Study Of Functional MRI At3.0T On Cervical Squamous Carcinoma Treated By Concurrent Chemoradiation

Part Ⅰ:FMRI evaluation on therapeutic effect of concurrent chemoradiation on cervical squamous carcinoma[Purpose]:Using functional imaging on3.0T MRI to investigate the evaluation of DCE (dynamic contrast-enhanced magnetic resonance imaging) derived semiquantitative parameters and ADC (apparent diffusion coefficient) of DWI (diffusion-weighted imaging) on therapeutic effect of concurrent chemoradiation on cervical squamous carcinoma.[Materials and methods]:106cases of cervical squamous carcinoma with concurrent chemoradiation in our hospital from October2009to January2012were included in our study. MRI examination performed at three time points:point1=before start of treatment, point2=during treatment (at the dose of30Gy), point3=at the end of treatment (conventional treatment completed. Measure the DCE derived TIC (time-signal intensity curve) and relative semiquantitative parameters including:rPEI (relative positive enhancement integral=PEItumor/PEImuscle), rMSI (relative maximum slop of increase=MSItumor/MSImuscle), rMSD (relative maximum slop of decrease=MSDtumor/MSDmuscle), rSER (relative signal enhancement ratio=SERtumor/SERmuscle) at15s,30s,45s, and60s after injection of contrast medium, rSERmax (relative maximum signal enhancement ratio=SERmax oftumor/SERmaxmuscle) and TTP (time to peak). ADC values were calculated including ADCmean (mean ADC) and ADCmin (minimum ADC).pairwise comparison of DCE parameters and ADC value at the three time points were carried out by wilcoxon rank sum test and paired t test respectively. Tumor response was evaluated at the end of treatment according to the RECIST (Response Evaluation Criteria In Solid Tumors). DCE parameters and ADC value were compared statistically and analyzed by ROC to acquire the threshold on diagnosing tumor residual.[Results]:All the106cases performed DWI series at point1and3, and33cases among them had DWI examination at point2. DCE-MRI were conducted in88cases at point1and3, and in29cases among them at point2. Comparison on DCE parameters showed increase of rMSD, rSERmax and TTP and decrease of rSER15及rSER30from time point1to point3with statistical difference (p<0.001,<0.001,0.001,0.031and0.001, respectively). rMSD and rSERmax increased from time pointl to point2with statistical difference (p=0.002and0.001, respectively) and rSER15decreased from time point2to point3with statistical difference (p=0.037). ADCmean and ADCmin showed increase in turn at three time points with statistical difference (p value were all lower than0.001). At the end of treatment, there were67cases in CR (complete response) group and39cases in PR (partial response). CR group had higher rPEI, rMSI, rSER60, rSERmax, ADCmin and ADCmeanthan those parameters of PR group with statistical difference (p<0.001,0.015,0.008,0.003,<0.001and<0.001, respectively). ROC showed that taking rPEI lower than and equal to0.84as a threshold for diagnosing tumor residual, the specificity, sensitivity and accuracy was52.5%,91.7%and73.9%with area under the ROC of0.775(p<0.001), and taking ADCmin lower than1.39×103mm2/s as a threshold for diagnosing tumor residual, the specificity, sensitivity and accuracy was55.6%,88.5%and74.5%with area under the ROC of0.759(p<0.001).[Conclusion]:DCE-MRI derived parameters and ADC value were able to reflect the changes of blood perfusion and water molecule diffusion after concurrent chemoradiation and differentiate the tumor response as CR or PR at the end of treatment. FMRI could provide a new method to evaluate the therapeutic effect. Part Ⅱ:The value of FMRI on predicting therapeutic outcome of concurrent chemoradiation on cervical squamous carcinoma[Purpose]:Using functional imaging on3.0T MRI to evaluate the value of DCE derived semiquantitative parameters and ADC of DWI on pridicting therapeutic outcome of concurrent chemoradiation on cervical squamous carcinoma.[Materials and methods]:106cases of cervical squamous carcinoma with concurrent chemoradiation in our hospital from October2009to January2012were included in our study. MRI examination performed at three time points:pointl=before start of treatment, point2=during treatment (at the dose of30Gy), point3=at the end of treatment (conventional treatment completed. Measure the DCE derived TIC (time-signal intensity curve) and relative semiquantitative parameters including:rPEI (relative positive enhancement integral=PEItumor/PEImuscle), rMSI (relative maximum slop of increase=MSItumor/MSImuscle), rMSD (relative maximum slop of decrease=MSDtumor/MSDmuscle), rSER (relative signal enhancement ratio=SERtumor/SERmuscle) at15s,30s,45s, and60s after injection of contrast medium, rSERmax (relative maximum signal enhancement ratio=SERmax tumor/SERmax muscle) and TTP (time to peak). ADC values were calculated including ADCmean (mean ADC) and ADCmin (minimum ADC). The patients were divided into CR group and PR group according to the tumor response at the end of treatment. DCE parameters at time point1and the change of time point2from time point1(Aparameter=parameter at time point2-parameter at time pointl) between CR group and PR group were compared respectively by Mann-Whitney U test. ADC value at time pointl and the change of time point2from time pointl (AADC=ADC at time point2-ADC at time point1) between CR group and PR group were compared respectively by independent t-test.[Results]:At the end of treatment, there were67cases in CR (complete response) group and39cases in PR (partial response). rPEI, rMSD, rSER15, rSER30and rSER45at time pointl of CR group were higher than those of PR group with statistical difference (p<0.001,<0.001,0.045,<0.001and<0.001, respectively). DCE parameters at time point2had no statistical difference between CR group and PR group.△rPEI,△rSER30and△rSER45of CR group were lower than those of PR group with statistical difference (0.045,0.027and0.040). However, there was no statistical difference between CR group and PR group both in ADC value at time pointl and in AADC[Conclusion]:DCE-MRI derived parameters, ADC value and those changes during treatment had potential to predict the therapeutic outcome of concurrent chemoradiation on cervical squamous carcinoma, which would be helpful in individualized therapy. Part Ⅲ:The value of FMRI on predicting short-term prognosis of cervical squamous carcinoma treated by concurrent chemoradiation[Purpose]:Using functional imaging on3.0T MRI to investigate the value of DCE derived semiquantitative parameters and ADC of DWI on pridicting short-term prognosis of cervical squamous carcinoma with concurrent chemoradiation.[Materials and methods]:95cases of cervical squamous carcinoma with concurrent chemoradiation in our hospital from May2009to December2010were included in our study. Analyze the DCE-MRI before treatment, including DCE derived TIC (time-signal intensity curve) and relative semiquantitative parameters:rPEI (relative positive enhancement integral=PEItumor/PEImuscle), rMSI (relative maximum slop of increase MSItumor/MSImuscle), rMSD (relative maximum slop of decrease=MSDtumor/MSDmuscle), rSER (relative signal enhancement ratio=SERtumor/SERmuscle) at15s,30s,45s, and60s after injection of contrast medium, rSERmax (relative maximum signal enhancement ratio=SERmax tumor/SERmax muscle) and TTP (time to peak). ADC values were calculated including ADCmean (mean ADC) and ADCmin (minimum ADC). All the cases were followed up. Compare the DCE derived parameters and ADC value between groups with different prognosis by using Mann-Whitney U test and independent t-test respectively. The cases were divided into two groups using DCE derived parameters and ADC value respectively, and Kaplan-Meier curve and Log-rank test were carried out to analyze the tumor progression between those two groups.[Results]:95cases with cervical squamous carcinoma treated by radical and palliative concurrent chemoradiation, were followed up with period from twelve to thirty months. There were74cases in progression-free group,19cases in tumor progression group, and only two cases lost from follow-up. Pre-therapy DCE derived rPEI, rMSI, rSER15, rSER30, rSER45, rSER60and rSERmax were all higher in progression-free group when compared those parameters in tumor progression group, with statistical difference (p<0.001,<0.001,<0.001,<0.001,<0.001,0.002and0.041, respectively). Tumor progression group had higher ADCmean than progression-free group (1.13±.13×10-3mm2/s VS1.03±0.10×10-3mm2/s), with statistical difference (p=0.002). However, no statistical difference was existed in ADCmin between the two groups.[Conclusion]:Pre-therapy DCE-MRI derived parameters and ADCmean were useful in predicting short-term prognosis of cervical squamous carcinoma treated by concurrent chemoradiation, which had potential to help clinician to implement individualized therapy and improve the prognosis.