Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

ONCORADIOLOGY
Year
: 2019  |  Volume : 29  |  Issue : 4  |  Page : 404--411

Role of ADC values in assessing clinical response and identifying residual disease post-chemo radiation in uterine cervix cancer


Ankush Jajodia1, Vivek Mahawar1, Arvind K Chaturvedi1, Avinash Rao1, Rishu Singla1, Swarupa Mitra2, Sumit Goyal3, Sikha Kesan4, Sunil Pasricha5, Udip Maheshwari3, Rupal Tripathi6, Venkata Pradeep Babu Koyyala3 
1 Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
2 Department of Radiation Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
3 Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
4 Department of Obstetrics and Gynecology, KEM Hospital, Mumbai, Maharashtra, India
5 Department of Histopathology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
6 Department of Research, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India

Correspondence Address:
Dr. Ankush Jajodia
Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini - 110 085, Delhi
India

Objectives: To evaluate the role of apparent diffusion coefficient (ADC) values in assessing response after chemo-radiotherapy in cervix cancer and investigate the utility of ADC as a tool to identify residual disease, after the treatment completion. Methods: A prospective study was done in 100 patients with histopathologically proven cancer of uterine cervix who were classified as either complete response (CR) or residual disease posttreatment. MRI was done pretreatment and after 6 weeks post-treatment with chemo-radiation. 53 patients among the cohort also underwent a fluoro-deoxy glucose positron-emission computed tomography (FDG-PET CT). ADC values, change in ADC values, and metabolic activity obtained from FDG-PET CT were correlated with clinical outcome, and statistical analysis was done to determine the better tool for assessing response evaluation between ADC and PET-CT. Results: Residual lesions have notably lower ADC value than that of posttreatment changes. The mean ADC values of residual tumors: 1.26 ± 0.238 × 10−3 mm2/s and mean ADC values of lesions due to posttreatment changes: 1.540 ± 0.218 × 10−3 mm2/s (statistically significant difference between malignant and posttreatment lesions, P < 0.05). ADC has 67% sensitivity, 83% specificity, 35% positive predictive values (PPV), 95% negative predictive values (NPV), and 81% accuracy in differentiating residual disease from post treatment changes. PPV, NPV, sensitivity, and specificity with PET-CT were 93%, 89%, 98%, and 73%, respectively. PPV, NPV, sensitivity, and specificity of contrast MRI were 16%, 91%, 58%, and 59%, respectively. Conclusion: Diffusion imaging differentiates residual cervix malignancies from post treatment changes based on ADC values and can be a promising and evocative biomarker. Complimentary use of ADC and PET/CT may increase diagnostic confidence.


How to cite this article:
Jajodia A, Mahawar V, Chaturvedi AK, Rao A, Singla R, Mitra S, Goyal S, Kesan S, Pasricha S, Maheshwari U, Tripathi R, Babu Koyyala VP. Role of ADC values in assessing clinical response and identifying residual disease post-chemo radiation in uterine cervix cancer.Indian J Radiol Imaging 2019;29:404-411


How to cite this URL:
Jajodia A, Mahawar V, Chaturvedi AK, Rao A, Singla R, Mitra S, Goyal S, Kesan S, Pasricha S, Maheshwari U, Tripathi R, Babu Koyyala VP. Role of ADC values in assessing clinical response and identifying residual disease post-chemo radiation in uterine cervix cancer. Indian J Radiol Imaging [serial online] 2019 [cited 2020 May 31 ];29:404-411
Available from: http://www.ijri.org/article.asp?issn=0971-3026;year=2019;volume=29;issue=4;spage=404;epage=411;aulast=Jajodia;type=0