The addition of diffusion weighted imaging to the conventional magnetic resonance imaging protocol allows precise assessment of uterine cervical carcinoma,
from lesion detection and characterization to staging of tumor.
When used in conjunction with apparent diffusion coefficient mapping ,
diffusion weighted imaging is a powerful tool with the potential for early and accurate prediction ,
assessment and monitoring of response to chemo radiation therapy.
Based on our data we found that:
Most of the patients with uterine cervical carcinoma are in the age group of 51-60 years and belong to FIGO stage II B.
The uterine cervical tumor demonstrates restriction on DW images and significantly lower values on ADC maps.
There was a serial increase in the tumor ADC values along with corresponding decrease in the tumor diameters and volumes during the chemo radiation therapy.
A significant and moderate positive linear correlation was found between the tumor ADCs and the final size response and volume response at pre-Tx,
mid-Tx and post –Tx.
The pre ,
mid and post treatment mean tumor ADCs showed significant differences between response groups being larger in the complete response (CR) and good response(GR) groups than that of partial response (PR) group.
This suggests that tumors with high diffusion values will respond better to therapy than low diffusion values.
A significant and moderate positive correlation was found between mid –Tx tumor ADC changes and the final tumor size and volume responses ,
indicating that patients with greater mid –Tx tumor ADC changes respond better to therapy than patients with lesser ADC changes.
The mid and post treatment tumor diameters and volumes compared to the pretreatment tumor diameter and volume showed significant difference between the response groups being lower in complete and good response groups than that of partial response (PR) group .Hence the patients with lower mid treatment tumor diameter and volumes show better response to therapy.
The mid and final size and volume % responses showed significant differences between response groups being greater in the complete response (CR) and good response(GR) groups than that of partial response (PR) group.
This indicates that patients with greater mid size and volume responses respond better to therapy.
There was no significant difference in tumor ADC values when evaluated for other parameters like parametrial and vaginal invasion,
lymph nodal involvement and FIGO stage.
Hence ADC mapping is less useful in predicting the extension and staging of uterine cervical carcinoma.
There was no significant difference in tumor ADC values and % tumor ADC changes with the addition of neoadjuvant chemotherapy to the routine chemo radiotherapy protocol concluding that the neoadjuvant chemotherapy does not alter the treatment outcome in uterine cervical carcinoma.