Predictive and prognostic value of intravoxel incoherent motion (IVIM) MR imaging in patients with advanced cervical cancers undergoing concurrent chemo-radiotherapy

Li Zhu,Weibo Chen,Xiaofeng Yang,Jie Meng,Zhengyang Zhou,Lijing Zhu,Yan Xu,Jian He,Baorui Liu,Huanhuan Wang

doi:10.1038/s41598-017-11988-2

Abstract

By using the intravoxel incoherent motion (IVIM) model, the diffusion-related coefficient (D) and the perfusion-related parameter (f) can be obtained simultaneously. Here, we explored the application of IVIM MR imaging in predicting long-term prognosis in patients with advanced cervical cancers treated with concurrent chemo-radiotherapy (CCRT). In this study, pelvic MR examinations including an IVIM sequence were performed on 30 women with advanced cervical cancers at three time points (within 2 weeks before, as well as 2 and 4 weeks after, the initiation of CCRT). The performance of tumour size and IVIM-derived parameters in predicting long-term prognosis was evaluated. After a median follow-up of 24 months (range, 10∼34 months), 25/30 (83.33%) patients were alive, and 21/30 (70.00%) remained free of disease. A shrinkage rate of maximum diameter (time point 1 vs. 3) ≥ 58.31% was useful in predicting a good long-term prognosis. The IVIM-derived apparent diffusion coefficient (ADCIVIM) value at time point 2 and the ADCIVIM and f values at time point 3 also performed well in predicting a good prognosis, with AUC of 0.767, 0.857 and 0.820, respectively. IVIM MR imaging has great potential in predicting long-term prognosis in patients with advanced cervical cancers treated with CCRT.

Highlights

Cervical cancer is the fourth most common gynaecologic malignancy and the fourth leading cause of cancer mortality in women worldwide
Five patients classified as complete response (CR) had poor prognosis (25.00%, 3 deaths and 2 recurrences), and 6 (60.00%) classified as partial response (PR) responded well later (Table 2)
We demonstrated the feasibility of using intravoxel incoherent motion (IVIM) parameters, especially the f and ADCIVIM values, to predict long-term prognosis in patients with advanced cervical cancer treated with concurrent chemo-radiotherapy (CCRT), which has never been reported previously

Summary

Introduction

Cervical cancer is the fourth most common gynaecologic malignancy and the fourth leading cause of cancer mortality in women worldwide. Clinical features Number of patients Mean age (range) FIGO stage: II III IV Metastasis: Retroperitoneal lymph nodes Rectum Brain Supraclavicular lymph nodes Early treatment outcome: CR PR Long-term prognosis: Complete remission Local recurrence Sustained disease Death. Associated with radiation changes during the therapy may cause misleading bias in the measurement of residual tumours and make drawing an accurate border difficult[10]. To address this issue, functional imaging modalities offer more advantages by providing both structural and physiological or even metabolic information for cervical cancers. Dynamic contrast-enhanced (DCE) MR imaging has proven useful in predicting better long-term treatment outcomes in cervical cancers with higher tissue permeability[11], yet this method involves the use of exogenous gadolinium contrast agents. Diffusion-weighted (DW) imaging can generate apparent diffusion coefficient (ADC) values, whose early change rate after therapy has predictive potential in cervical cancers treated with CCRT12–14

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