Abstract
Objectives
To assess the value of 18F-FDG PET and MR-IVIM parameters before and during concurrent chemoradiotherapy (CCRT) for evaluating early treatment response and predicting tumor recurrence in patients with locally advanced cervical cancer (LACC) using a hybrid PET/MR scanner.
Methods
Fifty-one patients with LACC underwent pelvic PET/MR scans with an IVIM sequence at two time-points (pretreatment [pre] and midtreatment [mid]). Pre- and mid-PET parameters (SUVmax, MTV, TLG) and IVIM parameters (D, F, D*) and their percentage changes (Δ%SUVmax, Δ%MTV, Δ%TLG, Δ%D, Δ%F, Δ%D*) were calculated. We selected independent imaging parameters and built a combined prediction model incorporating imaging parameters and clinicopathological risk factors. The performance of the combinative evaluation for tumor early shrinkage rates (TESR) and the prediction model for tumor recurrence was assessed.
Results
Thirty-two patients were classified into the good response (GR) group with TESR ≥ 50%, and 19 patients were categorized into the poor response (PR) group with TESR < 50%. Δ%D (p = 0.013) and Δ%F (p = 0.006) are independently related to TESR with superior combined diagnostic ability (AUC = 0.901). Pre-TLG, Δ%D, and suspicious lymph node metastasis (SLNM) were selected for the construction of the combined prediction model. The model for identifying the patients with high risk of tumor recurrence reached a moderate predictive ability and good stability with c-index of 0.764 (95% CI, 0.672–0.855).
Conclusion
The combined prediction model based on pretreatment PET metabolic parameter (pre-TLG), IVIM-D percentage changes, and LNs status provides great potential to identify the LACC patients with high risk of recurrence at early stage of CCRT.
Key Points
• PET/MR plus IVIM offers various complementary information for LACC.
• IVIM-D and IVIM-F percentage changes are independently related to tumor early shrinkage rates.
• The combined prediction model can help identify the LACC patients with high risk of tumor recurrence.
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Abbreviations
- 18F-FDG:
-
18F-fluorodeoxyglucose
- ADC:
-
Apparent diffusion coefficient
- CCRT:
-
Concurrent chemoradiotherapy
- D:
-
Slow diffusion coefficient
- D*:
-
Fast diffusion coefficient
- DWI:
-
Diffusion-weighted imaging
- F:
-
Perfusion-related diffusion fraction
- FIGO:
-
Federation International of Gynecology and Obstetrics
- GR:
-
Good response
- IVIM:
-
Intravoxel incoherent motion
- LACC:
-
Locally advanced cervical cancer
- LNs:
-
Lymph nodes
- MaxDiam:
-
Maximum diameter
- MRI:
-
Magnetic resonance imaging
- MTV:
-
Metabolic tumor volume
- PET:
-
Positron emission tomography
- PR:
-
Poor response
- RFS:
-
Recurrence-free survival
- ROC:
-
Receiver operator characteristic
- ROI:
-
Region of interest
- SLNM:
-
Suspicious lymph nodes metastasis
- SUVmax :
-
Maximum standardized uptake value
- TESR:
-
Tumor early shrinkage rates
- TLG:
-
Total lesion glycolysis
- VOI:
-
Volume of interest
- Week 4:
-
The end of the fourth week during CCRT
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Acknowledgements
All authors sincerely thank Dr. Shengtao Lin, Dr. Zhongwei Chen, and SAGE Language Service Team for providing language help on the writing of the paper. The authors also thank Dr. Qijun Wu for his constructive advice on the statistical analysis.
Funding
This study has received funding by the National Natural Science Foundation of China (No.81401438), LIAONING Science & Technology Project (No.2017225012).
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The scientific guarantor of this publication is Dr. Hongzan Sun.
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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.
Statistics and biometry
An expert in statistics Dr. Qijun Wu kindly provided statistical advice for this manuscript.
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Written informed consent was obtained from all patients in this study.
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Institutional Review Board approval from Ethics Committee of Shengjing Hospital affiliated to China Medical University (Shenyang, China) was obtained.
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• prospective
• prognostic study
• performed at one institution
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Gao, S., Du, S., Lu, Z. et al. Multiparametric PET/MR (PET and MR-IVIM) for the evaluation of early treatment response and prediction of tumor recurrence in patients with locally advanced cervical cancer. Eur Radiol 30, 1191–1201 (2020). https://doi.org/10.1007/s00330-019-06428-w
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DOI: https://doi.org/10.1007/s00330-019-06428-w