This poster is published under an
open license. Please read the
disclaimer for further details.
Keywords:
Genital / Reproductive system female, Pelvis, Oncology, MR, MR-Diffusion/Perfusion, Diagnostic procedure, Chemotherapy, Brachytherapy, Cancer, Multidisciplinary cancer care, Neoplasia
Authors:
P. Kala, D. V. Bhargavi, R. Avantsa, G. Narayan; Bangalore/IN
DOI:
10.1594/ecr2015/B-0665
Methods and materials
Study was approved by an independent ethical committee.
30 patients with carcinoma cervix,
who underwent chemo radiation therapy were examined with pelvic MRI and DWI before initiation of chemo radiation,
after completing external beam radiotherapy and following completion of brachytherapy with a 1.5-T MR scanner and a 16 channel torso coil.
MR Imaging protocol consisted of pulse sequences,
with and without contrast,
with parameters as shown in Table 1&2.
Table 1
Parameters
|
T1
|
T2
|
T2 CERVIX (axis of cervix)
|
|
AXIAL
|
AXIAL
|
CORONAL
|
SAGITTAL
|
AXIAL SPAIR
|
AXIAL
|
CORONAL
|
SAGITTAL
|
TR/TE(ms)
|
10/4.6
|
420/80
|
570/80
|
3500/90
|
469/80
|
3500/90
|
3500/80
|
3500/90
|
Slice thickness(mm)
|
7
|
7
|
7
|
3
|
7
|
3
|
3
|
3
|
Field of view(AP-mm)
|
256
|
305
|
119
|
200
|
305
|
260
|
79
|
200
|
Interslice gap (mm)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
Matrix
|
208X127
|
252X202
|
300X312
|
268X175
|
252X202
|
368X295
|
256X189
|
268X172
|
Table 2
Parameters
|
T1 POST GAD
|
DWI(b0&b1000)
|
|
SAGITTAL
|
CORONAL
|
AXIAL
|
TR/TE(ms)
|
597/10
|
691/10
|
1296/59
|
Slice thickness(mm)
|
3.2
|
3.2
|
5
|
Field of view(AP-mm)
|
200
|
200
|
305
|
Interslice gap (mm)
|
1
|
1
|
1
|
Matrix
|
276X165
|
320X152
|
124 X100
|
Image analysis:
Treatment response was determined by comparing pre and post treatment
conventional MR images.
The ADC values from diffusion sequences before,
during and after chemo radiotherapy were measured and compared.
The apparent diffusion coefficient (ADC) values in the tumour ,
normal gluteus muscle and normal rectal mucosa were automatically calculated by manual placement of the region of interest (ROI) .
The tumour size and tumour volume were measured at each therapeutic time based on T2W images.
Final or mid treatment tumour size or volume response (%) were calculated using the equation: {pre-diameter (volume) – post-diameter(volume)}/ pre-diameter(volume) x 100 or {pre-diameter(volume) – mid-diameter(volume)}/ pre-diameter(volume) x 100 .
Final or mid treatment change in tumour ADC values (%) were calculated using the equation: (post ADC - pre ADC)/ pre ADC x 100 or (mid ADC - pre ADC)/ pre ADC x 100.
Analysis of variance (ANOVA) and Student t test has been used to compare the ADC,
size and volume parameters between the different response groups. The response to treatment was determined by comparing pretreatment and post treatment conventional MR images.
Based on the response to treatment patients were categorized into complete,
good and partial response groups.
Patients with no residual tumour were considered as complete response group.
Patients with more than 60% of final tumour size response were concluded as good response group and those with less than 60% as partial response group.