title: Intravoxel incoherent motion MRI assessment of chemoradiation-induced pelvic bone marrow changes in cervical cancer and correlation with hematological toxicity.
abstract: To investigate bone marrow changes after chemoradiation (CRT) using intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) and correlate imaging changes with hematological toxicity (HT) in patients with locally advanced cervical cancer.
  
  
  
  Thirty-nine patients with newly diagnosed cervical cancer were prospectively recruited for two sequential 3.0T IVIM-MRI studies: before treatment (MRI-1) and 3-4 weeks after standardized CRT (MRI-2). The irradiated pelvic bone marrow was outlined as the regions of interest to derive the true diffusion coefficient (D) and perfusion fraction (f) based on a biexponential model. The apparent coefficient diffusion (ADC) was derived using the monoexponential model. Changes in these parameters between MRI-1 and MRI-2 were calculated as ΔD, Δf, and ΔADC. HT was defined accordingly to NCI-CTCAE (v. 4.03) of grade 3 and above. Statistical analysis was performed using Mann-Whitney U-test.
  
  
  
  The median age of patients was 54 years old (range 27-83 years old); 14 patients suffered from HT. Early bone marrow changes (3-4 weeks) of ΔD showed a significant difference between HT and non-HT groups (6.4 ± 19.7% vs. -6.4 ± 19.4%, respectively, P = 0.041). However, no significant changes were noted in Δf (3.7 ± 13.3% vs. 1.5 ± 12.5% respectively, P = 0. 592) and ΔADC (5.5 ± 26.3% vs. -3.3 ± 27.0% respectively, P = 0.303) between the HT and non-HT groups. Δf increased insignificantly for both groups.
  
  
  
  ΔD was the only significant parameter to differentiate early cellular environment changes in bone marrow after CRT, suggestive that ΔD was more sensitive than Δf and ΔADC to reflect the underlying microenvironment injury.
  
  
  
  2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1491-1498.
authors.affiliation: Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, P.R. China.
authors.forename: Elaine Yuen Phin
authors.initials: EYP
authors.lastname: Lee
authors.affiliation: Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, P.R. China.
authors.forename: Jose Angelo Udal
authors.initials: JAU
authors.lastname: Perucho
authors.affiliation: Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, P.R. China.
authors.forename: Vince
authors.initials: V
authors.lastname: Vardhanabhuti
authors.affiliation: Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, P.R. China.
authors.forename: Steven Wai Kwan
authors.initials: SWK
authors.lastname: Siu
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, P.R. China.
authors.forename: Siew Fei
authors.initials: SF
authors.lastname: Ngu
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle, Washington, USA.
authors.forename: Nina A
authors.initials: NA
authors.lastname: Mayr
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington, USA.
authors.forename: William T C
authors.initials: WTC
authors.lastname: Yuh
authors.affiliation: Philips Healthcare, Hong Kong, P.R. China.
authors.forename: Queenie
authors.initials: Q
authors.lastname: Chan
authors.affiliation: Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, P.R. China.
authors.forename: Pek-Lan
authors.initials: PL
authors.lastname: Khong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000633:toxicity; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000528:radiation effects*; D001859:Bone Neoplasms / Q000556:secondary; D059248:Chemoradiotherapy / Q000009:adverse effects*; D004058:Diffusion; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009038:Motion; D009362:Neoplasm Metastasis; D015588:Observer Variation; D010388:Pelvis / Q000000981:diagnostic imaging / Q000528:radiation effects; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging
chemical_list: D000970:Antineoplastic Agents
keywords: bone marrow; cervical cancer; diffusion measurement; hematological toxicity; intravoxel incoherent motion; radiation therapy