title: Role of 3T multiparametric-MRI with BOLD hypoxia imaging for diagnosis and post therapy response evaluation of postoperative recurrent cervical cancers.
abstract: OBJECTIVE
  To assess the diagnostic value of multiparametric-MRI (MPMRI) with hypoxia imaging as a functional marker for characterizing and detecting vaginal vault/local recurrence following primary surgery for cervical cancer.
  
  
  METHODS
  With institutional review board approval and written informed consent 30 women (median age: 45 years) from October 2009 to March 2010 with previous operated carcinoma cervix and suspected clinical vaginal vault/local recurrence were examined with 3.0T-MRI. MRI imaging included conventional and MPMRI sequences [dynamic contrast enhanced (DCE), diffusion weighted (DW), 1H-MR spectroscopy (1HMRS), blood oxygen level dependent hypoxia imaging (BOLD)]. Two radiologists, blinded to pathologic findings, independently assessed the pretherapy MRI findings and then correlated it with histopathology findings. Sensitivity, specificity, positive predictive value, negative predictive value and their confidence intervals were calculated. The pre and post therapy conventional and MPMRI parameters were analyzed and correlated with response to therapy.
  
  
  RESULTS
  Of the 30 patients, there were 24 recurrent tumors and 6 benign lesions. The accuracy of diagnosing recurrent vault lesions was highest at combined MPMRI and conventional MRI (100%) than at conventional-MRI (70%) or MPMRI (96.7%) alone. Significant correlation was seen between percentage tumor regression and pre-treatment parameters such as negative enhancement integral (NEI) (p = 0.02), the maximum slope (p = 0.04), mADC value (p = 0.001) and amount of hypoxic fraction on the pretherapy MRI (p = 0.01).
  
  
  CONCLUSIONS
  Conventional-MR with MPMRI significantly increases the diagnostic accuracy for suspected vaginal vault/local recurrence. Post therapy serial MPMRI with hypoxia imaging follow-up objectively documents the response. MPMRI and BOLD hypoxia imaging provide information regarding tumor biology at the molecular, subcellular, cellular and tissue levels and this information may be used as an appropriate and reliable biologic target for radiation dose painting to optimize therapy in future.
authors.affiliation: Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India; Department of Imaging Sciences and Biomedical Engineering, Kings College London, UK.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India.
authors.forename: Reena
authors.initials: R
authors.lastname: Engineer
authors.affiliation: Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Mahanshetty
authors.affiliation: Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India.
authors.forename: S L
authors.initials: SL
authors.lastname: Juvekar
authors.affiliation: Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Shrivastava
authors.affiliation: Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Desekar
authors.affiliation: Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India.
authors.forename: M H
authors.initials: MH
authors.lastname: Thakur
keywords: 1HMRS, proton magnetic resonance spectroscopy; ADC, apparent diffusion coefficient; BOLD; BOLD, blood oxygen level dependent; Blood oxygen level dependent(BOLD) imaging; Cervical cancer; DCE, dynamic contrast enhanced; DWI, diffusion weighted imaging; Hypoxia; Hypoxia imaging; Image guided radiotherapy; Intensity modulated radiotherapy (IMRT); MPMRI, multiparametric-MRI; MR-diffusion/perfusion; MR-functional imaging; MR-spectroscopy; MRI; Molecular; Molecular imaging; NEI, negative enhancement integral; Neoplasia; PD-IDEAL, proton density iterative decomposition of water and fat with echo asymmetric and least-squares estimation; Radiobiology