The Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Predicting Treatment Response for Cervical Cancer Treated with Concurrent Chemoradiotherapy

Purpose: To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting early treatment response. Materials and Methods: Patients with locally advanced cervical cancer (LACC) treated with concurrent chemoradiotherapy (CCRT) were enrolled. Pelvic DCE-MRI scans were performed before RT (pre-RT), in the middle of RT (mid-RT), and at the end of RT (post-RT), separately. Parameters (ie, K trans , K ep , and V e ) were measured. Pre-, mid-, and post-RT K trans were denoted as K trans -preTx, K trans -midTx, and K trans -postTx, respectively. And the same denoting rule also went for K ep and V e . Difference for the same parameter such as K trans measured between two consecutive time points was calculated as second K trans value minus first K trans value. The differences in K trans between pre-RT and post-RT, between pre-RT and mid-RT, and between mid-RT and post-RT were denoted as ΔK trans -post-preTx, ΔK trans -mid-preTx, and ΔK trans -post-midTx, respectively, and the same denoting rule was also applied to K ep and V e . Results: A total of 57 patients were enrolled. After the treatment, 31 patients had complete response (CR group). The remaining 26 patients had partial response (NCR group). Significant differences were found in K trans -postTx, K ep- postTx, V e- midTx, ΔK trans -post-preTx, ΔK trans -post-midTx, ΔK ep- post-preTx, ΔK ep- mid-preTx and ΔK ep- post-midTx between the two groups. Receiver operating characteristic (ROC) analysis for their performances in predicting treatment response showed an area under curve (AUC) of 0.656– 0.849, sensitivity of 61.3– 93.5%, specificity of 46.1– 73.1%, and maximal Youden Index of 36.5– 66.6. Among those parameters, K ep- postTx was the best, and its AUC, sensitivity, specificity, maximal Youden Index, and cutoff value were 0.849, 87.1%, 73.1%, 60.2, and 0.341, respectively. These combined parameters showed an AUC of 0.952, with sensitivity of 87.1%, specificity of 96.1%, and maximal Youden Index of 83.2. Conclusion: DCE-MRI parameters can predict early treatment outcome. Among those parameters, K ep- postTx is the best predictor. The combination of multi-parameters can increase the predictive potency. Keywords: cervical cancer, locally advanced disease, dynamic contrast-enhanced magnetic resonance imaging, concurrent chemoradiotherapy, prognosis prediction