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. 2016 Oct 22;11(1):141.
doi: 10.1186/s13014-016-0715-6.

Apparent diffusion coefficient histogram shape analysis for monitoring early response in patients with advanced cervical cancers undergoing concurrent chemo-radiotherapy

Jie Meng  1 , Lijing Zhu  2 , Li Zhu  1 , Huanhuan Wang  1 , Song Liu  1 , Jing Yan  2 , Baorui Liu  2 , Yue Guan  3 , Yun Ge  4 , Jian He  5 , Zhengyang Zhou  6 , Xiaofeng Yang  7
Affiliations

Apparent diffusion coefficient histogram shape analysis for monitoring early response in patients with advanced cervical cancers undergoing concurrent chemo-radiotherapy

Jie Meng et al. Radiat Oncol. .

Abstract

Background: To explore the role of apparent diffusion coefficient (ADC) histogram shape related parameters in early assessment of treatment response during the concurrent chemo-radiotherapy (CCRT) course of advanced cervical cancers.

Methods: This prospective study was approved by the local ethics committee and informed consent was obtained from all patients. Thirty-two patients with advanced cervical squamous cell carcinomas underwent diffusion weighted magnetic resonance imaging (b values, 0 and 800 s/mm2) before CCRT, at the end of 2nd and 4th week during CCRT and immediately after CCRT completion. Whole lesion ADC histogram analysis generated several histogram shape related parameters including skewness, kurtosis, s-sDav, width, standard deviation, as well as first-order entropy and second-order entropies. The averaged ADC histograms of 32 patients were generated to visually observe dynamic changes of the histogram shape following CCRT.

Results: All parameters except width and standard deviation showed significant changes during CCRT (all P < 0.05), and their variation trends fell into four different patterns. Skewness and kurtosis both showed high early decline rate (43.10 %, 48.29 %) at the end of 2nd week of CCRT. All entropies kept decreasing significantly since 2 weeks after CCRT initiated. The shape of averaged ADC histogram also changed obviously following CCRT.

Conclusions: ADC histogram shape analysis held the potential in monitoring early tumor response in patients with advanced cervical cancers undergoing CCRT.

Keywords: Apparent diffusion coefficient; Cervical cancer; Diffusion-weighted magnetic resonance imaging; Histogram shape; Treatment response.

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Figures

Fig. 1
Fig. 1
The variation trends of four kinds of ADC histogram parameters during concurrent chemo-radiotherapy (CCRT) in patients with cervical cancers. a, b Skewness and kurtosis show a quick and significant decrease from pre-CCRT to the end of 4th week of CCRT. c, d First-order entropy and entropy(H)mean show no significant early change followed by a progressive and remarkable decrease after 2nd week of CCRT. *: P < 0.05. time point 1: before CCRT; time point 2: at the end of 2nd week of CCRT; time point 3: at the end of 4th week of CCRT; time point 4: immediately after CCRT completion
Fig. 2
Fig. 2
Dynamic changes of the averaged apparent diffusion coefficient (ADC) histogram and the corresponding histogram curve of 32 patients with advanced cervical cancers during concurrent chemo-radiotherapy (CCRT) (with a bin size of 50 × 10−6 mm2/s). a The averaged ADC histogram changes continuously during the course of CCRT. b The corresponding histogram curve gradually moves toward the right and turns into a more symmetrical shape with conspicuous descending peak as treatment continues. time point 1: before CCRT; time point 2: at the end of 2nd week of CCRT; time point 3: at the end of 4th week of CCRT; time point 4: immediately after CCRT completion
See this image and copyright information in PMC

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