Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy.
Radioterapia Oncologica, Area Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy.
Clin Radiol. 2020 Mar;75(3):216-223. doi: 10.1016/j.crad.2019.10.021. Epub 2019 Dec 2.
To find diffusion-weighted (DW) magnetic resonance imaging (MRI) parameters predictive for radiation-induced vaginal stenosis (VS) in locally advanced cervical cancer (LACC) treated with neoadjuvant chemoradiation therapy (CRT).
Retrospective analysis of 43 patients with LACC who underwent 1.5 T DW-MRI before (baseline), after 2 weeks (early), and at the end of CRT (final). At MRI, vaginal length, thickness, width, and cervical tumour volume (TV) were measured. Vaginal signal intensity at DW-MRI was analysed at final MRI. CRT-induced VS was graded using Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Correlations between DW-MRI and clinical data were made using Wilcoxon's test, Mann-Whitney test, Fisher's exact test, or chi-squared test as appropriate. Receiver operating characteristic (ROC) curves were generated for variables to evaluate diagnostic ability to predict CRT-induced VS using a logistic regression model.
Asymptomatic vaginal toxicity (CTCAE Grade 1) was observed in 14 patients and symptomatic CRT-induced VS (CTCAE Grade ≥2) was detected in 29 patients. Baseline TV was higher in Grade 1 than in Grade ≥2 (p=0.013). Median vaginal length, thickness, and width decreased between baseline and final MRI in all patients (p<0.0001) without significant variances between CTCAE grades. Significant differences were observed in DW-MRI patterns (p<0.0001). In Grade ≥2, DWI showed signal loss of vaginal mucosa in 17 patients (63%) and diffuse restricted diffusion of vaginal wall in eight patients (30%). AUC was 0.938 (coefficient=4.72; p<0.001) for DWI and 0.712 (coefficient=-2.623×10 ; p=0.004) for TV.
This is the first study using DW-MRI for predicting CRT-induced VS. DWI is useful tool in patients with LACC after CRT for early prevention and management strategies for VS.
探讨磁共振弥散加权成像（DW-MRI）参数能否预测接受新辅助放化疗（CRT）的局部晚期宫颈癌（LACC）患者发生放射性阴道狭窄（VS）的风险。
回顾性分析 43 例 LACC 患者的资料，这些患者在接受 CRT 前（基线）、2 周时（早期）和结束时（终末）均进行了 1.5T DW-MRI 检查。在 MRI 上测量阴道长度、厚度、宽度和宫颈肿瘤体积（TV）。在终末 MRI 上分析阴道 DW-MRI 信号强度。采用通用不良事件术语标准（CTCAE）v4.03 分级评价 CRT 相关 VS。采用 Wilcoxon 检验、Mann-Whitney 检验、Fisher 确切检验或卡方检验对 DW-MRI 与临床数据之间的相关性进行分析。采用逻辑回归模型生成受试者工作特征（ROC）曲线，评估各变量预测 CRT 相关 VS 的诊断能力。
14 例患者出现无症状的阴道毒性（CTCAE 1 级），29 例患者出现有症状的 CRT 相关 VS（CTCAE ≥2 级）。1 级患者的基线 TV 高于 2 级患者（p=0.013）。所有患者的基线阴道长度、厚度和宽度在基线和终末 MRI 之间均降低（p<0.0001），但 CTCAE 分级之间无显著差异。DW-MRI 模式存在显著差异（p<0.0001）。在 2 级患者中，17 例（63%）患者的阴道黏膜 DW-MRI 信号丢失，8 例（30%）患者的阴道壁弥散受限。DWI 的 AUC 为 0.938（系数=4.72；p<0.001），TV 的 AUC 为 0.712（系数=-2.623×10 ；p=0.004）。
这是首次使用 DW-MRI 预测 CRT 相关 VS 的研究。DWI 是 CRT 后 LACC 患者的有用工具，可用于早期预测和制定 VS 的防治策略。
