524 AJR:195, August 2010 obtained from all patients. The inclusion criteria were histologic diagnosis of squamous cell carcinoma or adenocarcinoma of the cervix, International Federation of Gynecology and Obstetrics (FIGO) stage IB–IVA disease suitable for treatment with radical chemoradiotherapy, and no contraindications to MRI. Thirteen patients with carcinoma of the cervix were enrolled in this study. Eleven patients had squamous cell carcinoma and two had adeno- carcinoma. Four patients had FIGO stage IB disease, six had stage IIB disease, two had stage IIIB disease, and one had stage IVA disease. One patient had a grade 1 tumor, 10 patients had grade 2 tumors, and two patients had grade 3 tumors. All patients were treated with initial external-beam radiation therapy (45 Gy in 25 fractions over 5 weeks) and concurrent weekly cisplatin chemotherapy. Imaging Protocol DCE-MRI was carried out on a 1.5-T whole-body MRI scanner (Signa Excite, GE Healthcare) at three time points. Axial oblique T2-weighted images were obtained for volumetric measurements. The DCE- MRI sequence consisted of a sequentially ordered 3D T1-weighted fast spoiled gradient-recalled echo of four contiguous sagittal sections. Gadopentetate di- meglumine (Magnevist, Bayer HealthCare Pharma- ceuticals) was injected via a 21-gauge peripheral cannula. The bolus injection of gadopentetate dimeglumine (0.1 mmol/kg at a rate of 9 mL/s) was given 30 seconds after the start of acquisition of the dynamic sequence and was immediately followed by a flush of 25 mL of 0.9% sodium chloride solution at the same rate. The choice of four slices was to have adequate temporal and spatial resolution. Further details regarding the im- aging protocol have been previously published [1]. Evaluation of Nonenhancing Tumor Fraction Assessed by Dynamic Contrast-Enhanced MRI Subtraction as a Predictor of Decrease in Tumor Volume in Response to Chemoradiotherapy in Advanced Cervical Cancer Lorenzo Mannelli 1 Andrew J. Patterson 1 Mark Zahra 2 Andrew N. Priest 1 Martin J. Graves 1 David J. Lomas 1 Li Tee Tan 2 Robin Crawford 3 James Brenton 2 Evis Sala 1 Mannelli L, Patterson AJ, Zahra M, et al. Women’s฀Imaging฀•฀Technical฀Innovation AJR 2010; 195:524–527 0361–803X/10/1952–524 © American Roentgen Ray Society C ervical cancer is the second most common cancer among women worldwide. Radiotherapy is an ef- fective treatment of cervical can- cer, and the addition of concurrent cisplatin chemotherapy significantly improves survival. However, serious late treatment-related mor- bidity remains a concern. We have previously shown in this patient cohort that dynamic contrast-enhanced MRI (DCE-MRI) parameters can predict tumor re- sponse to treatment in cervical cancer [1]. DCE- MRI parameters are related to various tumor histopathologic features, including tumor oxy- genation, vascularity, and cellular proliferation [2–4]. However, in our experience, obtaining quantitative data requires substantial postpro- cessing, and the data may be difficult to interpret and communicate to the clinician. Subtraction imaging is a tool that easily overcomes problems with the variability in imaging protocols between different centers and could allow a qualitative as- sessment of tumor nonenhancing fraction. In this study, we retrospectively reanalyzed DCE-MRI with a qualitative approach using subtraction imaging with the intent of obtain- ing information that potentially could be easi- er to use in a clinical setting. Our aim was to investigate whether the percentage of nonen- hancing tumor tissue calculated using DCE- MRI subtraction could inversely predict re- sponse to chemoradiotherapy in patients with advanced cervical cancer. Methods and Materials Patients The study was approved by the local ethics committee and written informed consent was Keywords: cervical cancer, dynamic contrast-enhanced MRI, nonenhancing fraction, perfusion, predictor, subtraction DOI:10.2214/AJR.09.3437 Received August 4, 2009; accepted after revision January 7, 2010. 1 Department of Radiology and Cambridge University Hospitals NHS Trust, Addenbrooke’s Hospital, Hills Rd., Cambridge CB2 0QQ, United Kingdom. Address correspondence to L. Mannelli (lorenzo.mannelli@ nyumc.org). 2 Department of Oncology and Cambridge University Hospitals NHS Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom. 3 Department of Gynae-oncology and Cambridge University Hospitals NHS Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom. WOMEN’S IMAGING OBJECTIVE. In this study, we evaluated the feasibility of using dynamic contrast-en- hanced MRI (DCE-MRI) subtracted images as a predictor of a decrease in tumor volume in response to chemoradiotherapy in 13 patients with cervical cancer. CONCLUSION. This study shows that pretreatment tumor nonenhancing fraction assessed with arterial image subtraction inversely predicts the chemoradiation response in cervical cancer. Mannelli et al. MRI as Predictor of Tumor Volume Women’s Imaging Technical Innovation Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved