Session Item

The present study was conducted to evaluate disease and response to treatment in  cancer cervix patients undergoing chemoradiation, using  Functional MRI and Apparent Diffusion Coefficient (ADC) mapping. 

Present prospective study included 38 histopathologically proven patients. All patients underwent MRI before external radiotherapy (EBRT), before intracavitary application (ICR) and 3 months after treatment completion. Along with regular MRI sequences each patient underwent functional MRI, wherein DWI (Diffusion Weighted Imaging) and DCE (Dynamic Contrast Enhanced) were done. ADC maps were generated automatically with manufacturer’s software. ADC values in the tumours were documented using manual placement of regions-of-interest (ROIs) by two radiologists on pre-, mid- and post-treatment scans. The ROIs in tumours were drawn to include at least 3/4^th tumour possible in all images having visible tumour. In complete regression, ROIs were drawn over projected area of previously documented tumour bulk. On pre-ICR evaluation, patients without and with residual disease were labeled as Group-1 and Group-2, respectively.

On pre-ICR MRI, 26/38(72.72%) patients fitted into Group-1 and 12/38(27.28%) into Group-2. Three months post-treatment, all patients had complete response, both clinical and radiological.

The pre-treatment Mean ADC (MADC) value was 0.8441±0.1064x10^-3 m²/s, with mean as well as maximum and minimum values increasing after EBRT and further after treatment completion. 

Whereas, baseline MADC was higher, both Mean Blood Flow(MBF) and Mean Blood Volume(MBV) were lower in Group-1. 

Although there was no significant difference in the pre-EBRT values of MADC, MBF and MBV, there was significant difference in pre-ICT and post-treatment values of these, between Groups 1&2.

With regard to percentage change in MADC, 13/26(50%) patients in Group-1 and 5/12(41.6%) patients in Group-2 had >30% increment (p=0.089). Significant difference in MADC of mid-treatment values was significant for patients with and without vaginal involvement (p=0.037), and of mid and post-treatment values for patients with or without bladder involvement (p=0.005 and p<0.001, respectively). 

The percentage change of both MBF and MBV, between pre-ICT and post-treatment values was significantly higher in Group-1. 

With regard to percentage change in MBF, 23/26(88.46%) Group-1 patients and 2/12(16.67%) Group-2 patients, had >60% decrement (p<0.001). 25/26(96.15%) Group-1 patients of and 5/12(41.6%) Group-2 patients, had >50% decrement in MBV(p<0.001).

With help of Functional MRI, tumour response can be assessed by values of and percentage changes of ADC. The percentage increase of ADC with treatment reflected the disease outcome. Blood Flow and Blood Volume could serve as markers of Hypoxia and can predict response to radiotherapy. Use of functional MRI may act as an important tool for assessing tumour response in carcinoma cervix by studying both anatomical and physiological parameters.