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Multi-parametric MRI in cervical cancer: early prediction of response to concurrent chemoradiotherapy in combination with clinical prognostic factors

European Radiology volume 28, pages 437–445 (2018)Cite this article

Abstract

Objective

To investigate the prediction of response to concurrent chemoradiotherapy (CCRT) through a combination of pretreatment multi-parametric magnetic resonance imaging (MRI) with clinical prognostic factors (CPF) in cervical cancer patients.

Methods

Sixty-five patients underwent conventional MRI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) before CCRT. The patients were divided into non- and residual tumour groups according to post-treatment MRI. Pretreatment MRI parameters and CPF between the two groups were compared and prognostic factors, optimal thresholds, and predictive performance for post-treatment residual tumour occurrence were estimated.

Results

The residual group showed a lower maximum slope of increase (MSIL) and signal enhancement ratio (SERL) in low-perfusion subregions, a higher apparent diffusion coefficient (ADC) value, and a higher stage than the non-residual tumour group (p < 0.001, p = 0.003, p < 0.001, and p < 0.001, respectively). MSIL and ADC were independent prognostic factors. The combination of both measures improved the diagnostic performance compared with individual MRI parameters. A further combination of these two factors with CPF exhibited the highest predictive performance.

Conclusions

Pretreatment MSIL and ADC were independent prognostic factors for cervical cancer. The predictive capacity of multi-parametric MRI was superior to individual MRI parameters. The combination of multi-parametric MRI with CPF further improved the predictive performance.

Key points

• Pretreatment MSI L and ADC were independent prognostic factors for post-treatment residual tumours.

• The residual groups showed lower MSI L , higher ADC and higher stage.

• The predictive capacity of multi-parametric MRI was superior to individual MRI parameters.

• The combination of multi-parametric MRI with CPF exhibited the highest predictive performance.

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Abbreviations

MRI:

magnetic resonance imaging

DWI:

diffusion-weighted imaging

ADC:

apparent diffusion coefficient

DCE-MRI:

dynamic contrast-enhanced MRI

MSI:

maximum slope of increase

SER:

signal enhancement ratio

ROI:

region of interest

CPF:

clinical prognostic factor

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Author information

Affiliations

  1. Department of Radiology, The General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, 750004, China

    Wei Yang, Bing Chen, Ai Jun Wang & Jian Guo Zhao

  2. Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China

    Jin Wei Qiang

  3. Department of Pathology, The General Hospital of Ningxia Medical University, 804 Shengli Road, Yinchuan, 750004, China

    Hai Ping Tian

Authors
  1. Wei Yang
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  2. Jin Wei Qiang
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  3. Hai Ping Tian
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  4. Bing Chen
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  5. Ai Jun Wang
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Corresponding author

Correspondence to Jin Wei Qiang.

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Guarantor

The scientific guarantor of this publication is Jin Wei Qiang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

This study has received funding by National Natural Science Foundation of China (No.81471628); Shanghai Municipal Commission of Health and Family Planning, China (No.2013SY075 and No. ZK2015A05).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all patients in this study.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution.

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Cite this article

Yang, W., Qiang, J.W., Tian, H.P. et al. Multi-parametric MRI in cervical cancer: early prediction of response to concurrent chemoradiotherapy in combination with clinical prognostic factors. Eur Radiol 28, 437–445 (2018). https://doi.org/10.1007/s00330-017-4989-3

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  • DOI: https://doi.org/10.1007/s00330-017-4989-3

Keywords

  • Magnetic resonance imaging
  • Dynamic contrast-enhanced MR imaging
  • Diffusion-weighted imaging
  • Cervical cancer
  • Concurrent chemoradiotherapy