European Radiology

, Volume 30, Issue 1, pp 471–481 | Cite as

Strain elastography as an early predictor of long-term prognosis in patients with locally advanced cervical cancers treated with concurrent chemoradiotherapy

  • Yan Xu
  • Lijing Zhu
  • Li Zhu
  • Huanhuan Wang
  • Tong Ru
  • Baorui Liu
  • Jian He
  • Sibo Tian
  • Zhengyang ZhouEmail author
  • Xiaofeng YangEmail author



To explore the value of strain elastography as an early predictor of long-term prognosis in patients with locally advanced cervical cancers treated with concurrent chemoradiotherapy (CCRT).


Strain elastography examinations were performed on 45 patients with locally advanced cervical cancers at 3 time points: prior to CCRT, and at 1 and 2 weeks after the start of CCRT. The maximum tumor diameter (Dmax), strain ratio (SR), and their percentage changes (ΔDmax and ΔSR) were calculated to predict long-term prognosis. Based on the results of physical examinations, Papanicolaou test, and pelvic magnetic resonance imaging, we classified patients into two groups: responders (complete remission) and non-responders (sustained disease, recurrence, or death).


After a median follow-up of 30 months (range, 12–36 months), 36 of 45 (80%) patients were disease free. The Dmax as well as ΔDmax at 2 weeks during CCRT was able to predict the responder outcomes, with an area-under-the-curve (AUC) of 0.733 and 0.731, respectively. Furthermore, significant differences in SR and ΔSR at 1 and 2 weeks during therapy were shown between the responder and non-responder groups (all p < 0.05), and ΔSR at 2 weeks during CCRT presented with the highest AUC (0.91), yielding 88.9% sensitivity and 88.9% specificity with a selected cutoff value.


Strain elastography may be useful as an early predictor of long-term outcomes after CCRT for patients with cervical cancer.

Key Points

• The D max as well as ΔD max at 2 weeks during CCRT can predict the responder outcomes.

• The elastography parameters (SR and ΔSR) exhibited predictive values of favorable response after therapy initiation.

• ΔSR at 2 weeks during CCRT held the best predictive value for the responder outcomes.


Elastography Treatment outcome Cervical cancer Concurrent chemoradiotherapy 





Concurrent chemoradiotherapy


Confidence interval


Complete response


Maximum long axis diameter


External beam radiotherapy


International federation of gynecology and obstetrics


High dose rate


Intraclass correlation coefficient


Magnetic resonance imaging


Overall survival


Progression-free survival

Post T1

At 1 week during therapy

Post T2

At 2 weeks during therapy


Partial response

Pre Tx

Prior to therapy


Receiver-operating characteristic


Strain ratio



This study has received funding from the National Natural Science Foundation of China (ID: 81501441, 81671751), Social Development Foundation of Jiangsu Province (BE2015605), the Natural Science Foundation of Jiangsu Province (ID: BK20131281,BK20150109, BK20150102), Jiangsu Province Health and Family Planning Commission Youth Scientific Research Project (ID: Q201508), and Six Talent Peaks Project of Jiangsu Province (ID: 2015-WSN-079).

Compliance with ethical standards


The scientific guarantor of this publication is Zhengyang Zhou.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Yan Xu
    • 1
    • 2
  • Lijing Zhu
    • 3
  • Li Zhu
    • 1
  • Huanhuan Wang
    • 1
  • Tong Ru
    • 2
  • Baorui Liu
    • 3
  • Jian He
    • 1
  • Sibo Tian
    • 4
  • Zhengyang Zhou
    • 1
    Email author
  • Xiaofeng Yang
    • 4
    Email author
  1. 1.Department of Radiology, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
  2. 2.Department of Obstetrics and Gynecology, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
  3. 3.The Comprehensive Cancer Centre, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
  4. 4.Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaUSA

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