI significantly increases the specificity of MR imaging in the detection of local residual tumour. Furthermore, MR imaging with DWI has significant incremental diagnostic value over CRE, whereas adding the delta ADC has no incremental diagnostic value.Key Points• If MR imaging is used for response evaluation, DWI should be incorporated• MR imaging with DWI has diagnostic value comparable/complementary to clinical response evaluation• Inter-reader agreement is moderate to fair for two experienced radiologist readers• Quantitative measurements of ADC early post-therapy have limited diagnostic value
Highlights
Cervical cancer represents a major health burden, with for instance around 12,000 newly diagnosed patients in the USA each year (US Cancer Statistics Working Group 2016)
If magnetic resonance (MR) imaging is used for response evaluation, diffusion-weighted imaging (DWI) should be incorporated
The mean time interval between the end of radiotherapy and response evaluation was 51 days for clinical response evaluation (CRE) and 42 days for MRI
Summary
Cervical cancer represents a major health burden, with for instance around 12,000 newly diagnosed patients in the USA each year (US Cancer Statistics Working Group 2016). More than 90% of patients show complete local response after such treatment [6–8]. To detect local residual tumour at an early time point (2–3 months after treatment) and allow potentially curative salvage therapy, response assessment after radiotherapy is uniformly recommended [9–11]. The effect of salvage surgery on survival is not well studied, retrospective studies suggest that early detection of local residual disease in asymptomatic women may offer survival benefit [12, 13]. A wellfounded diagnosis of local residual tumour shortly after completing radiotherapy would be helpful in the timely selection of women for salvage surgery, and might contribute to enhanced survival. The patient with residual disease not suitable for salvage surgery might be quickly informed about her unfortunate prognosis in a timely manner
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
