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 Delta K-trans-post-preTx, Delta K-trans-mid-preTx, and Delta K-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, Delta K-trans-post-preTx, Delta K-trans-post-midTx, Delta K-ep-post-preTx, Delta K-ep-mid-preTx and Delta K-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.