Combined dynamic DCE-MRI and diffusion-weighted imaging to evaluate the effect of neoadjuvant chemotherapy in cervical cancer

Purpose: To prospectively investigate changes in quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in patients with cervical cancer before and after neoadjuvant chemotherapy (NACT). Methods: Thirty-eight patients with cervical cancer underwent DCE-MRI and DWI 1 week before and 4 weeks after NACT. The patients were classified into 2 groups: significant reaction (sCR) group and the non-sCR group. DCE-MRI parameters and ADC values were measured and compared between the 2 groups. Results: Before NACT, the mean K-trans value was higher, but the mean V-e was lower, in the sCR group compared with the non-sCR group; these differences were statistically significant (p<0.05). After NACT, the mean K-trans value and the delta (i.e., changed) value of K-trans were significantly lower in the sCR group compared with the non-sCR group (p<0.05). However, the mean ADC and the delta value of the mean ADC between the 2 groups were slightly higher in the sCR group compared with the non-sCR group (p<0.05). The area under the curve of pre-mean K-trans, DKtrans, and pre-mean K-trans combined with post-mean ADC values were 0.801, 0.955, and 0.878, respectively (p<0.05). The optimal cutoff values for distinguishing sCR from non-sCR were pretreatment K-trans (0.7020 min(-1)) and DKtrans (0.0437 min(-1)). Conclusions: Quantitative parameters (pre-mean K-trans, DKtrans, and pre-mean K-trans) combined with post-mean ADC could predict treatment efficacy more precisely. However, quantitative DCE-MRI combined with DWI could not significantly improve prognostic efficacy.