Abstract： Objective To assess the histological characteristics of cervical cancer using intravoxel incoherent motion magnetic resonance imaging (IVIMMRI) and to investigate the performance of IVIMMRI in evaluation of the efficacy of concurrent chemoradiotherapy in the treatment of intermediate/advanced cervical cancer. Methods Pelvic MRI scans, containing T2WI, IVIM (14 b values, b=0-1 000 s/mm2), and contrast-enhanced T1 scans were performed in 23 patients pathologically diagnosed with intermediate/advanced cervical cancer (stage ≥Ⅱb) before chemoradiotherapy, after two and four weeks of treatment, and at the end of treatment. The IVIMMRI data were processed with the bi-exponential model to generate three parameters, containing pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f). Apparent diffusion coefficient (ADC) was obtained using the mono-exponential model. The IVIMMRI parameters were measured at each time point and their dynamics and correlation were analyzed. Results The ADC, D, and f values were significantly higher after complete treatment (0.96×10-3vs. 1.77×10-3 mm2/s, P=0.000;0.76 ×10-3vs. 1.34±0.12×10-3 mm2/s, P=0.000;0.14% vs. 0.24%, P=0.012). The above three values significantly increased after two weeks of treatment (all P=0.000) and kept increasing until the end of the treatment. In contrast, the D* value was reduced from the second week to the end of the treatment. Conclusions IVIMMRI can monitor the dynamic functional changes and early tumor responses during chemoradiotherapy for cervical cancer, which holds promise for clinical application.
Wang Huanhuan,Zhou Zhengyang,Zhu Lijing et al. Intravoxel incoherent motion magnetic resonance imaging for evaluation of the efficacy of concurrent chemoradiotherapy in treatment of cervical cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(10): 1100-1105.
[1] Jemal A,Bray F,Center MM,et al. Global cancer statistics[J].CA Cancer J Clin,2011,61(2):69-90.DOI:10.3322/caac.20107. [2] zsarlak,Tjalma W,Schepens E,et al. The correlation of preoperative CT,MR imaging,and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma[J].Eur Radiol,2003,13(10):2338-2345.DOI:10.1007/s00330-003-1928-2. [3] Eisenhauer EA,Therasse P,Bogaerts J,et al. New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247.DOI:10.1016/j.ejca.2008.10.026. [4] Harry VN,Semple SI,Gilbert FJ,et al. Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer[J].Gynecol Oncol,2008,111(2):213-220.DOI:10.1016/j.ygyno.2008.07.048. [5] Takayama Y,Ohno T,Kishimoto R,et al. Prediction of early response to radiotherapy of uterine carcinoma with dynamic contrast-enhanced MR imaging using pixel analysis of MR perfusion imaging[J].Magn Reson Imaging,2009,27(3):370-376.DOI:10.1016/j.mri.2008.07.007. [6] Park JJ,Kim CK,Park SY,et al. Assessment of early response to concurrent chemoradiotherapy in cervical cancer:value of diffusion-weighted and dynamic contrast-enhanced MR imaging[J].Magn Reson Imaging,2014,32(8):993-1000.DOI:10.1016/j.mri.2014.05.009. [7] Lee EYP,Yu X,Chu MMY,et al. Perfusion and diffusion characteristics of cervical cancer based on intraxovel incoherent motion MR imaging-a pilot study[J].Eur Radiol,2014,24(7):1506-1513.DOI:10.1007/s00330-014-3160-7. [8] 李靖,曲金荣,黎海亮,等.宫颈癌患者MR体素内不一致运动序列的成像特征[J].中华放射学杂志,2013,47(11):1019-1022.DOI:10.3760/cma.j.issn.1005-1201.2013.11.015. Li J,Qu JR,Li HL,et al. Preliminary study of applying introvoxel incoherent motion sequence in cervical cancer[J].Chin J Radiol,2013,47(11):1019-1022.DOI:10.3760/cma.j.issn.1005-1201.2013.11.015. [9] Katanyoo K,Tangjitgamol S,Chongthanakorn M,et al. Treatment outcomes of concurrent weekly carboplatin with radiation therapy in locally advanced cervical cancer patients[J].Gynecol Oncol,2011,123(3):571-576.DOI:10.1016/j.ygyno.2011.09.001. [10] Le Bihan D,Breton E,Lallemand D,et al. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging[J].Radiology,1988,168(2):497-505.DOI:10.1148/ radiology.168.2.3393671. [11] Liu CL,Liang CH,Liu ZY,et al. Intravoxel incoherent motion (IVIM) in evaluation of breast lesions:comparison with conventional DWI[J].Eur J Radiol,2013,82(12):e782-e789.DOI:10.1016/j.ejrad.2013.08.006. [12] D pfert J,Lemke A,Weidner A,et al. Investigation of prostate cancer using diffusion-weighted intravoxel incoherent motion imaging[J].Magn Reson Imaging,2011,29(8):1053-1058.DOI:10.1016/j.mri.2011.06.001. [13] Hauser T,Essig M,Jensen A,et al. Prediction of treatment response in head and neck carcinomas using IVIM-DWI:evaluation of lymph node metastasis[J].Eur J Radiol,2014,83(5):783-787.DOI:10.1016/j.ejrad.2014.02.013. [14] Ganten MK,Schuessler M,Buerle T,et al. The role of perfusion effects in monitoring of chemoradiotherapy of rectal carcinoma using diffusion-weighted imaging[J].Cancer Imaging,2013,13(4):548-556.DOI:10.1102/1470-7330.2013.0045. [15] Gaeta M,Benedetto C,Minutoli F,et al. Use of diffusion-weighted,intravoxel incoherent motion,and dynamic contrast-enhanced MR imaging in the assessment of response to radiotherapy of lytic bone metastases from breast cancer[J].Acad Radiol,2014,21(10):1286-1293.DOI:10.1016/j.acra.2014.05.021. [16] Shibuya K,Tsushima Y,Horisoko E,et al. Blood flow change quantification in cervical cancer before and during radiation therapy using perfusion CT[J].J Radiat Res,2011,52(6):804-811.DOI:10.1269/jrr.11079. [17] Mayr NA,Wang JZ,Zhang DQ,et al. Longitudinal changes in tumor perfusion pattern during the radiation therapy course and its clinical impact in cervical cancer[J].Int J Radiat Oncol Biol Phys,2010,77(2):502-508.DOI:10.1016/j.ijrobp.2009.04.084. [18] Lyng H,Sundf'r K,Rofstad EK.Changes in tumor oxygen tension during radiotherapy of uterine cervical cancer:relationships to changes in vascular density,cell density,and frequency of mitosis and apoptosis[J].Int J Radiat Oncol Biol Phys,2000,46(4):935-946.DOI:10.1016/ S0360-3016(99)00497-6. [19] Lyng H,Sundf'r K,Tropé C,et al. Disease control of uterine cervical cancer:relationships to tumor oxygen tension,vascular density,cell density,and frequency of mitosis and apoptosis measured before treatment and during radiotherapy[J].Clin Cancer Res,2000,6(3):1104-1112. [20] 袁响林,于世英,高晓会,等.人宫颈癌移植瘤照射过程中氧分压变化规律的研究[J].中华放射医学与防护杂志,2005,25(2):124-126.DOI:10.3760/cma.j.issn.0254-5098.2005.02.008. Yuan XL,Yu SY,Gao XH,et al. Study on oxygen tension change in xenograft tumor of human cervical cancer during irradiation[J].Chin J Radiol Med Prot,2005,25(2):124-126.DOI:10.3760/cma.j.issn.0254-5098.2005.02.008. [21] 安永恒,丁爱萍,程熙国,等.低氧放疗对子宫颈癌的远期疗效[J].中华放射肿瘤学杂志,2006,15(3):204-207.DOI:10.3760/j.issn:1004-4221.2006.03.012. An YH,Ding AP,Cheng XG,et al. Long-term survival of hypoxia radiotherapy for carcinoma of uterine cervix[J].Chin J Radiat Oncol,2006,15(3):204-207.DOI:10.3760/j.issn.1004-4221.2006.03.012. [22] Koh DM,Collins DJ,Orton MR.Intravoxel incoherent motion in body diffusion-weighted MRI:reality and challenges[J].Am J Roentgenol,2011,196(6):1351-1361.DOI:10.2214/ AJR.10.5515.
2016, Vol. 25 
