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

Abstract

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/mm 2) and [18F]fluorodeoxyglucose PET. Assessment: Two radiologists measured the minimum and mean apparent diffusion coefficient (ADC min and ADC mean), maximum standardized uptake value (SUV max), 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), ADC min was significantly lower and MTV, TLG, MTV/ADC min , and TLG/ADC min were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADC min was significantly lower and MTV and MTV/ADC min were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUV max was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADC min was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADC min was a predictor of PFS in stage I disease (P = 0.003), ADC min (P = 0.038), and MTV (P = 0.020) in stage II, SUV max (P = 0.006), and TLG (P = 0.006) in stage IV; and ADC min 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. SUV max and ADC min are independent predictors of PFS and OS, respectively. Level of Evidence: 1 Technical Efficacy: 3

Added value of quantitative, multiparametric 18F-FDG PET/MRI in the locoregional staging of rectal cancer

“…In previous studies, mainly relying on PET/CT, the PET component often failed to provide additional locoregional staging information. In our quantitative analysis of the PET data, MTV was independently associated with higher T-stage, as well as with LARC, similar to what is known from other tumor entities, such as cervical or esophageal cancer [ 33 , 34 ]. Compared to MRI staging, MTV yielded an excellent sensitivity of 91.7% and specificity of 68.2% for LARC, significantly superior to anatomical MRI assessment.…”

18F-FDG PET/CT semi-quantitative parameters combined with SCC-Ag in predicting lymph node metastasis in stage I-II cervical cancer

“…Higher SUVmax values are often associated with a higher likelihood of metastatic spread to lymph nodes ( 21 ). Due to its susceptibility to noise and its inability to reflect the overall metabolic level of tumors, the SUVmax has limited value in predicting LNM or prognostic evaluation of cervical cancer ( 22 , 23 ). Additionally, physiological uptake of adjacent structures such as the ureter and bladder occasionally lead to increased FDG uptake in lymph nodes, or high FDG uptake in reactive hyperplasia lymph nodes, resulting in false positives.…”

Integrated Analysis of ceRNA Regulatory Network Associated With Tumor Stage in Cervical Cancer

“…In recent years, studies have found that once one or more RNA in the ceRNA regulatory network are abnormally expressed, the homeostasis is destroyed, leading to disease occurrence (Torre et al, 2015). The current study focused on treatment and prediction in early and advanced cancer (Pontes et al, 2020;Shih et al, 2021). Understanding the molecular mechanism is of great significance for better diagnosis and treatment of cervical cancer.…”