title: Evaluation of diffusion-weighted imaging (DWI) and MR spectroscopy (MRS) as early response biomarkers in cervical cancer patients.
abstract: OBJECTIVE
  To prospectively assess whether choline levels and Apparent Diffusion Coefficient (ADC) values within cervical cancers before, during, and after non-surgical therapy are predictive of tumour response.
  
  
  METHODS
  Patients undergoing MR examination for staging of cervical cancer, candidate for non-surgical therapy, were prospectively enrolled. According to the status at the end of therapies, patients were divided into responders and non-responders. The final outcome after a 5-year follow-up was classified as No Evidence of Disease (NED) or Progression of Disease (PD). Baseline values of mean ADC and Cho/H2O were compared between responders and non-responders, as well as between patients with NED and PD. The percent variation of ADC and Cho/H2O values over time was compared. P values <0.05 were considered significant.
  
  
  RESULTS
  16 patients were included. There was no significant difference at baseline between responders (n = 12) and non-responders (n = 4), nor between NED (n = 11) PD patients (n = 5), in ADC values and Cho/H2O ratio. There was no significant difference in percent variation of ADC values and of Cho/H2O, comparing responders and non-responders. There was a significant increase in absolute values of ADC from the initial to mid-therapy MRI (p = 0.0001), while Cho/H2O was stable (p value: 0.61). In the four non-responders, the ADC increase was not significant (p value: 0.25), while it was significant in the 11 responders (p value: 0.001). Values of spectroscopy were stable in both responders and non-responders.
  
  
  CONCLUSIONS
  High increases of ADC values from baseline to mid-therapy MR reflect response to therapies. There were no significant variations in choline/water ratios over time.
authors.affiliation: Department of Radiology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. stefania.rizzo@ieo.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rizzo
authors.affiliation: Department of Health Sciences, University of Milan, Via A.di Rudinì 8, 20142, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Buscarino
authors.affiliation: Medical Physics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Origgi
authors.affiliation: Department of Radiology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Paul
authors.initials: P
authors.lastname: Summers
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Adamello 16, 20139, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Raimondi
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lazzari
authors.affiliation: Department of Gynaecology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Landoni
authors.affiliation: Department of Radiology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.|Department of Oncology, University of Milan, Via Festa del Perdono 7, 20142, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Cervical cancer; DWI; MR spectroscopy; Response biomarkers