Predicting treatment response to concurrent chemoradiotherapy in squamous cell carcinoma of the cervix using amide proton transfer imaging and intravoxel incoherent motion imaging

Abstract

Purpose: The purpose of this study was to investigate whether amide proton transfer (APT) imaging and intravoxel incoherent motion (IVIM) imaging can predict tumor response to concurrent chemoradiotherapy (CCRT) in patients with squamous cell carcinoma of the cervix (SCCC).

Material and methods: Fifty-nine women (mean age, 54 years ± 10 [standard deviation] years; age range: 32-81 years) with pathologically confirmed SCCC underwent magnetic resonance imaging examination of the pelvis including APT and IVIM before concurrent chemoradiotherapy. They were divided into complete remission (CR) and non-CR groups according to therapeutic effect. APT values and IVIM-derived parameters were measured. Intra- and interobserver agreement for IVIM and APT parameters was assessed using intraclass correlation coefficient (ICC) The independent samples t-test was performed to compare the evaluated parameters between the two groups. Predictive performance for treatment response was evaluated by receiver operator characteristic (ROC) curve analysis.

Results: There were 38 and 21 patients in the non-CR and CR groups, respectively. Excellent interobserver and intraobserver agreement were obtained for all IVIM and APT parameters, with ICCs ranging from 0.844 to 0.962. Perfusion fraction (f) and APT values were lower in the CR group compared with the non-CR group (both P < 0.05). The combination of f and APT values showed good diagnostic performances in predicting response to concurrent chemoradiotherapy, with an area under the ROC curve of 0.852 (95% CI: 0.744-0.961), 79% sensitivity (95% CI: 63-90%), 90% specificity (95% CI: 70-99%) and 83% accuracy (95% CI: 71-92%).

Conclusion: APT and IVIM imaging may serve as noninvasive tools for predicting response to concurrent chemoradiotherapy in patients with SCCC.

Keywords: Amide proton transfer imaging; Carcinoma squamous cell; Cervical cancer; Intravoxel incoherent motion imaging; Magnetic resonance imaging; Pelvis.