Diffusion-weighted MRI and PET/CT reproducibility in epithelial ovarian cancers during neoadjuvant chemotherapy.

Abstract

PURPOSE:

To 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 METHODS:

Ten 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).

RESULTS:

For 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).

CONCLUSION:

While both modalities demonstrated high reproducibility at baseline, only SUV-max, SUL-peak, SUV-mean and their changes maintained high reproducibility during chemotherapy.

• Authors: Amandine Crombé, Lisa Gauquelin, Stéphanie Nougaret, Marine Chicart, Marina Pulido, Anne Floquet, Frédéric Guyon, Sabrina Croce, Michèle Kind, Anne-Laure Cazeau
• Journal: Diagnostic and interventional imaging (Diagn Interv Imaging) Vol. 102 Issue 10 Pg. 629-639 (Oct 2021) ISSN: 2211-5684 [Electronic] France
• PMID: 34112625 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2021 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Chemical References

• Radiopharmaceuticals

Topics

• Adult
• Aged
• Carcinoma, Ovarian Epithelial (diagnostic imaging, drug therapy)
• Diffusion Magnetic Resonance Imaging
• Female
• Humans
• Middle Aged
• Neoadjuvant Therapy
• Ovarian Neoplasms (diagnostic imaging, drug therapy)
• Positron Emission Tomography Computed Tomography
• Positron-Emission Tomography
• Prospective Studies
• Radiopharmaceuticals
• Reproducibility of Results