title: Advanced ovarian cancer: multiparametric MR imaging demonstrates response- and metastasis-specific effects.
abstract: OBJECTIVE
  To investigate the role of multiparametric magnetic resonance (MR) imaging in the evaluation of response to platinum-based neoadjuvant chemotherapy in advanced ovarian cancer and to compare imaging parameters between primary ovarian mass and metastatic disease.
  
  
  METHODS
  Evaluable patients suspected of having advanced ovarian carcinoma were enrolled in a prospective protocol-driven study. Research ethics committee approval and written informed consent were obtained. Multiparametric MR imaging (diffusion-weighted MR imaging, dynamic contrast material-enhanced [DCE] MR imaging, and hydrogen 1 MR spectroscopy) was performed with a 3.0-T wholebody MR imaging system. Three marker lesions-primary ovarian mass, omental cake, and peritoneal deposit-were outlined by a radiologist on apparent diffusion coefficient (ADC) and vascular signal fraction (VSF) maps and on DCE MR images. Comparisons of mean ADC, mean VSF, DCE MR imaging parameters, and choline concentration between responders and nonresponders were based on Response Evaluation Criteria in Solid Tumors and CA-125 criteria.
  
  
  RESULTS
  Twenty-two patients were evaluable. The mean ADC for peritoneal metastases was lower than that for ovarian (P = .015) and omental (P = .006) sites. There were no differences in pretreatment DCE MR imaging parameters between tumor sites. After treatment, responders showed a significantly larger increase in ADC (P = .021) and fractional volume of the extravascular extracellular space (v(e)) (P = .025) of ovarian lesions compared with nonresponders, but there was no change in ADC at other sites. Pre- and posttreatment values of choline concentration of ovarian lesions were lower in responders (P = .025) than in nonresponders (P = .010).
  
  
  CONCLUSIONS
  The significant differences in baseline ADCs among primary ovarian cancer, omental cake, and peritoneal deposits indicate that diffusivity profiles may be tumor-site dependent, suggesting biologic heterogeneity of disease. ADC and v(e) parameters correlated with the cytotoxic effects of platinum-based therapy and may be useful response markers, while choline concentration predicted but did not reflect response.
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, England. es220@radiol.cam.ac.uk
authors.forename: Evis
authors.initials: E
authors.lastname: Sala
authors.forename: Masako Y
authors.initials: MY
authors.lastname: Kataoka
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Priest
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Gill
authors.forename: Mary A
authors.initials: MA
authors.lastname: McLean
authors.forename: Ilse
authors.initials: I
authors.lastname: Joubert
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Graves
authors.forename: Robin A F
authors.initials: RA
authors.lastname: Crawford
authors.forename: Mercedes
authors.initials: M
authors.lastname: Jimenez-Linan
authors.forename: Helena M
authors.initials: HM
authors.lastname: Earl
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hodgkin
authors.forename: John R
authors.initials: JR
authors.lastname: Griffiths
authors.forename: David J
authors.initials: DJ
authors.lastname: Lomas
authors.forename: James D
authors.initials: JD
authors.lastname: Brenton
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000032:analysis; D018394:CA-125 Antigen / Q000032:analysis; D016190:Carboplatin / Q000627:therapeutic use*; D002794:Choline / Q000032:analysis; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D009942:Organometallic Compounds; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D017239:Paclitaxel / Q000627:therapeutic use*; D010534:Peritoneal Neoplasms / Q000556:secondary; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D016190:Carboplatin; D002794:Choline; D017239:Paclitaxel