title: Value of Dynamic Contrast-enhanced and Diffusion-weighted MR Imaging in the Detection of Pathologic Complete Response in Cervical Cancer after Neoadjuvant Therapy: A Retrospective Observational Study.
abstract: Purpose To evaluate the association between dynamic contrast material-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance (MR) imaging with pathologic complete response after preoperative combined chemotherapy and radiation therapy for cervical carcinoma and evaluate the risk of local recurrence. Materials and Methods The institutional ethics committee approved the study and waived the requirement to obtain informed consent. The study comprised 52 patients with locally advanced carcinoma, treated first with combined chemotherapy and radiation therapy, who underwent MR imaging before final surgery between June 2011 and July 2015. Three radiologists evaluated conventional, DW, and DCE MR images to identify a complete response. The standard of reference was surgical-pathologic findings. Results An initial increase in signal intensity on DCE MR images that was greater in the cervical lesion than in the myometrium was defined as time-signal intensity curve type B and showed a significant association with incomplete response (P = .0004). DCE MR imaging parameters (ie, maximum slope enhancement, area under the gadolinium concentration-time curve during the first 90 seconds after gadolinium injection [AUGC90], and volume transfer constant [Ktrans]) and a low signal intensity on apparent diffusion coefficient (ADC) maps were significantly associated with an incomplete response (P = .027, P = .041, P = .037, and P = .032, respectively). A mean ADC of 0.0014 m2/sec or less (hazard ratio [HR] = 8.3), low ADC signal intensity (HR = 7.3), high signal intensity at DW imaging (HR = 7.1), and time-signal intensity curve type B (HR = 4.3) were associated with earlier recurrence (P < .05). Excellent agreement between readers was found for time-signal intensity curve analysis (κ > 0.9) and the following parameters: AUGC90, Ktrans, and maximum slope enhancement (intraclass correlation coefficient, >0.9). Conclusion DCE MR imaging parameters, especially the time-signal intensity curve, and DW imaging are associated with complete response and incomplete response and could potentially help oncologists with management decisions. Moreover, DCE and DW MR imaging could help oncologists accentuate the follow-up for patients with a high risk of local recurrence to assess for recurrence.©RSNA, 2017 Online supplemental material is available for this article.
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Aurélie
authors.initials: A
authors.lastname: Jalaguier-Coudray
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Rim
authors.initials: R
authors.lastname: Villard-Mahjoub
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Aurélie
authors.initials: A
authors.lastname: Delouche
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Béatrice
authors.initials: B
authors.lastname: Delarbre
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Eric
authors.initials: E
authors.lastname: Lambaudie
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Mathieu
authors.initials: M
authors.lastname: Minsat
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Agnès
authors.initials: A
authors.lastname: Tallet
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Renaud
authors.initials: R
authors.lastname: Sabatier
authors.affiliation: From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06, IUC, Sorbonne Universités, Paris, France (I.T.N.).
authors.forename: Isabelle
authors.initials: I
authors.lastname: Thomassin-Naggara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009942:Organometallic Compounds; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine