Original Research Article
Year: 2022 | Month: January | Volume: 9 | Issue: 1 | Pages: 17-27
DOI: https://doi.org/10.52403/ijrr.20220103
Diffusion Weighted and Dynamic Contrast Enhanced Magnetic Resonance Imaging in Carcinoma of Cervix: Role of Apparent Diffusion Coefficient Value and Time Intensity Curve Pattern in Chemoradiotherapeutic Response Evaluation
Raghavendra H K1, Alpana Manchanda2, Anju Garg3, Kishore Singh4,Gauri Gandhi5
1Consultant Radiologist, Satyakiran Healthcare, Atlas Road, Sonipat- 131001, India
2Director Professor, Department Of Radiodiagnosis, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi- 110002, India
3Director Professor And Head Of Department, Department Of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.
4Director Professor And Head Of Department, Department Of Radiotherapy, Maulana Azad Medical College, New Delhi, India.
5Director Professor, Department Of Obstetrics And Gynecology, Maulana Azad Medical College, New Delhi, India.
Corresponding Author: Raghavendra H K
ABSTRACT
Introduction: Magnetic resonance imaging (MRI) is a widely used imaging modality in the imaging evaluation of carcinoma of cervix. The aim of our study was to evaluate the response in carcinoma cervix patients following chemoradiotherapy by Diffusion weighted (DW-MRI) and Dynamic contrast enhanced-MRI (DCE-MRI).
Methods: 21 inoperable biopsy proven patients (mean age 48.43 years) of carcinoma cervix were included in the study. All patients underwent MRI (conventional, DW and DCE) of the pelvis thrice. Baseline MRI, Post chemotherapy MRI after neoadjuvant chemotherapy and Post chemoradiotherapy MRI after completion of concurrent chemoradiotherapy. Post treatment apparent diffusion coefficient(ADC) values and Time intensity curve(TIC) pattern were compared with baseline values.
Results: Baseline meanADC value of all patients was 0.82 x10-3 mm2/s. After completion of treatment, 18 patients showed complete resolution of tumor and showed 0.50 x10-3 mm2/s increase in meanADC value from baseline MRI which was significantly higher than remaining 3 patients with residual tumor (0.50 x10-3 mm2/s v/s 0.17 x10-3 mm2/s). ADC threshold value of 1.15 x10-3 mm2/s was defined, differentiating the residual tumor from the healthy cervical tissue after chemoradiation. On post treatment MRI, 17 out of 18 patients with complete resolution of tumor showed increasing trend of enhancement on TIC and only one patient showed plateau pattern. 2 of the 3 patients with residual tumor showed washout pattern and one patient showed plateau pattern.
Conclusion: ADC values and TIC pattern differ in patients with complete response to chemoradiotherapy from patients with residual tumor, so helps in differentiating residual tumor from cancer free cervix.
Keywords: Carcinoma of cervix; Chemoradiotherapy; Diffusion weighted MRI; Dynamic contrast enhanced MRI; Time intensity curve.
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