Application Of MR Diffusion Weighted Imaging In Evaluating The Therapeutic Effect Of Chemoradiotheraphy In Patients With Cervical Cancer

Part I:Dynamical monitoring the therapeutic response of advanced cervical cancer to concurrent chemoradiation with Magnetic resonance diffusion weighted imagingObjective:To study the utilization of magnetic resonance(MR)diffusion weighted imaging(DWI)in monitoring the therapeutic response of advanced cervical cancer to concurrent chemoradiation.Methods:Ethics committee approved this study and written consent from the patient was obtained.From 2012.05 to 2014.02,Forty two women with advanced cervical cancer(≥IIb)confirmed by biopsy,who would receive concurrent chemoradiation,were prospectively included in our study.MR imaging were executed including plan scan,DWI and enhanced scan prior to,immediately and one month later on a 3.0 T MR scanner after the therapy,and the apparent diffusion coefficient(ADC)values and maximum diameter were measured correspondingly.The remaining 39 patients included 28 complete response(CR),10 partial response(PR),and 1 stable disease(SD).In 28 CR patients,11 patients fell into immediate response group whose lesions completely disappeared immediately after therapy and the other 17 cases fell into delayed response group whose lesions disappeared one month later.Three patients underwent surgery immediately after the therapy.The ADC values and the maximum diameter of the lesions with different therapeutic response were monitored and compared.Results:ADC value of CR group was significantly higher than that of PR group(1.43×10-3mm2/s vs.1.29×10-3mm2/s P<0.001)one month after therapy.Tumor5s maximum diameter of immediate response group was significantly smaller than that of delayed response group(3.6±0.9 VS.5.3±2.5 cm,P= 0.046)and that of patients with residual lesions immediately after therapy(3.6±0.9 VS.5.1±1.9cm,P=0.021).The dynamic change of the ADC value and tumor’s maximum diameter differed among groups with different therapeutic responses.The change rate of the tumor ADC values and maximum diameter correlated significantly(r=0.421,P=0.005).Conclusion:The tumor diameter and ADC value have different change trends in different therapeutic groups.Therapeutic effect of advanced cervical cancer to concurrent chemoradiation can be partly predicted by tumor maximum diameter.The ADC value of the tumor can be considered as an auxiliary tool to evaluate the curative effect.Part Ⅱ:Assessment of the therapeutic effect of concurrent chemoradiotheraphy in patients with cervical cancer by intravoxel incoherent motion MR imagingObjective:To investigate the value of introvoxel incoherent motion(IVIM)magnetic resonance(MR)imaging in assessing the treatment efficacy of concurrent chemoradiotherapy in patients with advanced cervical cancers.Methods:Ethics committee approved this study and written consent from the patient was obtained.From 2014.01 to 2014.11,17 patients with advanced cervical cancers confirmed by biopsy who would receive concurrent chemoradiotherapy were recruited.MR imaging including IVIM MR imaging(b=0,10,20,30,40,50,100,150,200,350,500,650,800,1000s/mm2)were performed prior to,during(2 and 4 weeks after the start of therapy)and at the end of therapy.The IVIM derived parameters,including pure molecular diffusion coefficient(D),pseudodiffusion coefficient(D*)and perfusion fraction(f)of the cancer were obtained based on bi-exponential analysis.Apparent diffusion coefficient(ADC)value was also calculated with mono-exponential analysis.Dynamic changes of the above parameters were recorded and compared during the treatment period.The maximum diameter of the lesion was measured to evaluate the treatment response.Results:The ADC,D,and f values of cervical cancers were remarkable higher at the end of chemoradiotherapy than former(ADC(0.93±0.1 VS.1.72±0.1)×10-3 mm2/s,D(0.78±0.12 VS.1.34±0.12)×10-3 mm2/s,and f(0.13±0.05 VS.0.22±0.07)%,all P<0.001).The ADC,D,f and D*values increased significantly at two weeks after the start of therapy(P<0.05).After 2 weeks,the D and ADC values of the lesion continued to increase,while D*and f values decreased.Conclusions:IVIM MR imaging can assess the dynamic changes of cervical cancers during concurrent chemoradiotherapy.It serves as a useful biomarker in treatment response as early as 2 weeks after the initiation of therapy.