Intravoxel incoherent motion MRI assessment of chemoradiation‐induced pelvic bone marrow changes in cervical cancer and correlation with hematological toxicity

摘要

Purpose To investigate bone marrow changes after chemoradiation (CRT) using intravoxel incoherent motion magnetic resonance imaging (IVIM‐MRI) and correlate imaging changes with hematological toxicity (HT) in patients with locally advanced cervical cancer. Materials and Methods Thirty‐nine patients with newly diagnosed cervical cancer were prospectively recruited for two sequential 3.0T IVIM‐MRI studies: before treatment (MRI‐1) and 3–4 weeks after standardized CRT (MRI‐2). The irradiated pelvic bone marrow was outlined as the regions of interest to derive the true diffusion coefficient (D) and perfusion fraction ( f ) based on a biexponential model. The apparent coefficient diffusion (ADC) was derived using the monoexponential model. Changes in these parameters between MRI‐1 and MRI‐2 were calculated as ΔD, Δ f , and ΔADC. HT was defined accordingly to NCI‐CTCAE (v. 4.03) of grade 3 and above. Statistical analysis was performed using Mann–Whitney U ‐test. Results The median age of patients was 54 years old (range 27–83 years old); 14 patients suffered from HT. Early bone marrow changes (3–4 weeks) of ΔD showed a significant difference between HT and non‐HT groups (6.4?±?19.7% vs. –6.4?±?19.4%, respectively, P ?=?0.041). However, no significant changes were noted in Δ f (3.7?±?13.3% vs. 1.5?±?12.5% respectively, P ?=?0. 592) and ΔADC (5.5?±?26.3% vs. –3.3?±?27.0% respectively, P ?=?0.303) between the HT and non‐HT groups. Δ f increased insignificantly for both groups. Conclusion ΔD was the only significant parameter to differentiate early cellular environment changes in bone marrow after CRT, suggestive that ΔD was more sensitive than Δ f and ΔADC to reflect the underlying microenvironment injury. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1491–1498.