| Objective:The purpose of this study is to explore the variation characteristics of intravoxel incoherent motion?IVIM?imaging and diffusion kurtosis imaging?DKI?related parameters before and after neoadjuvant chemoradiotherapy?NACT?in cervical cancers and to evaluate the value of pre-treatment parameters of IVIM and DKI in predicting the efficacy of NACT for cervical cancers.Materials and Methods:28 females with histologically proven untreated cervical cancers from March 2018to December 2018 were enrolled.All the patients underwent routine MRI examination,IVIM and DKI examination before and after two chemotherapy cycles on a 3.0T MR station?Discovery MR750W,GE Healthcare,USA?.The ROIs were manually placed on the maximal section of each lesion,and carefully to avoid the area of cystic degeneration,necrosis and bleeding.The NACT treatment regimen used the TP regimen?cisplatin+paclitaxel?.After NACT,the patients were divided into effective group and ineffective group according to the Response Evaluation Criteria in Solid Tumors?RECIST?.The effective group included the cases of complete response?CR?and partial response?PR?,and the ineffective group included the cases of stable disease?SD?and progressive disease?PD?.Images analyses were performed on GE AW4.6workstation by two radiologists for IVIM related parameters?ADC,D,D*,f?and DKI related parameters?MK,MD?.The SPSS25.0 statistical software was used to analyze the differences of IVIM and DKI related parameters between the two groups before and after NACT.The efficacy of NACT for cervical cancers was evaluated by comparing the parameters of IVIM and DKI before treatment and the efficacy of combined diagnosis of IVIM and DKI with ROC?Receiver Operating Characteristic Curve?.Results:1.The average age of 28 patients was 43.1±11.2 years old.The pathological types of the cases were squamous cell carcinoma.NACT was completed twice and the TP chemotherapy regimen was used.After treatment we had 20 patients in effective group and 8 patients in ineffective group.2.Before NACT,the ADC,D,D*,f,MK and MD values of the effective group were?1.079±0.269?×10-3mm2/s,?0.861±0.126?×10-3mm2/s,?8.853±5.098?×10-3mm2/s,0.182±0.103,0.978±0.119,?0.911±0.268?×10-3mm2/s;ADC,D,D*,f,MK,and MD values of the ineffective group were?0.743±0.101?×10-3mm2/s,?0.690±0.129?×10-3mm2/s,?10.778±5.074?×10-3mm2/s,0.113±0.052,0.794±0.115,?0.975±0.189?×10-3mm2/s;The ADC,D and MK values of the effective group significantly were higher than those of the ineffective group?P<0.05?.There was no significant difference in D*,f and MD values between the two groups?P>0.05?.3.After NACT,the ADC,D,D*,f,MK and MD values of the effective group were?1.194±0.218?×10-3mm2/s,?0.967±0.206?×10-3mm2/s,?8.728±4.548?×10-3mm2/s,0.228±0.103,0.855±0.128,?0.975±0.189?×10-3mm2/s;ADC,D,D*,f,MK,and MD values of the ineffective group were:?0.868±0.147?×10-3mm2/s,?0.830±0.111?×10-3mm2/s,?7.771±3.652?×1010-3mm2/s,0.172±0.113,0.742±0.081,?0.786±0.078?×10-3mm2/s;The ADC,MK and MD values of the effective group were significantly higher than those of the ineffective group?P<0.05?.There were no significant difference in D,D*and f values between the two groups?P>0.05?.4.The mean ADC values before and after NACT treatment were?0.983±0.278?×10-3mm2/s,?1.101±0.248?×10-3mm2/s;Dvalueswere?0.812±0.147?×10-3mm2/s,?0.928±0.192?×10-3mm2/s;f values were 0.163±0.096,0.212±0.107;MK values were 0.925±0.143,0.823±0.126;The mean ADC,D,f values after treatment increased,MK values decreased,the differences were statistically significant?P<0.05?.In the effective group,ADC and D values increased after NACT,and MK values decreased,and the differences were statistically significant?P values were 0.031,0.003,and 0.001?.In the ineffective group,ADC and D values increased after NACT,and MK values decreased,and the differences were statistically significant?P values were 0.006,0.002,and 0.006?.There were no statistical differences in other parameters.5.The AUC of ADC,D and MK values before NACT of cervical cancers were0.894,0.869 and 0.863?P<0.05?.The AUC of the D*,f and MD values before NACT of cervical cancers were 0.369,0.728,and 0.494?P>0.05?.The AUC of ADC combined with MK and D combined with MK for predicting the therapeutic effect of cervical cancer were 0.919 and 0.956?P<0.05?.Conclusions:1.IVIM and DKI related parameters may reflect the changes of water molecule diffusion and tissue complexity before and after NACT in cervical cancers.It is a new method to evaluate the therapeutic effect from the microscopic point of view,and it is expected to be a non-invasive imaging technology to evaluate the efficacy of NACT in cervical cancers.2.ADC,D and MK can predict the therapeutic effect of NACT in cervical cancers to a certain extent,and ADC has higher diagnostic efficiency.3.The combination of IVIM and DKI can improve the efficacy of predicting the efficacy of NACT in cervical cancers,and the diagnostic efficiency of D combined with MK value is optimal. |
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