Cervical carcinoma is the third most common gynecologic malignancy with an approximate 85% of the global burden is from developing countries, where it accounts for 13% of all female cancers [1, 2]. Even though there have been significant advances in surgical techniques, radiotherapy, and chemotherapy, there are still approximately 30% of these patients with invasive cervical carcinoma who die as a result of residual or recurrent disease .
As the prognosis and survival has improved with advance in the management of these patients with additional radiation therapy or chemotherapy, early detection of recurrent cervical carcinoma is imperative. The follow-up after primary ...view middle of the document...
2. To compare the pre and post therapy changes in the imaging findings for evaluating its role in predicting response.
MATERIALS & METHODS:
Patients and treatment:
The study was approved by our institutional review board and the hospital ethics committee. From Oct 2009 to March 2010, 45 women with previously operated carcinoma cervix were recruited in the study. Patients who had a final histopathology diagnosis and no contraindications to chemotherapy/ radiotherapy or any MRI contraindications and or were lost to follow up were excluded. 30 patients were included for the final analysis. 2 years follow-up was performed all the surviving patients was performed (last follow-up November 2012)
All patients underwent baseline CT and MPMRI. Patients with histopathological diagnoses of recurrence received image guided intensity modulated radiotherapy (IG-IMRT) with concomitant chemotherapy. IG-IMRT schedule consisted of 50 Gy/25 fractions delivered over 5 weeks along with concurrent weekly cisplatin (40 mg/m 2). Response assessment and brachytherapy preplanning MRI were performed within a week of completing IG-IMRT. Subsequently, all patients underwent template guided high dose rate pelvic interstitial brachytherapy (20 Gy/5 #/ 3 days).
MR Imaging Methodology:
MRI protocol was standardized in all cases. MRI was performed on the 3.0-T system (GE Signa 3.0T HDx, GE Healthcare, Milwaukee, WI) using a torso phased-array with the patient in the supine position. We approximately used 60 ml of bacteriostatic ultrasound jelly to distend the vaginal lumen. The various imaging parameters are summarized in Table 1.
Qualitative and Quantitative image analysis for assessment of response.
MR imaging data sets were prospectively evaluated by two radiologists. MR imaging data sets were assessed in consensus, and both reviewers were blinded to histopathology findings. Based on the MR signal intensity pattern the lesions were categorized, into three categories:
1. Normal (no focal soft-tissue nodule);
2. Indeterminate (soft-tissue nodule hypointense or isointense to muscle on T1-weighted sequences and mildly hyperintense to muscle on T2-weighted sequences);
3. Recurrent (soft-tissue nodule hypointense on T1-weighted sequence and markedly hyperintense or heterogeneous on T2-weighted sequences).
For MPMRI assessment of various functional sequences, data were transferred to a GE Advantage Workstation, and manually drawn regions of interest (ROIs) around the areas of interest were analyzed using functool (GE Healthcare). The results of MPMRI were individually analyzed on each functional sequence.
Diffusion-MR imaging analysis was done by quantitative analysis of the data acquired from DW imaging and pixel-by-pixel ADC maps were derived generated by using software provided by the MR imaging system manufacturer (GE Healthcare). Obvious areas of air or fluid from central ulceration were excluded.
Dynamic contrast-enhanced images were obtained after administration of a...