| Objectives:1. To investigate the apparent diffusion coefficients (ADCs) of the normaluterine cervical zonal structures (cervical epithelium, junctional zone andmyometrium) during different phases of the menstrual cycle amongpremenopausal women in different age groups.2. To evaluate the value of different b-value combinations for differentiation ofmalignant and benign or normal cervical tissues.3. To evaluate the potential value of apparent diffusion coefficient (ADC)measurement in the assessment of cervical cancer when divided by somefeatures.4. To investigate the value of diffusion-weighted magnetic resonance imaging(DW-MRI) to predict and monitor the response to chemoradiation foradvanced cervical cancer.Methods: 1. Sixty-seven healthy women, who were divided into3age groups (Group A,24women, age range:20-29years, mean age:25.86years; Group B,22women, age range:30-39years, mean age:34.05years; Group C,21women,age range:40-49years, mean age:44.62years), underwent3.0T MR scanningwith sequences of T2WI and DWI during the mid-proliferative and themid-secretory phases. The ADC values of cervix in different zonal structures,ages and phases of the menstrual cycle were compared.2.106patients with cervical carcer,8patients with cervical leiomyoma and12patients with cervical intraepithelial neoplasia (CIN Ⅲ) underwentdiffusion-weighted imaging (DWI) in addition to routine MR imaging. AllADCs were calculated from b=0,600s/mm2and b=0,1000s/mm2.3.112patients with cervical carcer underwent diffusion-weighted imaging(DWI) in addition to routine MR imaging and dynamic contrast-enhancedMRI (DCE-MRI) at3.0T MRI. The ADCs were divided into the followinggroups:1) different pathologic grades of cervical cancer (G1, G2, G3);2)squamous carcinoma and adenocarcinoma;3) tumor subsequent recurrence ormetastasis and tumor free;4) early stage (FIGOⅠb/Ⅱa) tumor and advancedtumor (FIGOⅡb, Ⅲ and Ⅳ);5) cervical cancer with different lymph nodestatus (0,1,2,3);6) cervical cancer with different tumor size (greatestdiameter≤2cm,2-4cm,＞4cm);7) cervical cancer with different age range.All ADCs were calculated from b=0,600s/mm2and b=0,1000s/mm2.4. Forty-six advanced cervical cancer patients treated with chemoradiationreceived conventional MRI and DWI prior to chemoradiation, after2weeksof chemoradiation, after the twenty-fifth pelvic external beam radiotherapyand at the completion of therapy. The tumor size and apparent diffusioncoefficient (ADC) values of cervical cancer were measured at each examination. Treatment response was determined according to the changes intumour size after6months of completion of therapy and was classified ascomplete response (CR), partial response (PR), stable disease (SD). Dynamicchanges of ADCs and tumor size in tumor response groups were observed andcompared，and the ADCs of pretreatment and therapy completion werecompared among the different tumor response groups and control group. Theage and tumor differentiation were compared among the cancer groups. AllADCs were calculated from b=0,600s/mm2and b=0,1000s/mm2. Thecorrelation of the percentage of ADC change and the percentage of tumor sizechange was investigated.Results:1. The ADC values of each cervical zonal structures (cervical epithelium,junctional zone and myometrium) were significantly different from oneanother (P <0.001). The ADC values of epithelium and junctional zone wereboth lower during the mid-secretory phase than those during themid-proliferative phase in each age groups (P <0.05). No statisticaldifference in ADC values of myometrium was observed in the comparisonbetween the two phases in each age groups (P＞0.05). There were nosignificant difference in the ADC values of any cervical zones among thethree age groups for a given phase (P＞0.05).2. The ADCs of cervical cancer were significantly lower than those ofbenign/normal cervical tissues at both ADC maps; statistical differences werealso showed between cervical leiomyoma and CINⅢ, between leiomyomaand normal cervix at both ADC maps; there was no significant differencebetween CINⅢ and normal cervix at both ADC maps.3. There was a statistically significant difference between the ADCs of well/moderately differentiated tumors (G1/2) and poorly differentiated tumors(G3), between the ADCs of squamous carcinoma and adenocarcinoma,between the ADCs of patients with subsequent tumor recurrence or metastasisand tumor free at both ADC maps. There was no significant difference amongthe ADCs of the cervical cancer when divided by other features (FIGO,lymph node status, tumor size and age groups) at both ADC maps.4. The percentage of ADC change for CR after2weeks therapy and thetwenty-fifth pelvic external beam radiotherapy were statistically higher thanPR and SD, the ADC values for CR at the completion of therapy weresignificantly higher than PR and SD; the ADC values of pretheraphy, after2weeks therapy and the twenty-fifth pelvic external beam radiotherapy in threetumor groups didn’t show significant difference, there were no significantdifference in three tumor groups when compared the pretheraphy tumor size,age, tumor differentiation and the tumor size change at2weeks therapy andthe twenty-fifth pelvic external beam radiotherapy; and there were nosignificant correlation between the percentage of ADC change and thepercentage of tumor size change.Conclusion:1. The ADC values of normal cervical epithelium and junctional zone changewith different phases of the menstrual cycle，which should be taken intoconsideration when we detect early cervical pathologies, monitor treatmentresponse and differentiate tumor early recurrence.2. ADC values were reliably in differentiating cervical malignancies frombenign/normal cervical tissues with high diagnostic accuracy. The diagnosticaccuracy was equal at both ADC maps.3. The ADC values were reliably in predicting prognosis with high diagnostic accuracy. The ADCs can be used to indicate degree and histologic type ofcervical cancer although some overlap. The diagnostic accuracy was equal atboth ADC maps.4. The percentage of ADC change after2weeks therapy have the potential to beused to predict therapy response of uterine cervical cancer, and the percentageof ADC change after the twenty-fifth pelvic external beam radiotherapy canbe used to monitor the therapy response. The ADCs can predict the responsemore earlier and monitor the response more reliably than morphologicimaging. High b-value combination was more accurately monitor theresponse than low b-value combination. |
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