Evaluation of T2-W MR imaging and diffusion-weighted imaging for the early post-treatment local response assessment of patients treated conservatively for cervical cancer: a multicentre study

Abstract

Objectives To compare MR imaging with or without DWI and clinical response evaluation (CRE) in the local control evaluation of cervical carcinoma after radiotherapy. Methods In 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). Results Using 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. Conclusions DWI 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

Diffusion-weighted MRI in Advanced Epithelial Ovarian Cancer: Apparent Diffusion Coefficient as a Response Marker

“…A 10-center study of 272 patients with breast cancer demonstrated that ADC changes after 12 weeks of neoadjuvant chemotherapy was predictive of a complete pathologic response (30). However, a three-center study, with differences in protocols between centers, did not find additional diagnostic value in ADC changes in cervical tumors following radiation therapy (31). The importance cle) increase in ADC in those with residual disease may be used independently of other clinical factors (duration of platinumfree interval, number of previous lines of therapy) to identify response and to indicate longer progression-free survival (PFS).…”

Predictive Value of Early Response to Chemoradiotherapy in Advanced Esophageal Squamous Cell Carcinoma by Diffusion-Weighted MR Imaging

“…It has been widely reported the application of DWI to evaluate the therapeutic effect in cervical cancer, breast cancer, and colorectal cancer. 8 - 10 Research has shown that the increase in the ADC value was related to the decrease in tumorous cellular density after effective treatment. 11 Before CRT, esophageal cancer with high tumor cell proliferation, high cellularity, decreased extracellular volume, cell membrane barrier, and increased absorption of protein to water molecules all districted the diffusion of water molecules and decreased the ADC value of tumor.…”

Qualitative and quantitative comparison of image quality between single-shot echo-planar and interleaved multi-shot echo-planar diffusion-weighted imaging in female pelvis

“…Studies have shown that DWI coupled with T2W images can improve the evaluation of various gynecological cancers. A prediction model was constructed combining both sequences to evaluate parametrial invasion (PMI) in cervical cancer [31]; DWI significantly increases the specificity of MR imaging in the detection of residual tumor compared with T2W images alone in cervical cancer after radiotherapy [32,33]. For endometrial cancer, the depth of myometrial invasion and the presence of lymph node metastasis are important prognostic factors.…”