Evaluation of diffusion-weighted imaging (DWI) and MR spectroscopy (MRS) as early response biomarkers in cervical cancer patients
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To prospectively assess whether choline levels and Apparent Diffusion Coefficient (ADC) values within cervical cancers before, during, and after non-surgical therapy are predictive of tumour response.
Patients and methods
Patients undergoing MR examination for staging of cervical cancer, candidate for non-surgical therapy, were prospectively enrolled. According to the status at the end of therapies, patients were divided into responders and non-responders. The final outcome after a 5-year follow-up was classified as No Evidence of Disease (NED) or Progression of Disease (PD). Baseline values of mean ADC and Cho/H2O were compared between responders and non-responders, as well as between patients with NED and PD. The percent variation of ADC and Cho/H2O values over time was compared. P values <0.05 were considered significant.
16 patients were included. There was no significant difference at baseline between responders (n = 12) and non-responders (n = 4), nor between NED (n = 11) PD patients (n = 5), in ADC values and Cho/H2O ratio. There was no significant difference in percent variation of ADC values and of Cho/H2O, comparing responders and non-responders. There was a significant increase in absolute values of ADC from the initial to mid-therapy MRI (p = 0.0001), while Cho/H2O was stable (p value: 0.61). In the four non-responders, the ADC increase was not significant (p value: 0.25), while it was significant in the 11 responders (p value: 0.001). Values of spectroscopy were stable in both responders and non-responders.
High increases of ADC values from baseline to mid-therapy MR reflect response to therapies. There were no significant variations in choline/water ratios over time.
KeywordsMR spectroscopy DWI Cervical cancer Response biomarkers
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1.Siegel RL, Miller KD, Jemal A (2015) CA Cancer J Clin. Jan-Feb;65(1):5-29. doi: 10.3322/caac.21254 Cancer statistics, 2015
- 2.Klostergaard J, Parga K, Raptis RG (2010) Current and future applications of magnetic resonance imaging (MRI) to breast and ovarian cancer patient management. PR Health Sci J 29(3):223–231Google Scholar
- 4.Heo SH, Shin SS, Kim JW, Lim HS, Jeong YY, Kang WD et al (2013) Pre-treatment diffusion-weighted MR imaging for predicting tumor recurrence in uterine cervical cancer treated with concurrent chemoradiation: value of histogram analysis of apparent diffusion coefficients. Korean J Radiol 14(4):616–625CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Pinker K, Stadlbauer A, Bogner W, Gruber S, Helbich TH (2012) Molecular imaging of cancer: MR spectroscopy and beyond. Eur J Radiol Mar;81(3):566–577Google Scholar
- 7.Payne GS, Schmidt M, Morgan VA, Giles S, Bridges J, Ind T, DeSouza NM (2010) Evaluation of magnetic resonance diffusion and spectroscopy measurements as predictive biomarkers in stage 1 cervical cancer. Gynecol Oncol Feb;116(2):246–52Google Scholar
- 8.Schwarz AJ, Maisey NR, Collins DJ, Cunningham D, Huddart R, Leach MO (2002) Early in vivo detection of metabolic response: a pilot study of 1H MR spectroscopy in extracranial lymphoma and germ cell tumours. Br J Radiol Dec;75(900): 959–66Google Scholar
- 9.Haddadin IS, McIntosh A, Meisamy S, Corum C, Styczynski Snyder AL, Powell NJ, et al (2009) Metabolite quantification and high-field MRS in breast cancer. NMR Biomed 22(1):65–76Google Scholar
- 14.Morse DL, Raghunand N, Sadarangani P, Murthi S, Job C, Day S et al (2007) Response of choline metabolites to docetaxel therapy is quantified in vivo by localized (31)P MRS of human breast cancer xenografts and in vitro by high-resolution (31)P NMR spectroscopy of cell extracts. Magn Reson Med 58:270–280CrossRefPubMedGoogle Scholar
- 31.Das S, Chandramohan A (2015) Rami Reddy JK, Mukhopadhyay S, Kumar RM, Isiah R, John S, Oommen R, Jeyaseelan V. Role of conventional and diffusion weighted MRI in predicting treatment response after low dose radiation and chemotherapy in locally advanced carcinoma cervix. Radiother Oncol 117(2):288–293CrossRefPubMedGoogle Scholar
- 32.SEER Stat Fact Sheets: Cervix Uteri Cancer (2016). http://seer.cancer.gov/statfacts/html/cervix.html. Accessed 12/05/2016
- 33.Osman M (2014) The role of neoadjuvant chemotherapy in the management of locally advanced cervix cancer: a systematic review.Oncol Rev. Sep 23;8(2):250. doi: 10.4081/oncol.2014.250. eCollection 2014