The value of diffusion-weighted magnetic resonance imaging in assessing the response of locally advanced cervical cancer to neoadjuvant chemotherapy.

Objective: The objective of this study was to investigate whether magnetic resonance diffusion-weighted imaging (DWI) of locally advanced cervical cancer (LACC) both in the sagittal and axial planes could be used to assess the response of LACC to neoadjuvant chemotherapy (NACT).

Methods: Thirty women with LACC received conventional magnetic resonance imaging and DWI at 3 different times (before NACT, 2 weeks after the first NACT, and 2 weeks after the second NACT). Treatment response was determined according to the change in tumor size 2 weeks after the second NACT, and they were classified as the effective group and the ineffective group. The apparent diffusion coefficients (ADCs) were compared between 2 imaging planes, and dynamic changes in ADCs were observed in different chemotherapy-sensitive groups and imaging planes. One-way analysis of variance was calculated between those ADC parameters and tumor response.

Results: The effective chemotherapy rate was 76.67%. Apparent diffusion coefficient values of the axial plane at 3 different times were 0.88 (SD, 0.08) × 10⁻³ mm²/s, 0.96 (SD, 0.10) × 10⁻³ mm²/s, and 1.19 (SD, 0.11) × 10⁻³ mm²/s, respectively. Meanwhile, ADC values of the sagittal planes were 0.89 (SD, 0.09) × 10⁻³ mm²/s, 0.97 (SD, 0.12) × 10⁻³ mm²/s, and 1.19 (SD, 0.12) × 10⁻³ mm²/s at 3 different stages. There were no statistical differences between the ADC values of the 2 planes at 3 different times (P = 0.927, P = 0.863, P = 0.946). Apparent diffusion coefficients 2 weeks after the first NACT were significantly increased compared with those before chemotherapy both in the axial and sagittal planes (P = 0.003, P = 0.012). In the ineffective group, ADCs 2 weeks after the first NACT were not statistically higher than those before chemotherapy (axial planes, P = 0.694; sagittal planes, P = 0.900). After 2 weeks of the first NACT, ADCs in both planes were obviously increased in the effective group than those in the ineffective group (P = 0.043, P = 0.022).

Conclusions: The axial and sagittal DWI may detect the changes in LACC after therapy. Apparent diffusion coefficient values measured both in the 2 planes may be used to evaluate the response of LACC to NACT.