The Value Of Functional Magnetic Resonance Imaging In Evaluating The Efficacy Of Radiotherapy And Chemotherapy In Cervical Cancer

ObjectiveTo explore the value of DWI and DCE-MRI in the evaluation of early curative effect of concurrent chemoradiation for cervical cancer.MethodThe clinical data of fifty patients with cervical cancer confirmed by pathology underwent concurrent chemoradiation during from December 2015 to January 2018 in Lanzhou University second hospital was retrospectively analyzed,includingFIGO?_A-?_B stage 39 cases and FIGO?-?_A stage 11 cases.One month after concurrent chemoradiation,29 cases were present as CR and 21 cases were present as PR.All patients underwent conventional MRI and DWI before concurrent chemoradiation,at the end of concurrent chemoradiation and one month after concurrent chemoradiation.Among patients,DCE-MRI was performed in 23patients(CR 14 cases and PR 9 cases)before and at the end of concurrent chemoradiation.After finishing MR examination,DWI and DCE-MRI finding were evaluated quantitatively between before and after treatment,between CR and PR,between FIGO?_A-?_B stage and FIGO?-?_A stage:(1)To measure ADC values before treatment,at the end of treatment and one month after treatment.Meanwhile DCE semi-quantitative parameters(OT,TTP,SImax,SImax%)were also measured before and at the end of treatment.Comparing ADC and DCE values between before and after concurrent chemoradiation for cervical cancer.(2)Sixty pelvic suspected metastatic lymph nodes(short diameter?10mm)were selected randomly before concurrent chemoradiation,and ADC values and the size of lymph nodes were evaluated before and at the end of concurrent chemoradiation.(3)To compare the difference in ADC values and DCE values between CR and PR groups,and evaluate the value of DWI and DCE in the evaluation on Curative effect of cervical cancer.Results1?ADC values in patients with FIGO?_A-?_B and?-?_A stage at the end treatments were significantly higher than before treatment(P<0.01),And One month after treatment,ADC values in patients with FIGO?_A-?_B and?-?_A stage were still significantly higher than those at the end of treatment(P<0.01);ADC values in patients with FIGO?-?_A stage before treatment,at the end of treatment and one month after treatment(823.6±231mm2/s,1104±117mm2/s and 1496±587mm2/s)were lower than those in patients with FIGO?_A-?_B stage(846.7±79.5mm2/s,1202±273mm2/s and 1598±218mm2/s),but there was no significant difference between FIGO?_A-?_B stage and FIGO?-?_A stage(P>0.05).2?The tumor ADC value(1185±366mm2/s)at the end of treatment in CR group was statistically different from that before treatment(827.9±673mm2/s)and one month after treatment(1554±228mm2/s)(P<0.01).In PR group,the tumor ADC value before treatment(804.9±353mm2/s)was less than that at the end of treatment(895±452mm2/s),but there was no significant difference between pretreatment and posttreatment(P>0.05).ThetumorADCvalueatonemonthafter treatment(1464±876mm2/s)was significantly higher than that before treatment(P<0.01).3?Before treatment of cervical cancer,there was no significant difference in ADC value between lymph node(779±212mm2/s)and tumor(834.8±214mm2/s)(P>0.05).At the end of treatment,the ADC value of lymph node(1345±549 mm~2/s)was markedly higher than that of tumor(1085±297mm2/s)(P<0.01).The aspect ratio(S/L)of the lymph nodes after treatment was markedly shorter than that before treatment(P<0.05).4?Tumor OT at the end of treatment(32.28±9.42s)was markedly later than that before treatment(21.34±10.37s)in CR group(P<0.05),and TTP at the end of treatment(169.43±44.02s)was also markedly later than that before treatment(89.77±31.66s)(P<0.01).There were no significant difference in SImax and SImax%of tumors between before and after treatment(P>0.05).5?In PR group,the SImax and SImax%(1678.04±1101.3 and 165.89±23.1)of tumor at the end of treatment were lower than those before treatment(1870.44±443.7and 173.42±22.9),but there was no significant difference between two group(P>0.05).There were no significant difference in tumor OT and TTP between at the end of treatment and before treatment(P>0.05).6?At the end of treatment,the change rate of ADC value of cervical cancer in CR group(43.54±12.32%)was significantly different from that in PR group(12.19±6.17%)(P<0.05),there was no significant difference in ADC value between CR and PR group(P>0.05).The ADC value in CR group was significantly higher than that in PR group at the end of the treatment(P<0.05).One month after treatment,the ADC values of both CR and PR group increased,but no significant difference was found in ADC value between CR and PR group(P>0.05).7?There was significant difference in TTP and SImax%between CR group and PR group before treatment of cervical cancer(P<0.05),The SImax in CR group was markedly higher than that in PR group at the end of treatment(P<0.05).Conclusions1?Cervical cancer showes high signal on DWI images and low signal in different degrees on ADC images,which reflected the diffusion-constrained characteristics of tumor tissues.The higher FIGO staging in tumor and the larger tumor volume,the lower ADC value.2?The detection of tumor DWI-ADC values and semi-quantitative parameters(OT,TTP,Simax and SImax%)during concurrent chemoradiotherapy for cervical cancer are helpful to early evaluation of therapeutic efficacy.