Role of ADC values in assessing clinical response and identifying residual disease post-chemo radiation in uterine cervix cancer

Autor: Ankush Jajodia, Vivek Mahawar, Arvind K Chaturvedi, Avinash Rao, Rishu Singla, Swarupa Mitra, Sumit Goyal, Sikha Kesan, Sunil Pasricha, Udip Maheshwari, Rupal Tripathi, Venkata Pradeep Babu Koyyala
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Indian Journal of Radiology and Imaging, Vol 29, Iss 04, Pp 404-411 (2019)
Druh dokumentu: article
ISSN: 0971-3026
1998-3808
DOI: 10.4103/ijri.IJRI_339_19
Popis: Objectives: To evaluate the role of apparent diffusion coefficient (ADC) values in assessing response after chemo-radiotherapy in cervix cancer and investigate the utility of ADC as a tool to identify residual disease, after the treatment completion. Methods: A prospective study was done in 100 patients with histopathologically proven cancer of uterine cervix who were classified as either complete response (CR) or residual disease posttreatment. MRI was done pretreatment and after 6 weeks post-treatment with chemo-radiation. 53 patients among the cohort also underwent a fluoro-deoxy glucose positron-emission computed tomography (FDG-PET CT). ADC values, change in ADC values, and metabolic activity obtained from FDG-PET CT were correlated with clinical outcome, and statistical analysis was done to determine the better tool for assessing response evaluation between ADC and PET-CT. Results: Residual lesions have notably lower ADC value than that of posttreatment changes. The mean ADC values of residual tumors: 1.26 ± 0.238 × 10−3 mm2/s and mean ADC values of lesions due to posttreatment changes: 1.540 ± 0.218 × 10−3 mm2/s (statistically significant difference between malignant and posttreatment lesions, P < 0.05). ADC has 67% sensitivity, 83% specificity, 35% positive predictive values (PPV), 95% negative predictive values (NPV), and 81% accuracy in differentiating residual disease from post treatment changes. PPV, NPV, sensitivity, and specificity with PET-CT were 93%, 89%, 98%, and 73%, respectively. PPV, NPV, sensitivity, and specificity of contrast MRI were 16%, 91%, 58%, and 59%, respectively. Conclusion: Diffusion imaging differentiates residual cervix malignancies from post treatment changes based on ADC values and can be a promising and evocative biomarker. Complimentary use of ADC and PET/CT may increase diagnostic confidence.
Databáze: Directory of Open Access Journals
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