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.