Department of Radiology, Kuopio University Hospital, Kuopio, Finland.
Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland.
PLoS One. 2023 May 11;18(5):e0285786. doi: 10.1371/journal.pone.0285786. eCollection 2023.
To evaluate whether 1) the intratumoral apparent diffusion coefficients (ADCs) change during cervical cancer treatment and 2) the pretreatment ADC values or their change after treatment predict the treatment outcome or overall survival of patients with cervical cancer.
We retrospectively enrolled 52 patients with inoperable cervical cancer treated with chemoradiotherapy, who had undergone diffusion weighted MRI before treatment and post external beam radiotherapy (EBRT) and concurrent chemotherapy. A subgroup of patients (n = 28) underwent altogether six consecutive diffusion weighted MRIs; 1) pretreatment, 2) post-EBRT and concurrent chemotherapy; 3-5) during image-guided brachytherapy (IGBT) and 6) after completing the whole treatment course. To assess interobserver and intertechnique reproducibility two observers independently measured the ADCs by drawing freehand a large region of interest (L-ROI) covering the whole tumor and three small ROIs (S-ROIs) in areas with most restricted diffusion.
Reproducibility was equally good for L-ROIs and S-ROIs. The pretreatment ADCs were higher in L-ROIs (883 mm2/s) than in S-ROIs (687 mm2/s, P < 0.001). The ADCs increased significantly between the pretreatment and post-EBRT scans (L-ROI: P < 0.001; S-ROI: P = 0.001). The ADCs remained significantly higher than pretreatment values during the whole IGBT. Using S-ROIs, greater increases in ADCs between pretreatment and post-EBRT MRI predicted better overall survival (P = 0.018).
ADC values significantly increase during cervical cancer treatment. Greater increases in ADC values between pretreatment and post-EBRT predicted better overall survival using S-ROIs. Standardized methods for timing and delineation of ADC measurements are advocated in future studies.
评估 1）宫颈癌治疗过程中肿瘤内表观扩散系数（ADC）是否发生变化，以及 2）治疗前 ADC 值或治疗后变化能否预测宫颈癌患者的治疗效果或总生存。
我们回顾性纳入 52 例接受放化疗的局部晚期宫颈癌患者，所有患者在治疗前、外照射放疗（EBRT）后同步化疗后以及图像引导近距离放疗（IGBT）期间进行了弥散加权 MRI 检查。部分患者（n=28）共进行了 6 次连续的弥散加权 MRI 检查：1）治疗前，2）EBRT 后同步化疗后，3-5）IGBT 期间，6）完成整个治疗过程后。为了评估观察者间和技术间的可重复性，两名观察者分别通过绘制包含整个肿瘤的大 ROI（L-ROI）和三个在弥散受限最明显区域的小 ROI（S-ROI），独立测量 ADC 值。
L-ROI 和 S-ROI 的重复性均较好。L-ROI 的 ADC 值（883mm2/s）高于 S-ROI（687mm2/s，P＜0.001）。与治疗前相比，EBRT 后 ADC 值明显升高（L-ROI：P＜0.001；S-ROI：P=0.001）。在整个 IGBT 期间，ADC 值仍明显高于治疗前。使用 S-ROI，EBRT 前后 ADC 值增加与总生存改善显著相关（P=0.018）。
宫颈癌治疗过程中 ADC 值明显升高。S-ROI 显示 EBRT 前后 ADC 值增加与总生存改善相关。在未来的研究中应提倡采用标准化的方法来测量 ADC 值的时间和勾画范围。
