Diffusion-weighted MRI and PET/CT reproducibility in epithelial ovarian cancers during neoadjuvant chemotherapy |
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Abstract: | PurposeTo investigate the reproducibility of diffusion-weighted (DW) MRI and 18F-Fluorodeoxyglucose (18F-FDG)-Positron emission tomography/CT (PET/CT) in monitoring response to neoadjuvant chemotherapy in epithelial ovarian cancer.Materials and methodsTen women (median age, 67 years; range: 41.8–77.3 years) with stage IIIC-IV epithelial ovarian cancers were included in this prospective trial (NCT02792959) between 2014 and 2016. All underwent initial laparoscopic staging, four cycles of carboplatine-paclitaxel-based chemotherapy and interval debulking surgery. PET/CT and DW-MRI were performed at baseline (C0), after one cycle (C1) and before surgery (C4). Two nuclear physicians and two radiologists assessed five anatomic sites for the presence of ≥ 1 lesion. Target lesions in each site were defined and their apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV-max), SUV-mean, SUL-peak, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were monitored (i.e., 10 patients × 5 sites × 3 time-points). Their relative early and late changes were calculated. Intra/inter-observer reproducibilities of qualitative and quantitative analysis were estimated with Kappa and intra-class correlation coefficients (ICCs).ResultsFor both modalities, inter- and intra-observer agreement percentages were excellent for initial staging but declined later for DW-MRI, leading to lower Kappa values for inter- and intra-observer variability (0.949 and 1 at C0, vs. 0.633 and 0.643 at C4, respectively) while Kappa values remained > 0.8 for PET/CT. Inter- and intra-observer ICCs were > 0.75 for SUV-max, SUL-peak, SUV-mean and their change regardless the time-point. ADC showed lower ICCs (range: 0.013–0.811). ANOVA found significant influences of the evaluation time, the measurement used (ADC, SUV-max, SUV-mean, SUV-max, SUL-peak, MTV or TLG) and their interaction on ICC values (P = 0.0023, P< 0.0001 and P =0.0028, respectively).ConclusionWhile both modalities demonstrated high reproducibility at baseline, only SUV-max, SUL-peak, SUV-mean and their changes maintained high reproducibility during chemotherapy. |
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Keywords: | Carcinoma, Ovarian epithelial Diffusion-weighted magnetic resonance imaging Positron-emission tomography/Computed tomography Reproducibility of results Biomarkers Tumors 18F-FDG" },{" #name" :" keyword" ," $" :{" id" :" kw0045" }," $$" :[{" #name" :" text" ," _" :" 18F-Fluorodeoxyglucose ADC" },{" #name" :" keyword" ," $" :{" id" :" kw0055" }," $$" :[{" #name" :" text" ," _" :" Apparent diffusion coefficient ANOVA" },{" #name" :" keyword" ," $" :{" id" :" kw0065" }," $$" :[{" #name" :" text" ," _" :" Analysis of variance C0" },{" #name" :" keyword" ," $" :{" id" :" kw0075" }," $$" :[{" #name" :" text" ," _" :" Baseline evaluation C1" },{" #name" :" keyword" ," $" :{" id" :" kw0085" }," $$" :[{" #name" :" text" ," _" :" Evaluation performed after 1st cycle of chemotherapy C4" },{" #name" :" keyword" ," $" :{" id" :" kw0095" }," $$" :[{" #name" :" text" ," _" :" Evaluation performed after 4th cycle of chemotherapy CE" },{" #name" :" keyword" ," $" :{" id" :" kw0105" }," $$" :[{" #name" :" text" ," _" :" Contrast-enhanced CI" },{" #name" :" keyword" ," $" :{" id" :" kw0115" }," $$" :[{" #name" :" text" ," _" :" Confidence interval dC0C1" },{" #name" :" keyword" ," $" :{" id" :" kw0125" }," $$" :[{" #name" :" text" ," _" :" Relative changes from C0 to C1 dC0C4" },{" #name" :" keyword" ," $" :{" id" :" kw0135" }," $$" :[{" #name" :" text" ," _" :" Relative changes from C0 to C4 DWI" },{" #name" :" keyword" ," $" :{" id" :" kw0145" }," $$" :[{" #name" :" text" ," _" :" Diffusion-weighted imaging ICC" },{" #name" :" keyword" ," $" :{" id" :" kw0155" }," $$" :[{" #name" :" text" ," _" :" intra-class correlation coefficient LOA" },{" #name" :" keyword" ," $" :{" id" :" kw0165" }," $$" :[{" #name" :" text" ," _" :" Limits of agreement MTV" },{" #name" :" keyword" ," $" :{" id" :" kw0175" }," $$" :[{" #name" :" text" ," _" :" Metabolic tumor volume PCI" },{" #name" :" keyword" ," $" :{" id" :" kw0185" }," $$" :[{" #name" :" text" ," _" :" Peritoneal carcinomatosis index PET/CT" },{" #name" :" keyword" ," $" :{" id" :" kw0195" }," $$" :[{" #name" :" text" ," _" :" Positron emission tomography fused with CT ROI" },{" #name" :" keyword" ," $" :{" id" :" kw0205" }," $$" :[{" #name" :" text" ," _" :" Region of interest SD" },{" #name" :" keyword" ," $" :{" id" :" kw0215" }," $$" :[{" #name" :" text" ," _" :" Standard deviation SUL-peak" },{" #name" :" keyword" ," $" :{" id" :" kw0225" }," $$" :[{" #name" :" text" ," _" :" Peak standardized uptake value corrected for lean body mass SUV-max" },{" #name" :" keyword" ," $" :{" id" :" kw0235" }," $$" :[{" #name" :" text" ," _" :" Maximum standardized uptake value SUV-mean" },{" #name" :" keyword" ," $" :{" id" :" kw0245" }," $$" :[{" #name" :" text" ," _" :" Mean standardized uptake value TLG" },{" #name" :" keyword" ," $" :{" id" :" kw0255" }," $$" :[{" #name" :" text" ," _" :" Total lesion glycolysis |
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