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This study included forty-eight patients (48 patients), 34 patients had 2 examinations for initial and post treatment MRI assessment and 14 patients had only post treatment MRI assessment.
21 patients had Concurrent Chemo Radio Therapy (CCRTH), 20 patients had Concurrent Chemo Radio Therapy (CCRTH) & surgery, 6 patients had radiotherapy alone and only 1 patient had surgery alone.
Of the 48 cases, 32 patients were proven histologically, by follow up or by clinical correlation to have post-treatment malignant uterine cervix carcinoma and 16 patients had benign post treatment changes (inflammation/fibrosis).
We aimed at evaluation of the added value of DWI with ADC mapping to conventional MRI and contrast enhanced MRI in the detection of post-treatment residual/ recurrent masses in uterine cervical carcinoma in addition to detect the post-treatment sequalae and complications.
Both of the conventional MRI and CE MRI had low specificity (87.5%) with a high false-positive rate that may lead to unnecessary biopsy of a mass like region of post-treatment sequalae.
DWI is completely noninvasive and does not involve exposure to ionizing radiation. So, Diffusion Weighted Imaging permits more frequent examinations, allowing for repeated monitoring throughout the cancer treatment regimen.
DWI was obtained with 3 b values including 0, 300 and 600 mm/sec. The Apparent Diffusion Coefficient (ADC) was generated by measuring identical images at different b-values and represented as ADC map from which ADC value was calculated.
Qualitative DWI managed to detect 31 out of 32 of the malignant post treatment tumors with sensitivity of 96.8%. The addition of DWI to T2W imaging allowed five patients to be reclassified as having a malignant post -treatment tumor.
Recorded mean ADC values of post-treatment malignant masses were significantly different from those of post-treatment benign changes.
The addition of qualitative and quantitative assessment of the ADC maps provided 100 % specificity in post-treatment malignant masses, and raised the sensitivity to 96.8%.
Our results suggested that the use of DWI &ADC can be helpful in differentiating post-treatment malignant tumor masses from benign post-treatment changes with an estimated cut off mean ADC value of 1.3x10 -3 mm 2 /s.
Our results also suggested the value of baseline mean ADC in predicting the tumor response to treatment as there was noted significant difference regarding the average baseline mean ADC of the complete responders (mean 0.8 +/-0.024 × 10 -3 mm 2 /sec), compared to those with partial response/residual or disease progression (mean 0.96+/-0.045 × 10 -3 mm 2 /sec) (P < 0.0001).
So the use of qualitative DW imaging with ADC mapping provide added value in the detection of post-treatment malignant masses and differentiating it from post-treatment benign changes with sensitivity & specificity 96.8% & 100% respectively.