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Association between IVIM parameters and treatment response in locally advanced squamous cell cervical cancer treated by chemoradiotherapy

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To examine the associations of intravoxel incoherent motion (IVIM) parameters with treatment response in cervical cancer following concurrent chemoradiotherapy (CCRT).

Materials and methods

Forty-five patients, median age of 58 years (range: 28–82), with pre-CCRT and post-CCRT MRI, were retrospectively analysed. The IVIM parameters pure diffusion coefficient (D) and perfusion fraction (f) were estimated using the full b-value distribution (BVD) as well as an optimised subsample BVD. Dice similarity coefficient (DSC) and intraclass correlation coefficient (ICC) were used to measure observer repeatability in tumour delineation at both time points. Treatment response was determined by the response evaluation criteria in solid tumour (RECIST) 1.1 between MRI examinations. Mann-Whitney U tests were used to test for significant differences in IVIM parameters between treatment response groups.

Results

Pre-CCRT tumour delineation repeatability was good (DSC = 0.81) while post-CCRT delineation repeatability was moderate (DSC = 0.67). Values of D and f had good repeatability at both time points (ICC > 0.80). Pre-CCRT f estimated using the full BVD and optimised subsample BVD were found to be significantly higher in patients with partial response compared to those with stable disease or disease progression (p = 0.01 and 95% CI = -0.02–0.00 for both cases).

Conclusion

Pre-CCRT f was associated with treatment response in cervical cancer with good observer repeatability. Similar discriminative ability was also observed in estimated pre-CCRT f from an optimised subsample BVD.

Key Points

• Pre-treatment tumour delineation and IVIM parameters had good observer repeatability.

• Post-treatment tumour delineation was worse than at pre-treatment, but IVIM parameters retained good ICC.

• Pre-treatment perfusion fraction estimated from all b-values and an optimised subsample of b-values were associated with treatment response.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

BVD:

B-value distribution

CCRT:

Concurrent chemoradiotherapy

D :

Pure diffusion coefficient

DSC:

Dice similarity coefficient

D*:

Pseudo-diffusion coefficient

f :

Perfusion fraction

FIGO:

International Federation of Gynecology and Obstetrics

ICC:

Intraclass correlation coefficient

LACC:

Locally advanced cervical cancer

RECIST:

Response evaluation criteria in solid tumours

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

ROI:

Region of interest

SCC:

Squamous cell carcinoma

SENSE:

Sensitivity encoding

TE:

Echo time

TR:

Repetition time

TSE:

Turbo spin echo

T2W:

T2-weighted

VOI:

Volume of interest

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Funding

This study has received funding by the General Research Fund (GRF, No. 17119916) of the Research Grants Council (RGC), Hong Kong.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Pok Fu Lam Road, Hong Kong, People’s Republic of China

    Jose Angelo Udal Perucho, Mandi Wang, Varut Vardhanabhuti & Elaine Yuen Phin Lee

  2. Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, People’s Republic of China

    Ka Yu Tse & Karen Kar Loen Chan

Authors
  1. Jose Angelo Udal Perucho
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  2. Mandi Wang
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  3. Varut Vardhanabhuti
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  6. Elaine Yuen Phin Lee
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Corresponding author

Correspondence to Elaine Yuen Phin Lee.

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Guarantor

The scientific guarantor of this publication is Dr. Elaine Y.P. Lee.

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (Reference No. UW 16-325) approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported on in previous studies with different aims than the current manuscript.

One study in Journal of Magnetic Resonance Imaging investigated the relationship between intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) MRI in cervical cancer perfusion.

One study in Korean Journal of Radiology assessed the feasibility of a parameter-free IVIM approach in locally advanced cervical cancer to determine the optimal b-value threshold for different histological cancer types.

One study in Acta Radiologica Open examined the associations of texture features of T2W and DWI with tumour histological grading and pelvic lymph nodal status.

One study in Journal of Magnetic Resonance Imaging investigated the bone marrow changes after concurrent chemoradiotherapy (CCRT) using IVIM and correlated these parameters with haematological toxicity in patients with cervical cancer.

One study in BMC Cancer assessed the concordance between the metabolic tumour volume measured by positron emission tomography (PET), anatomical tumour volume measured by T2-weighted (T2W) MRI and the functional tumour volume measured on diffusion-weighted MRI in cervical cancer.

One study in Academic Radiology examined the utility of diffusion kurtosis imaging in the characterisation of cervical cancer.

One study in Korean Journal of Radiology aimed to optimise the number of b-values needed for IVIM analysis in cervical cancer using simulated and in vivo data.

One study in European Radiology investigated the associations of histogram features of T2W and apparent diffusion coefficient (ADC) with treatment response of cervical cancer following CCRT

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• observational

• performed at one institution

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Perucho, J.A.U., Wang, M., Vardhanabhuti, V. et al. Association between IVIM parameters and treatment response in locally advanced squamous cell cervical cancer treated by chemoradiotherapy. Eur Radiol 31, 7845–7854 (2021). https://doi.org/10.1007/s00330-021-07817-w

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