Quantitative Diffusion and Perfusion MRI as Response Predictor in Cervical Squamous Cell Carcinoma Treated with CCRT

Abstract This article evaluates the treatment response to chemoradiotherapy in locally advanced cervical squamous cell carcinoma using quantitative diffusion and perfusion magnetic resonance imaging (MRI) parameters and studies their role as response predictors. Patients diagnosed with locally advanced squamous cell carcinoma cervix (LASCC) and planned for concurrent chemoradiotherapy (CCRT) were included. Diffusion-weighted imaging (DWI) and perfusion MRI were performed both pre- and post-CCRT. Statistical analysis of quantitative DWI (apparent diffusion coefficient ADC) and perfusion MRI parameters (Ktrans, Kep, Ve, Vp, SImax, SIrel, and time-to-peak) was done to assess the tumor regression rate and compare them between the residual and nonresidual groups. All the MR perfusion parameters showed statistically significant results (p < 0.05) for the evaluation of the treatment response of LASCC to CCRT using the obtained cutoff values, except for Vp. The highest diagnostic performance was of pretreatment Kep with a sensitivity of 100%, specificity of 80%, positive predictive value of 54.5%, negative predictive value of 100%, area under the curve of 0.833, and diagnostic accuracy of 74.2%. However, ADC values did not show any significant result for the evaluation of the treatment response of LASCC. Quantitative MR perfusion parameters have a significant role in evaluating treatment response to CCRT in LASCC.