Dhesi Simran Singh, Frood Russell, Swift Sarah, Cooper Rachel, Muzumdar Siddhant, Jamal Mehvish, Scarsbrook Andrew
Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK.
Leeds Institute of Health Research, Faculty of Medicine & Health, University of Leeds, Leeds LS9 7TF, UK.
Cancers (Basel). 2024 Jan 23;16(3):476. doi: 10.3390/cancers16030476.
To evaluate the utility and comparative effectiveness of three five-point qualitative scoring systems for assessing response on PET-CT and MRI imaging individually and in combination, following curative-intent chemoradiotherapy (CRT) in locally advanced cervical cancer (LACC). Their performance in the prediction of subsequent patient outcomes was also assessed; Methods: Ninety-seven patients with histologically confirmed LACC treated with CRT using standard institutional protocols at a single centre who underwent PET-CT and MRI at staging and post treatment were identified retrospectively from an institutional database. The post-CRT imaging studies were independently reviewed, and response assessed using five-point scoring tools for T2WI, DWI, and FDG PET-CT. Patient characteristics, staging, treatment, and follow-up details including progression-free survival (PFS) and overall survival (OS) outcomes were collected. To compare diagnostic performance metrics, a two-proportion z-test was employed. A Kaplan-Meier analysis (Mantel-Cox log-rank) was performed.
The T2WI ( < 0.00001, < 0.00001) and DWI response scores ( < 0.00001, = 0.0002) had higher specificity and accuracy than the PET-CT. The T2WI score had the highest positive predictive value (PPV), while the negative predictive value (NPV) was consistent across modalities. The combined MR scores maintained high NPV, PPV, specificity, and sensitivity, and the PET/MR consensus scores showed superior diagnostic accuracy and specificity compared to the PET-CT score alone ( = 0.02926, = 0.0083). The Kaplan-Meier analysis revealed significant differences in the PFS based on the T2WI ( < 0.001), DWI ( < 0.001), combined MR ( = 0.003), and PET-CT/MR consensus scores ( < 0.001) and in the OS for the T2WI ( < 0.001), DWI ( < 0.001), and combined MR scores ( = 0.031) between responders and non-responders.
Post-CRT response assessment using qualitative MR scoring and/or consensus PET-CT and MRI scoring was a better predictor of outcome compared to PET-CT assessment alone. This requires validation in a larger prospective study but offers the potential to help stratify patient follow-up in the future.
评估三种五分制定性评分系统在局部晚期宫颈癌（LACC）根治性放化疗（CRT）后，单独及联合用于评估PET-CT和MRI成像反应的效用及比较有效性。还评估了它们在预测患者后续结局方面的表现；方法：从机构数据库中回顾性识别出97例经组织学确诊为LACC且在单一中心按照标准机构方案接受CRT治疗的患者，这些患者在分期及治疗后均接受了PET-CT和MRI检查。对CRT后的影像学研究进行独立评估，并使用针对T2WI、DWI和FDG PET-CT的五分制评分工具评估反应。收集患者特征、分期、治疗及随访细节，包括无进展生存期（PFS）和总生存期（OS）结局。为比较诊断性能指标，采用双比例z检验。进行Kaplan-Meier分析（Mantel-Cox对数秩检验）。
T2WI（<0.00001，<0.00001）和DWI反应评分（<0.00001，=0.0002）比PET-CT具有更高的特异性和准确性。T2WI评分具有最高的阳性预测值（PPV），而阴性预测值（NPV）在各检查方式中保持一致。联合MR评分保持了较高的NPV、PPV、特异性和敏感性，且PET/MR共识评分与单独的PET-CT评分相比显示出更高的诊断准确性和特异性（=0.02926，=0.0083）。Kaplan-Meier分析显示，基于T2WI（<0.001）、DWI（<0.001）、联合MR（=0.003）和PET-CT/MR共识评分（<0.001）的反应者与无反应者之间在PFS方面存在显著差异，基于T2WI（<0.001）、DWI（<0.001）和联合MR评分（=0.031）的反应者与无反应者之间在OS方面存在显著差异。
与单独的PET-CT评估相比，使用定性MR评分和/或PET-CT与MRI共识评分进行CRT后反应评估对结局的预测更好。这需要在更大规模的前瞻性研究中进行验证，但有望在未来帮助对患者随访进行分层。
