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Multiparametric PET/MR (PET and MR-IVIM) for the evaluation of early treatment response and prediction of tumor recurrence in patients with locally advanced cervical cancer

  • Si Gao
  • Siyao Du
  • Zaiming Lu
  • Jun Xin
  • Song Gao
  • Hongzan SunEmail author
Molecular Imaging

Abstract

Objectives

To assess the value of 18F-FDG PET and MR-IVIM parameters before and during concurrent chemoradiotherapy (CCRT) for evaluating early treatment response and predicting tumor recurrence in patients with locally advanced cervical cancer (LACC) using a hybrid PET/MR scanner.

Methods

Fifty-one patients with LACC underwent pelvic PET/MR scans with an IVIM sequence at two time-points (pretreatment [pre] and midtreatment [mid]). Pre- and mid-PET parameters (SUVmax, MTV, TLG) and IVIM parameters (D, F, D*) and their percentage changes (Δ%SUVmax, Δ%MTV, Δ%TLG, Δ%D, Δ%F, Δ%D*) were calculated. We selected independent imaging parameters and built a combined prediction model incorporating imaging parameters and clinicopathological risk factors. The performance of the combinative evaluation for tumor early shrinkage rates (TESR) and the prediction model for tumor recurrence was assessed.

Results

Thirty-two patients were classified into the good response (GR) group with TESR ≥ 50%, and 19 patients were categorized into the poor response (PR) group with TESR < 50%. Δ%D (p = 0.013) and Δ%F (p = 0.006) are independently related to TESR with superior combined diagnostic ability (AUC = 0.901). Pre-TLG, Δ%D, and suspicious lymph node metastasis (SLNM) were selected for the construction of the combined prediction model. The model for identifying the patients with high risk of tumor recurrence reached a moderate predictive ability and good stability with c-index of 0.764 (95% CI, 0.672–0.855).

Conclusion

The combined prediction model based on pretreatment PET metabolic parameter (pre-TLG), IVIM-D percentage changes, and LNs status provides great potential to identify the LACC patients with high risk of recurrence at early stage of CCRT.

Key Points

PET/MR plus IVIM offers various complementary information for LACC.

IVIM-D and IVIM-F percentage changes are independently related to tumor early shrinkage rates.

The combined prediction model can help identify the LACC patients with high risk of tumor recurrence.

Keywords

Concurrent chemoradiotherapy Positron emission tomography Diffusion magnetic resonance imaging Cervical cancer 

Abbreviations

18F-FDG

18F-fluorodeoxyglucose

ADC

Apparent diffusion coefficient

CCRT

Concurrent chemoradiotherapy

D

Slow diffusion coefficient

D*

Fast diffusion coefficient

DWI

Diffusion-weighted imaging

F

Perfusion-related diffusion fraction

FIGO

Federation International of Gynecology and Obstetrics

GR

Good response

IVIM

Intravoxel incoherent motion

LACC

Locally advanced cervical cancer

LNs

Lymph nodes

MaxDiam

Maximum diameter

MRI

Magnetic resonance imaging

MTV

Metabolic tumor volume

PET

Positron emission tomography

PR

Poor response

RFS

Recurrence-free survival

ROC

Receiver operator characteristic

ROI

Region of interest

SLNM

Suspicious lymph nodes metastasis

SUVmax

Maximum standardized uptake value

TESR

Tumor early shrinkage rates

TLG

Total lesion glycolysis

VOI

Volume of interest

Week 4

The end of the fourth week during CCRT

Notes

Acknowledgements

All authors sincerely thank Dr. Shengtao Lin, Dr. Zhongwei Chen, and SAGE Language Service Team for providing language help on the writing of the paper. The authors also thank Dr. Qijun Wu for his constructive advice on the statistical analysis.

Funding information

This study has received funding by the National Natural Science Foundation of China (No.81401438), LIAONING Science & Technology Project (No.2017225012).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Hongzan Sun.

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

An expert in statistics Dr. Qijun Wu kindly provided statistical advice for this manuscript.

Informed consent

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

Ethical approval

Institutional Review Board approval from Ethics Committee of Shengjing Hospital affiliated to China Medical University (Shenyang, China) was obtained.

Methodology

• prospective

• prognostic study

• performed at one institution

Supplementary material

330_2019_6428_MOESM1_ESM.doc (112 kb)
ESM 1 (DOC 111 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyShengjing Hospital of China Medical UniversityShenyangPeople’s Republic of China
  2. 2.Liaoning Provincial Key Laboratory of Medical ImagingShenyangPeople’s Republic of China
  3. 3.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyShengjing Hospital of China Medical UniversityShenyangPeople’s Republic of China

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