The Clinical Study Of Influential Factors Of Cervical Squamous Carcinoma Blood Supply And Predicting Treatment Response To Concurrent Radiochemotherapy Used The Volume CT Perfusion Imaging

Objective: To evaluate whether the whole uterine volume CT perfusion(vCTP)imaging can accurately show the size of the cervical squamous carcinoma(CSC)with use of MR as the reference standard,and analyze the imaging features and the influence factors of blood supply in CSC,and assess the value of vCTP in predicting the efficacy of concurrent chemoradiotherapy(CCRT)for CSC patients.Method: From September 2016 to March 2017 in the Cancer Hospital of China Medical University,43 cases of patients with CSC underwent preoperative uterine vCTP scan,and 26 of them underwent pelvic MR dynamic enhanced scan.Paired t test was used to compare the difference of two imaging methods in measuring tumor size in different orientations.Artery blood flow(AF),blood volume(BV),permeability surface(PS)value of CSC and normal uterus body,external iliac artery AF,gluteus maximus AF,gluteus maximus CT and hip fat layer CT value were measured respectively by two radiologists,and using interclass correlation coefficient(ICC)to evaluate the interobserver reliability.The difference of the parameters between CSC and normal uterine body were compared with paired t-test,and independent sample t test was further used to compare parameters difference between premenopausal and postmenopausal patients.The rank sum test was used to compare the parameters of CSCs with different FIGO stage and pathological grade.The correlation analysis between perfusion parameters and related factors of CSCs were performed by Pearson or Spearman test.22 cases of the 43 patients underwent CCRT,and routine enhanced CT was performed in the third to fourth week after treatment.The patients were divided into different groups according to the solid tumor efficacy evaluation criteria(RECIST).The general data,AF,BV and PS of CSCs patients in different groups were compared with t test or Fisher exact probability test,and statistically significant CT perfusion parameters were further analyzed by receive operating characteristic(ROC)curve.Result: 1.All 43 patients successfully completed the whole uterine vCTP scan with high-quality images,and the success rate was 100%.The radiation dose for the perfusion scan was 9.1 mSv.2.The CSC lesions were appeared in the vCTP imaging AF pseudo-color map as an irregular hyperperfusion area(red color)with irregular margin.The maximum transverse axis diameter of CSCs with vCTP imaging AF pseudo-color map and MR T1 enhanced imaging were(41.7±11.5)mm and(40.9±11.7)mm respectively,and the maximum sagittal diameter was(32.2±10.5)mm and(34.0±11.1)mm,and the maximum coronal diameter was(31.1±9.9)mm and(31.6±12.3)mm respectively.There were no significant difference in the tumor size between the two imaging methods in three different orientations.The corresponding P values were 0.593,0.105 and 0.709 respectively.3.The ICCs of the parameters measured by the two physicians were 0.759~0.988,and the consistency was good.The AF value of CSCs [(179.4±51.8)ml/min/100g] was higher than that of the normal uterine body [(151.2±48.7)ml/min/100g],and the difference was statistically significant(P<0.05).There was no significant difference in the BV and PS values between the CSCs [(29.6±12.3)ml/100 g and(29.9±14.1)ml/min/100g] and normal uterine body [(32.6±14.7)ml/100 g and(32.0±15.4)ml/min/100g].The parameters of CSCs and normal uterus body between premenopausal and postmenopausal patients were statistically different(P<0.05)except for the BV value of CSCs.There were no significant differences in the AF,BV and PS values of CSCs in different FIGO stages and pathological grades(P>0.05).Besides BV value of CSCs,the perfusion parameters of CSC and normal uterine body were negatively correlated with the age,and the R values ranged from-0.424 to-0.550(P<0.05).4.After CCRT,15 of the 22 patients were divided into the complete response(CR)group and the other 7 cases in the partial response(PR)group.There were no significant difference in patients' age,BMI,FIGO stage,pathological grade,maximum diameter and maximum area of the tumor before treatment between two groups(P>0.05).The AF,BV and PS value of CSCs in the CR group before treatment were(213.48±35.96)ml/min/100 g,(29.25±10.66)ml/100 g,(30.04±12.72)ml/min/100 g,respectively.And the AF,BV and PS value of CSCs in the PR group were(173.17±22.97)ml/min/100 g,(30.67±10.24)ml/100 g,(26.39±6.02)ml/min/100 g,respectively.The AF values of CSC in CR group were significantly higher than those in PR group(P<0.05).However,the BV and PS values of CSC were not statistically different between two groups(P>0.05).ROC curve analysis revealed that the Area Under the Curve(AUC)of the AF value of CSC to predict the short-term efficacy of CCRT for CSC was 0.829.Conclusion: 1.The vCTP could accurately show the size of the CSC lesions with use of MR T1 enhanced image as the reference standard.2.The stability of vCTP imaging parameters was proved to be well in assessing CSC.The blood flow of CSC was richer than normal uterine body.Age,menstrual status are factors that affect the blood supply of CSC and uterine.3.The parameter AF value of vCTP is helpful for predicting the short-term response to CCRT for CSC patients.The higher the AF value of CSC lesion is,the greater the likelihood of a remission after CCRT appears.