Wang Yan-Chun, Hu Dao-Yu, Hu Xue-Mei, Shen Ya-Qi, Meng Xiao-Yan, Tang Hao, Li Zhen
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Chin Med J (Engl). 2016 Mar 20;129(6):665-71. doi: 10.4103/0366-6999.177995.
Diffusion-weighted imaging (DWI) with the intravoxel incoherent motion (IVIM) model has shown promising results for providing both diffusion and perfusion information in cervical cancer; however, its use to predict and monitor the efficacy of neoadjuvant chemotherapy (NACT) in cervical cancer is relatively rare. The study aimed to evaluate the use of DWI with IVIM and monoexponential models to predict and monitor the efficacy of NACT in cervical cancer.
Forty-two patients with primary cervical cancer underwent magnetic resonance exams at 3 time points (pre-NACT, 3 weeks after the first NACT cycle, and 3 weeks after the second NACT cycle). The response to treatment was determined according to the response evaluation criteria in solid tumors 3 weeks after the second NACT treatment, and the subjects were classified as two groups: responders and nonresponders groups. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion-related pseudo-diffusion coefficient (DFNx01), and perfusion fraction (f) values were determined. The differences in IVIM-derived variables and ADC between the different groups at the different time points were calculated using an independent samples t-test.
The D and ADC values were all significantly higher for the responders than for the nonresponders at all 3 time points, but no significant differences were observed in the DFNx01 and f values. An analysis of the receiver operating characteristic (ROC) curves indicated that a D value threshold <0.93 × 10-3 mm 2 /s and an ADC threshold <1.11 × 10-3 mm 2 /s could differentiate responders from nonresponders at pre-NACT time point, yielding area under the curve (AUC) of which were 0.771 and 0.806, respectively. The ROC indicated that the AUCs of D and ADC at the 3 weeks after the first NACT cycle and 3 weeks after the second NACT cycle were 0.823, 0.763, and 0.787, 0.794, respectively. The AUC values of D and ADC at these 3 time points were not significantly different (P = 0.641, 0.512, and 0.547, respectively).
D and ADC values may be useful for predicting and monitoring the efficacy of NACT in cervical cancer. An IVIM model may be equal to monoexponential model in predicting and monitoring the efficacy of NACT in cervical cancer.
采用体素内不相干运动（IVIM）模型的扩散加权成像（DWI）在提供宫颈癌的扩散和灌注信息方面已显示出有前景的结果；然而，其用于预测和监测宫颈癌新辅助化疗（NACT）疗效的情况相对较少。本研究旨在评估采用IVIM和单指数模型的DWI在预测和监测宫颈癌NACT疗效方面的应用。
42例原发性宫颈癌患者在3个时间点（NACT前、第一个NACT周期后3周、第二个NACT周期后3周）接受了磁共振检查。根据第二个NACT治疗后3周的实体瘤疗效评价标准确定治疗反应，并将受试者分为两组：反应者组和无反应者组。测定表观扩散系数（ADC）、真实扩散系数（D）、灌注相关伪扩散系数（DFNx01）和灌注分数（f）值。使用独立样本t检验计算不同时间点不同组之间IVIM衍生变量和ADC的差异。
在所有3个时间点，反应者的D值和ADC值均显著高于无反应者，但DFNx01和f值未观察到显著差异。对受试者工作特征（ROC）曲线的分析表明，在NACT前时间点，D值阈值<0.93×10⁻³mm²/s和ADC阈值<1.11×10⁻³mm²/s可区分反应者和无反应者，其曲线下面积（AUC）分别为0.771和0.806。ROC表明，在第一个NACT周期后3周和第二个NACT周期后3周，D和ADC的AUC分别为0.823、0.763和0.787、0.794。这3个时间点D和ADC的AUC值无显著差异（P分别为0.641、0.512和0.547）。
D值和ADC值可能有助于预测和监测宫颈癌NACT的疗效。在预测和监测宫颈癌NACT疗效方面，IVIM模型可能等同于单指数模型。
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