Mahajan Abhishek, Engineer Reena, Chopra Supriya, Mahanshetty Umesh, Juvekar S L, Shrivastava S K, Desekar Naresh, Thakur M H
Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India; Department of Imaging Sciences and Biomedical Engineering, Kings College London, UK.
Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India.
Eur J Radiol Open. 2015 Dec 12;3:22-30. doi: 10.1016/j.ejro.2015.11.003. eCollection 2016.
To assess the diagnostic value of multiparametric-MRI (MPMRI) with hypoxia imaging as a functional marker for characterizing and detecting vaginal vault/local recurrence following primary surgery for cervical cancer.
With institutional review board approval and written informed consent 30 women (median age: 45 years) from October 2009 to March 2010 with previous operated carcinoma cervix and suspected clinical vaginal vault/local recurrence were examined with 3.0T-MRI. MRI imaging included conventional and MPMRI sequences [dynamic contrast enhanced (DCE), diffusion weighted (DW), 1H-MR spectroscopy (1HMRS), blood oxygen level dependent hypoxia imaging (BOLD)]. Two radiologists, blinded to pathologic findings, independently assessed the pretherapy MRI findings and then correlated it with histopathology findings. Sensitivity, specificity, positive predictive value, negative predictive value and their confidence intervals were calculated. The pre and post therapy conventional and MPMRI parameters were analyzed and correlated with response to therapy.
Of the 30 patients, there were 24 recurrent tumors and 6 benign lesions. The accuracy of diagnosing recurrent vault lesions was highest at combined MPMRI and conventional MRI (100%) than at conventional-MRI (70%) or MPMRI (96.7%) alone. Significant correlation was seen between percentage tumor regression and pre-treatment parameters such as negative enhancement integral (NEI) (p = 0.02), the maximum slope (p = 0.04), mADC value (p = 0.001) and amount of hypoxic fraction on the pretherapy MRI (p = 0.01).
Conventional-MR with MPMRI significantly increases the diagnostic accuracy for suspected vaginal vault/local recurrence. Post therapy serial MPMRI with hypoxia imaging follow-up objectively documents the response. MPMRI and BOLD hypoxia imaging provide information regarding tumor biology at the molecular, subcellular, cellular and tissue levels and this information may be used as an appropriate and reliable biologic target for radiation dose painting to optimize therapy in future.
评估以缺氧成像作为功能标志物的多参数磁共振成像（MPMRI）在宫颈癌初次手术后阴道穹窿/局部复发的特征描述和检测中的诊断价值。
在获得机构审查委员会批准并取得书面知情同意后，于2009年10月至2010年3月对30名（中位年龄：45岁）既往有宫颈癌手术史且临床怀疑阴道穹窿/局部复发的女性进行3.0T磁共振成像检查。磁共振成像包括传统序列和MPMRI序列[动态对比增强（DCE）、扩散加权（DW）、1H磁共振波谱（1HMRS）、血氧水平依赖性功能磁共振成像（BOLD）]。两名对病理结果不知情的放射科医生独立评估治疗前磁共振成像结果，然后将其与组织病理学结果进行关联。计算敏感性、特异性、阳性预测值、阴性预测值及其置信区间。分析治疗前后的传统和MPMRI参数，并将其与治疗反应进行关联。
30例患者中，有24例为复发性肿瘤，6例为良性病变。联合MPMRI和传统MRI诊断复发性穹窿病变的准确率（100%）高于单独使用传统MRI（70%）或MPMRI（96.7%）。肿瘤消退百分比与治疗前参数如负增强积分（NEI）（p = 0.02）、最大斜率（p = 0.04）、平均表观扩散系数（mADC）值（p = 0.001）和治疗前磁共振成像上的缺氧分数（p = 0.01）之间存在显著相关性。
传统磁共振成像与MPMRI显著提高了疑似阴道穹窿/局部复发的诊断准确性。治疗后采用MPMRI联合缺氧成像进行系列随访可客观记录治疗反应。MPMRI和BOLD缺氧成像提供了有关肿瘤在分子、亚细胞、细胞和组织水平生物学特性的信息，这些信息可能作为未来优化治疗的放射剂量描绘的合适且可靠的生物学靶点。
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