Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, England.
Radiology. 2012 Apr;263(1):149-59. doi: 10.1148/radiol.11110175. Epub 2012 Feb 13.
To investigate the role of multiparametric magnetic resonance (MR) imaging in the evaluation of response to platinum-based neoadjuvant chemotherapy in advanced ovarian cancer and to compare imaging parameters between primary ovarian mass and metastatic disease.
Evaluable patients suspected of having advanced ovarian carcinoma were enrolled in a prospective protocol-driven study. Research ethics committee approval and written informed consent were obtained. Multiparametric MR imaging (diffusion-weighted MR imaging, dynamic contrast material-enhanced [DCE] MR imaging, and hydrogen 1 MR spectroscopy) was performed with a 3.0-T wholebody MR imaging system. Three marker lesions-primary ovarian mass, omental cake, and peritoneal deposit-were outlined by a radiologist on apparent diffusion coefficient (ADC) and vascular signal fraction (VSF) maps and on DCE MR images. Comparisons of mean ADC, mean VSF, DCE MR imaging parameters, and choline concentration between responders and nonresponders were based on Response Evaluation Criteria in Solid Tumors and CA-125 criteria.
Twenty-two patients were evaluable. The mean ADC for peritoneal metastases was lower than that for ovarian (P = .015) and omental (P = .006) sites. There were no differences in pretreatment DCE MR imaging parameters between tumor sites. After treatment, responders showed a significantly larger increase in ADC (P = .021) and fractional volume of the extravascular extracellular space (v(e)) (P = .025) of ovarian lesions compared with nonresponders, but there was no change in ADC at other sites. Pre- and posttreatment values of choline concentration of ovarian lesions were lower in responders (P = .025) than in nonresponders (P = .010).
The significant differences in baseline ADCs among primary ovarian cancer, omental cake, and peritoneal deposits indicate that diffusivity profiles may be tumor-site dependent, suggesting biologic heterogeneity of disease. ADC and v(e) parameters correlated with the cytotoxic effects of platinum-based therapy and may be useful response markers, while choline concentration predicted but did not reflect response.
探讨多参数磁共振成像（MR 成像）在评价晚期卵巢癌对铂类新辅助化疗反应中的作用，并比较原发性卵巢肿块和转移性疾病的影像学参数。
对疑似患有晚期卵巢癌的可评估患者进行前瞻性方案驱动研究。获得研究伦理委员会批准和书面知情同意书。使用 3.0T 全身 MR 成像系统进行多参数 MR 成像（扩散加权 MR 成像、动态对比增强 [DCE] MR 成像和氢 1 MR 波谱）。一位放射科医生在表观扩散系数（ADC）和血管信号分数（VSF）图以及 DCE MR 图像上勾勒出三个标记病变——原发性卵巢肿块、大网膜饼和腹膜沉积物。根据实体瘤反应评价标准和 CA-125 标准，比较应答者和无应答者的平均 ADC、平均 VSF、DCE MR 成像参数和胆碱浓度。
22 例患者可评估。腹膜转移的平均 ADC 低于卵巢（P =.015）和大网膜（P =.006）部位。肿瘤部位之间的预处理 DCE MR 成像参数无差异。治疗后，与无应答者相比，应答者的卵巢病变 ADC （P =.021）和血管外细胞外空间的分数体积（v(e)）（P =.025）增加显著，而其他部位的 ADC 无变化。与无应答者相比，应答者卵巢病变的胆碱浓度的治疗前后值较低（P =.025）。
原发性卵巢癌、大网膜饼和腹膜沉积物之间的基线 ADC 差异显著，表明扩散率谱可能与肿瘤部位有关，提示疾病的生物学异质性。ADC 和 v(e)参数与铂类药物治疗的细胞毒性作用相关，可能是有用的反应标志物，而胆碱浓度可预测但不能反映反应。
