The Application Of DWI Combined With DCE-MRI In Staging And Therapy Of Uterine Cervical Carcinoma

Objective: To study the advantages of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in diagnosis and staging of cervical carcinoma. To evaluate the value of DWI and DCE-MRI in monitoring the response of cervical carcinoma after concurrent chemoradiation.Materials and Methods: Fifteen female patients without cervical disease and thirty-five female patients with cervical carcinoma were performed conventional MRI, DWI and DCE-MR scanning. All thirty-five patients were confirmed by surgery or cervical biopsy. Twenty cervical carcinoma patients in operation group underwent surgery, and fifteen patients in chemoradiation group received concurrent chemoradiation. The apparent diffusion coefficient(ADC) value and time-signal intensity curve(TIC)were analyzed by using GE ADW 4.3 workstations. To compare the ADC values between normal uterine cervix and cervical carcinoma. To compare the TIC types between the cervical carcinoma and surrounding normal myometrium. Twenty patients in surgery group, the staying of conventional MR combined with DWI and DCE-MRI staging was compared with pathologic staging. Fifteen patients in chemoradiation group, the staying of conventional MR combined with DWI and DCE-MRI was compared with clinical staging. Ten patients were done again in order to analyze changes of the mean ADC value and TIC types before and after chemoradiation. The mean ADC value and TIC types between CR and PR group were studied.Results:1. The mean ADC value of cervical endometrium, conjunctive zone and muscular layer was(1.62±0.23)×10-3mm~2/s,(1.35±0.14)×10-3mm~2/s and(1.87±0.21)×10-3mm~2/s respectively, with statistical significance(F=26.395,P<0.05). The mean ADC value of normal uterine cervix was (1.61±0.29)×10-3mm~2/s. 2. The mean ADC value of cervical carcinoma((0.88±0.24)×10-3mm~2/s) was much lower than normal uterine cervix, ADC value was statistically different between cancerous and normal tissue in the uterine cervix(t=11.931,P<0.05). The mean ADC value of squamous carcinoma of the cervix was(0.82±0.17)×10-3mm~2/s, and adenocarcinoma of the uterine cervix was (1.18±0.32)×10-3mm~2/s; there were statistic differences between them(t=-3.703,P<0.05). In 35 patients with cervical carcinoma, 3 patients had typeⅠcurve, 19 patients had typeⅡcurve, 13 patients had typeⅢcurve. In surrounding normal myometrium, 30 patients had typeⅠcurve, 5 patients had typeⅡcurve. The accurate rates were compared with pathological results.3. Compared with pathologic staging, the accuracy of conventional MR staging and conventional MR combined with DWI and DCE staging was 80%(16/20)and 95%(19/20)respectively. Pathologic observation confirmed four patients of lymph node metastasis, and three confirmed in MRI. The coincidence rate of fifteen patients after concurrent chemoradiation between conventional MR combined with DWI and DCE staging and clinical staging was 67%.4. After chemoradiation therapeutic of cervical carcinoma, ADC values were increased. The mean ADC value of pre- chemoradiation was (0.83±0.07)×10-3mm~2/s, and post- chemoradiation was (1.33±0.31)×10-3mm~2/s. The mean ADC value and TIC types between pre-and post- chemoradiation showed statistically significant changes (P<0.05). The mean ADC value of CR and PR group was (1.56±0.12)×10-3mm~2/s and(1.00±0.11)×10-3mm~2/s respectively. The mean ADC value of CR group was statistically higher than that of PR group (P<0.05). The TIC types between CR group and PR group was statistically significant (P<0.05).Conclusion:1. DWI and DCE-MRI may have potential ability to differentiate between cancerous and normal tissue in the uterine cervix and to display relationship between lesions and surrounding tissues. They may be helpful to improve diagnosis.2. The mean ADC value of squamous and adenocarcinoma carcinoma of the cervix were statistically significant(t=-3.703,P<0.05). The ADC value may indicate the pathological type of cervix carcinoma.3. Compared with pathologic staging, the accuracy of conventional MR staging was 80%, and the accuracy of conventional MR combined with DWI and DCE staging was 95%. DWI and DCE can be helpful to improve the preoperative staging accuracy in cervical carcinoma. 4. DWI and DCE-MRI have the ability to monitor the response of cervical carcinoma after concurrent chemoradiation.