Association between MRI histogram features and treatment response in locally advanced cervical cancer treated by chemora
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ONCOLOGY
Association between MRI histogram features and treatment response in locally advanced cervical cancer treated by chemoradiotherapy Jose Angelo Udal Perucho 1 & Mandi Wang 1 & Ka Yu Tse 2 & Philip Pun Ching Ip 3 & Steven Wai Kwan Siu 4 & Hextan Yuen Sheung Ngan 2 & Pek-Lan Khong 1 & Elaine Yuen Phin Lee 1 Received: 9 April 2020 / Revised: 14 July 2020 / Accepted: 20 August 2020 # European Society of Radiology 2020
Abstract Objective To examine the associations of histogram features of T2-weighted (T2W) images and apparent diffusion coefficient (ADC) with treatment response in locally advanced cervical cancer (LACC) following concurrent chemoradiotherapy (CCRT). Materials and methods Fifty-eight patients who underwent a 4-week CCRT regimen with MRI prior to treatment (preCCRT) and after treatment (post-CCRT) were retrospectively analysed. Histogram features were calculated from volumes of interest (VOIs) from one radiologist on T2W images and ADC maps. VOIs from two radiologists were used to assess observer repeatability in delineation and feature values at both time-points with the Dice similarity coefficient (DSC) and intraclass correlation coefficient (ICC). Treatment response was defined as a 90% reduction in tumour volume. Paired Mann-Whitney U tests were used to determine if features changed significantly between examinations. Two-sample Mann-Whitney U tests were used to identify features that were significantly different between response groups. Receiver operating characteristic (ROC) analysis was done on significantly different MRI features between treatment response groups. Results Pre-CCRT delineation and feature repeatability were generally good (DSC > 0.700; ICC > 0.750). Post-CCRT repeatability was low (DSC < 0.700; ICC < 0.750), but ADC mean and percentiles retained good ICC scores. All features, except for T2WKurtosis, significantly changed between examinations. Post-CCRT ADC50 was the only feature that demonstrated both good observer variability and significant differences between treatment response groups (p = 0.036) and had an AUC of 0.701 with a cut-off of 1.357 × 10−6 mm2/s. Conclusion ADC and T2W histogram features could be used to track changes in LACC tumours undergoing CCRT. Post-CCRT ADC50 was associated with treatment response with good observer repeatability. Key Points • Pre-treatment tumour delineation and histogram feature values had good observer repeatability, while these were less repeatable at post-treatment. • MRI histogram analysis could be used to track changes in the tumour as it undergoes concurrent chemoradiotherapy. • Post-treatment median ADC was associated with treatment response and had good repeatability. Keywords Uterine cervical neoplasms . Chemoradiotherapy . Observer variation . Magnetic resonance imaging . Diffusion magnetic resonance imaging
* Elaine Yuen Phin Lee [email protected] 1
Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong SAR, People’s Republic of China
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