Combined pre-treatment MRI and 18F-FDG PET/CT parameters as prognostic biomarkers in patients with cervical cancer Journal Article


Authors: Micco, M.; Vargas, H. A.; Burger, I. A.; Kollmeier, M. A.; Goldman, D. A.; Park, K. J.; Abu-Rustum, N. R.; Hricak, H.; Sala, E.
Article Title: Combined pre-treatment MRI and 18F-FDG PET/CT parameters as prognostic biomarkers in patients with cervical cancer
Abstract: Objective: To determine the associations of quantitative parameters derived from multiphase contrast-enhanced magnetic resonance imaging (CE-MRI), diffusion-weighted (DW) MRI and 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT) with clinico-histopathological prognostic factors, disease-free survival (DFS) and overall survival (OS) in patients with cervical cancer. Methods and materials: Our institutional review board approved this retrospective study of 49 patients (median age, 45 years) with histopathologically proven IB-IVB International Federation of Gynecology and Obstetrics (FIGO) cervical cancer who underwent pre-treatment pelvic MRI and whole-body 18F-FDG PET/CT between February 2009 and May 2012. Maximum diameter (maxTD), percentage enhancement (PE) and mean apparent diffusion coefficient (ADCmean) of the primary tumor were measured on MRI. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG) were measured on 18F-FDG PET/CT. Correlations between imaging metrics and clinico- histopathological parameters including revised 2009 FIGO stage, tumor histology, grade and lymph node (LN) metastasis at diagnosis were evaluated using the Wilcoxon rank sum test. Cox modeling was used to determine associations with DFS and OS. Results: Median follow-up was 17 months. 41 patients (83.6%) were alive. 8 patients (16.3%) died of disease. Progression/recurrence occurred in 17 patients (34.6%). Significant differences were observed in ADCmean, SUVmax, MTV and TLG according to FIGO stage (p < 0.001-0.025). There were significant correlations between ADCmean, MTV, TLG and LN metastasis (p = 0.017-0.032). SUVmax was not associated with LN metastasis. FIGO stage (p = 0.017/0.033), LN metastases (p = 0.001/0.020), ADCmean (p = 0.007/0.020) and MTV (p = 0.014/0.026) were adverse predictors of both DFS/OS. maxTD (p = 0.005) and TLG (p = 0.024) were adverse predictors of DFS. PE and SUVmax did not correlate with DFS or OS (p = 0.18-0.72). Conclusions: Quantitative parameters derived from pre-treatment DW-MRI (ADCmean) and from 18F-FDG PET/CT (MTV and TLG) were associated with high-risk features and may serve as prognostic biomarkers of survival in patients with cervical cancer. © 2014 Elsevier Ireland Ltd.
Keywords: survival; mri; pet/ct; cervical cancer; dwi; quantitative parameters
Journal Title: European Journal of Radiology
Volume: 83
Issue: 7
ISSN: 0720-048X
Publisher: Elsevier Ireland Ltd.  
Date Published: 2014-07-01
Start Page: 1169
End Page: 1176
Language: English
DOI: 10.1016/j.ejrad.2014.03.024
PROVIDER: scopus
PUBMED: 24767630
DOI/URL:
Notes: Eur. J. Radiol. -- Export Date: 8 July 2014 -- CODEN: EJRAD -- Source: Scopus
Altmetric Score
MSK Authors
  1. Evis Sala
    95 Sala
  2. Marisa A Kollmeier
    146 Kollmeier
  3. Kay Jung Park
    183 Park
  4. Hedvig Hricak
    333 Hricak
  5. Debra Alyssa Goldman
    97 Goldman
  6. Irene Andrea Burger
    10 Burger
  7. Maura Micco
    10 Micco