PET/MRI in Cervical Cancer: Associations Between Imaging Biomarkers and Tumor Stage, Disease Progression, and Overall Survival

• Published in: Journal of magnetic resonance imaging Vol. 53; no. 1; pp. 305 - 318
• Main Authors: Shih, I‐Lun, Yen, Rouh‐Fang, Chen, Chi‐An, Cheng, Wen‐Fang, Chen, Bang‐Bin, Chang, Yu‐Hsuan, Cheng, Mei‐Fang, Shih, Tiffany Ting‐Fang
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-01-2021; Wiley Subscription Services, Inc
• Subjects: Biomarkers; Cancer; Cervical cancer; Cervix; Diffusion coefficient; Disease Progression; Evaluation; Female; Field strength; Fluorodeoxyglucose F18; Glycolysis; Hazard assessment; Health hazards; Humans; Image analysis; Image processing; imaging biomarker; Magnetic Resonance Imaging; Medical imaging; overall survival; PET/MRI; Population studies; Positron emission; Positron emission tomography; Prognosis; progression‐free survival; Prospective Studies; Radiopharmaceuticals; Retrospective Studies; Statistical analysis; Statistical models; Statistical tests; Subgroups; Survival; Survival analysis; Tomography; Tumor Burden; Tumors; Uterine Cervical Neoplasms - diagnostic imaging; overall survival; PET/MRI; imaging biomarker; cervical cancer; progression-free survival
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.27311

Background
Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression‐free survival (PFS) and overall survival (OS) merit further investigation.
Purpose
To evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer.
Study Type
Prospective cohort study.
Population
In all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis.
Field Strength/Sequence
3.0T integrated PET/MRI including diffusion‐weighted echo‐planar imaging (b = 50 and 1000 s/mm2) and [18F]fluorodeoxyglucose PET.
Assessment
Two radiologists measured the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors.
Statistical Tests
A Mann–Whitney U‐test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival.
Results
In advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADCmin was significantly lower and MTV, TLG, MTV/ADCmin, and TLG/ADCmin were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADCmin was significantly lower and MTV and MTV/ADCmin were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUVmax was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADCmin was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADCmin was a predictor of PFS in stage I disease (P = 0.003), ADCmin (P = 0.038), and MTV (P = 0.020) in stage II, SUVmax (P = 0.006), and TLG (P = 0.006) in stage IV; and ADCmin was a predictor of OS in stage III disease (P = 0.008).
Data Conclusion
PET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUVmax and ADCmin are independent predictors of PFS and OS, respectively.
Level of Evidence
1
Technical Efficacy
3