title: Apparent diffusion coefficient histogram shape analysis for monitoring early response in patients with advanced cervical cancers undergoing concurrent chemo-radiotherapy.
abstract: BACKGROUND
  To explore the role of apparent diffusion coefficient (ADC) histogram shape related parameters in early assessment of treatment response during the concurrent chemo-radiotherapy (CCRT) course of advanced cervical cancers.
  
  
  METHODS
  This prospective study was approved by the local ethics committee and informed consent was obtained from all patients. Thirty-two patients with advanced cervical squamous cell carcinomas underwent diffusion weighted magnetic resonance imaging (b values, 0 and 800 s/mm2) before CCRT, at the end of 2nd and 4th week during CCRT and immediately after CCRT completion. Whole lesion ADC histogram analysis generated several histogram shape related parameters including skewness, kurtosis, s-sDav, width, standard deviation, as well as first-order entropy and second-order entropies. The averaged ADC histograms of 32 patients were generated to visually observe dynamic changes of the histogram shape following CCRT.
  
  
  RESULTS
  All parameters except width and standard deviation showed significant changes during CCRT (all P < 0.05), and their variation trends fell into four different patterns. Skewness and kurtosis both showed high early decline rate (43.10 %, 48.29 %) at the end of 2nd week of CCRT. All entropies kept decreasing significantly since 2 weeks after CCRT initiated. The shape of averaged ADC histogram also changed obviously following CCRT.
  
  
  CONCLUSIONS
  ADC histogram shape analysis held the potential in monitoring early tumor response in patients with advanced cervical cancers undergoing CCRT.
authors: Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
authors: Jie
authors: J
authors: Meng
authors: The Comprehensive Cancer Centre of Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
authors: Lijing
authors: L
authors: Zhu
authors: Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
authors: Li
authors: L
authors: Zhu
authors: Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
authors: Huanhuan
authors: H
authors: Wang
authors: Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
authors: Song
authors: S
authors: Liu
authors: The Comprehensive Cancer Centre of Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
authors: Jing
authors: J
authors: Yan
authors: The Comprehensive Cancer Centre of Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
authors: Baorui
authors: B
authors: Liu
authors: School of Electronic Science and Engineering, Nanjing University, Nanjing, China, 210046.
authors: Yue
authors: Y
authors: Guan
authors: School of Electronic Science and Engineering, Nanjing University, Nanjing, China, 210046. geyun@nju.edu.cn.
authors: Yun
authors: Y
authors: Ge
authors: Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008. hjxueren@126.com.
authors: Jian
authors: J
authors: He
authors: Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008. zyzhou@nju.edu.cn.
authors: Zhengyang
authors: Z
authors: Zhou
authors: Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA.
authors: Xiaofeng
authors: X
authors: Yang
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000628:therapy*; D059248:Chemoradiotherapy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Apparent diffusion coefficient; Cervical cancer; Diffusion-weighted magnetic resonance imaging; Histogram shape; Treatment response