Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning, People's Republic of China.
Liaoning Provincial Key Laboratory of Medical Imaging, Shenyang, Liaoning, People's Republic of China.
Eur Radiol. 2020 Feb;30(2):1191-1201. doi: 10.1007/s00330-019-06428-w. Epub 2019 Sep 6.
To assess the value of F-FDG PET and MR-IVIM parameters before and during concurrent chemoradiotherapy (CCRT) for evaluating early treatment response and predicting tumor recurrence in patients with locally advanced cervical cancer (LACC) using a hybrid PET/MR scanner.
Fifty-one patients with LACC underwent pelvic PET/MR scans with an IVIM sequence at two time-points (pretreatment [pre] and midtreatment [mid]). Pre- and mid-PET parameters (SUV, MTV, TLG) and IVIM parameters (D, F, D*) and their percentage changes (Δ%SUV, Δ%MTV, Δ%TLG, Δ%D, Δ%F, Δ%D*) were calculated. We selected independent imaging parameters and built a combined prediction model incorporating imaging parameters and clinicopathological risk factors. The performance of the combinative evaluation for tumor early shrinkage rates (TESR) and the prediction model for tumor recurrence was assessed.
Thirty-two patients were classified into the good response (GR) group with TESR ≥ 50%, and 19 patients were categorized into the poor response (PR) group with TESR < 50%. Δ%D (p = 0.013) and Δ%F (p = 0.006) are independently related to TESR with superior combined diagnostic ability (AUC = 0.901). Pre-TLG, Δ%D, and suspicious lymph node metastasis (SLNM) were selected for the construction of the combined prediction model. The model for identifying the patients with high risk of tumor recurrence reached a moderate predictive ability and good stability with c-index of 0.764 (95% CI, 0.672-0.855).
The combined prediction model based on pretreatment PET metabolic parameter (pre-TLG), IVIM-D percentage changes, and LNs status provides great potential to identify the LACC patients with high risk of recurrence at early stage of CCRT.
• PET/MR plus IVIM offers various complementary information for LACC. • IVIM-D and IVIM-F percentage changes are independently related to tumor early shrinkage rates. • The combined prediction model can help identify the LACC patients with high risk of tumor recurrence.
在使用杂交 PET/MR 扫描仪的情况下，评估 F-FDG PET 和 MR-IVIM 参数在局部晚期宫颈癌（LACC）患者同步放化疗（CCRT）前后的价值，以评估早期治疗反应和预测肿瘤复发。
51 例 LACC 患者分别在两个时间点（治疗前[pre]和治疗中[mid]）进行盆腔 PET/MR 扫描和 IVIM 序列扫描。计算了治疗前后的 PET 参数（SUV、MTV、TLG）和 IVIM 参数（D、F、D*）及其百分比变化（Δ%SUV、Δ%MTV、Δ%TLG、Δ%D、Δ%F、Δ%D*）。我们选择了独立的影像学参数，并建立了一个结合影像学参数和临床病理危险因素的综合预测模型。评估了综合评估肿瘤早期退缩率（TESR）和预测模型对肿瘤复发的性能。
32 例患者被分为 TESR≥50%的良好反应（GR）组，19 例患者被分为 TESR<50%的不良反应（PR）组。Δ%D（p=0.013）和Δ%F（p=0.006）与 TESR 独立相关，具有更好的联合诊断能力（AUC=0.901）。治疗前 TLG、Δ%D 和可疑淋巴结转移（SLNM）被选择用于构建联合预测模型。用于识别肿瘤复发高风险患者的模型具有中等预测能力和良好的稳定性，c 指数为 0.764（95%CI，0.672-0.855）。
基于治疗前 PET 代谢参数（pre-TLG）、IVIM-D 百分比变化和 LNs 状态的联合预测模型为识别 LACC 患者 CCRT 早期复发高风险提供了巨大潜力。
PET/MR 联合 IVIM 为 LACC 提供了各种互补信息。
IVIM-D 和 IVIM-F 的百分比变化与肿瘤早期退缩率独立相关。
联合预测模型有助于识别 LACC 患者肿瘤复发的高风险。
