| Objective: To prospectively investigate the changes of quantitative parameters in dynamic contrast-enhanced MRI (DCE-MRI) and the apparent diffusion coefficient(ADC) of diffusion weighted imaging (DWI) in cervical cancer patients before and after neoadjuvant chemotherapy (NACT).Materials and methods: Thirty-eight patients with locally advanced cervical cancer(in stage ?B2??A??B) under-went DCE-MRI and DWI one week before and 4 weeks after NACT. The patients were classified into two groups: significant reaction group (sCR include CR and PR) and non-sCR(include PD and SD) group according to the Response Evaluation Criteria in Solid Tumors (RECIST). The DCE-MRI pharmacokinetics parameters (mean Ktrans,mean Kep,mean Ve,mean Vp) and ADC value (mean ADC, Minimum ADC) were measured and compared between the sCR and non sCR groups. Receiver operating characteristic (ROC) curves were constructed to describe the diagnostic accuracy of the significant parameters and their decision thresholds.Results:38 consecutive female patients aged (44.79 ± 8.17) years were enrolled in this study. Each of them had only one tumor. According to 2009 FIGO staging system,the staging status was as follows: I B2, 10 patients; ?AI, 14 patients; ? A, 1 patient and II B, 23 patients. All of these tumors were divided into 2 groups according to RECIST grading. There were 22 and 16 patients in sCR and non sCR groups.respectively, respectively. Before NACT, the meanKtrans was higher but the mean Ve was lower in sCR (0.875 ± 0.329 min-1,0.661 ± 0.184 min-1) group than those in non sCR group (0.549± 0.314 min-1,0.791 ±0.117 min-1),and these differences were statistically significant (z = -3.134, p< 0.05; z = -2.129,p< 0.05, respectively). After NACT,the meanKtrans (0.553 ± 0.347 min-1 versus 0.942 ± 0.508 min-1; z ?-2.602, p< 0.05) and the changed value ofKtrans (?Ktrans=-0.322 ± 0.261 min-1 versus ?Ktrans = 0.393 ± 0.415 min-1; t=-6.074,p< 0.05) were significantly lower in the sCR group compared with those in the non-sCR group. However the meanADC(1048.239 ± 139.899 mm2/s versus 947.050 ± 153.514 mm2/s;z ?-2.099,p<0.05)and the minADC (710.916± 155.863mm2/s versus 545.458± 163.015 mm2/s; t=3.170,p<0.05) between the two groups were just higher in the sCR group compared with those in the non-sCR group. The remained parameters such as Vp and Kep had no statistically difference between the two groups. When combined the parameters values before and aftertreatment by using ROC curves, the area under curve (AUC) of pre-mean Ktrans and pre-mean Ktrans combined with post meanADC were 0.801 (p<0.05.) and 0.878 (p< 0.05 ) . The optimal cut off value for distinguishing sCR from non sCR were the pretreatment Ktrans (0.7020 min-1) its sensitivity and specificity were 77.3 %, 81.2 %respectively.Conclusion:1. DCE-MRI quantitative parameters and ADC value can reflect the hemodynamic changes of the cervical cancer before and after NACT.It is a new way and method to evaluate the curative effect of tumor,which is expected to be an early imaging method for evaluating the therapeutic effect of cervical cancer.2. Quantitative DCE-MRI combined with DWI can not significantly improve the efficacy of neoadjuvant chemotherapy for cervical cancer. |
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