Value of diffusion-weighted imaging for assessing site-specific response of advanced ovarian cancer to neoadjuvant chemotherapy: correlation of apparent diffusion coefficients with epithelial and stromal densities on histology

This study correlates apparent diffusion coefficients (ADCs) from Diffusion-weighted Imaging (DWI) in primary ovarian tumours and their omental metastases following neoadjuvant chemotherapy with epithelial and stromal densities in order to relate them to histological composition. Eight patients underwent DWI at 1.5 T with four b-values (0, 600, 900, and 1,050 s/mm(2))at baseline and after one and three cycles of platinum-based chemotherapy. Mean ADCs were calculated at each timepoint from solid tumour at ovarian and omental sites. Specimens from 15 corresponding lesions (8 ovarian, 7 omental), obtained at interval debulking surgery, were stained immunohistochemically to quantify epithelial and stromal components. End-of-treatment ADC was correlated with epithelial and stromal densities. Longitudinal changes in ADC with treatment were compared between primary and metastatic lesions using parametric tests. No baseline differences in ADC between primary and metastatic sites were seen. Mean ADC increased significantly from baseline after both first and third cycle (P < 0.001) in both ovarian and omental lesions. ADC and total epithelial plus stromal density (lesion cellularity) were negatively correlated in ovarian lesions (r= -0.79, P=0.02) but not in omental metastases or when both sites were considered together. However, ADC and epithelial density were negatively correlated in ovarian (r=- 0.78, P=0.02) and omental lesions (r=-0.75, P=0.04) and when both sites were considered together (r=-0.77, P< 0.001). There was no significant correlation between ADC and stromal density. Thus ADC reflects mainly epithelial content in advanced ovarian cancer and is not solely a function of lesion cellularity.

Phase I trial of a selective c-MET inhibitor ARQ 197 incorporating proof of mechanism pharmacodynamic studies

PURPOSE

The hepatocyte growth factor/c-MET axis is implicated in tumor cell proliferation, survival, and angiogenesis. ARQ 197 is an oral, selective, non-adenosine triphosphate competitive c-MET inhibitor. A phase I trial of ARQ 197 was conducted to assess safety, tolerability, and target inhibition, including intratumoral c-MET signaling, apoptosis, and angiogenesis.

PATIENTS AND METHODS

Patients with solid tumors amenable to pharmacokinetic and pharmacodynamic studies using serial biopsies, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and circulating endothelial cell (CEC) and circulating tumor cell (CTC) enumeration were enrolled.

RESULTS

Fifty-one patients received ARQ 197 at 100 to 400 mg twice per day. ARQ 197 was well tolerated, with the most common toxicities being grade 1 to 2 fatigue, nausea, and vomiting. Dose-limiting toxicities included grade 3 fatigue (200 mg twice per day; n = 1); grade 3 mucositis, palmar-plantar erythrodysesthesia, and hypokalemia (400 mg twice per day; n = 1); and grade 3 to 4 febrile neutropenia (400 mg twice per day, n = 2; 360 mg twice per day, n = 1). The recommended phase II dose was 360 mg twice per day. ARQ 197 systemic exposure was dose dependent and supported twice per day oral dosing. ARQ 197 decreased phosphorylated c-MET, total c-MET, and phosphorylated focal adhesion kinase and increased terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling (TUNEL) staining in tumor biopsies (n = 15). CECs decreased in 25 (58.1%) of 43 patients, but no significant changes in DCE-MRI parameters were observed after ARQ 197 treatment. Of 15 patients with detectable CTCs, eight (53.3%) had ≥ 30% decline in CTCs after treatment. Stable disease, as defined by Response Evaluation Criteria in Solid Tumors (RECIST), ≥ 4 months was observed in 14 patients, with minor regressions in gastric and Merkel cell cancers.

CONCLUSION

ARQ 197 safely inhibited intratumoral c-MET signaling. Further clinical evaluation focusing on combination approaches, including an erlotinib combination in non-small-cell lung cancer, is ongoing.

Endovaginal magnetic resonance imaging of stage 1A/1B cervical cancer with A T2- and diffusion-weighted magnetic resonance technique: effect of lesion size and previous cone biopsy on tumor detectability

OBJECTIVE

To evaluate the effects of previous cone biopsy and lesion size on detectability of stage 1a/1b cervical cancer using endovaginal T2- and diffusion-weighted magnetic resonance imaging.

METHODS

One hundred and thirteen patients with cervical tumor were imaged using an endovaginal coil with T2-weighted (T2-W) and diffusion-weighted single-shot echo-planar sequences; 85 managed surgically (58 with prior cone biopsy/LLETZ) were evaluated. T2-W images and ADC maps viewed simultaneously were scored positive or negative for tumor and compared with histology at surgery. MRI tumor volumes, maximum radiological and histological dimensions were recorded. ROC analysis determined the MRI volume with optimal sensitivity/specificity for identifying tumor in those without and with prior cone biopsy/LLETZ and the maximum histological dimension for correctly identifying tumor with MRI. Mean apparent diffusion coefficients (ADCs) from tumor and adjacent normal epithelium were compared.

RESULTS

Sensitivity and specificity for detecting tumor in those without (100%; 100% respectively) and with (80%; 78.9% respectively) prior cone biopsy/LLETZ were significantly different (p<0.001). Following cone biopsy/LLETZ, MRI tumor volume of 83 mm3 detected tumor with 80% sensitivity, 94.7% specificity; a 5.3mm maximal histological dimension was detected on MRI with 100% sensitivity, 100% specificity. Tumor ADCs were significantly lower (p<0.001) than paired normal epithelial tissue (median, 988×10(-6) mm2/s vs. 1564×10(-6) mm2/s) but neither tumor nor epithelial ADCs differed significantly between patients with or without prior cone biopsy/LLETZ (p=0.48 and 0.15, respectively).

CONCLUSIONS

Endovaginal MRI with T2- and diffusion-weighted sequences has significantly lower sensitivity and specificity for tumor detection following cone biopsy/LLETZ.

Diffusion Weighted Magnetic Resonance Imaging of metastatic bone disease: A biomarker for treatment response monitoring

Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) combined with conventional MRI can provide a whole body assessment of metastatic bone disease, improved lesion detection compared to other imaging techniques and a direct quantitative assessment of treatment response. In bone marrow, the presence of fat and bone trabeculae and their changing contributions with disease progression and response to treatment present unique challenges for data acquisition and image interpretation. This article discusses these challenges and reviews the potential of DW-MRI to provide a biomarker of response in metastatic bone disease.

Abstract 50: Comparison of NMR lipid profiles in mitotic arrest and apoptosis as indicators of drug resistance

Aim: To compare NMR-visible lipids in paclitaxel exposed cells undergoing apoptosis or mitotic arrest in order to explore their utility as a biomarker of drug resistance.

Methods: Cultured cervical cell lines (HeLa, C33A and Me180, ATCC, USA) were exposed to 1 µM paclitaxel (Sigma, UK) for 8, 16, 24, and 48 hours (n=3). Diffusion-weighted (DW) spectra were acquired using a 11.74T spectrometer (Avance Bruker BioSpin, Germany) using a stimulated echo sequence with bipolar gradients. Cellular morphology was assessed with transmission electron microscopy (TEM) using uranyl acetate followed by lead citrate staining. Following TOPRO-3 and nile red co-staining, flow cytometry and confocal microscopy verified cell size and viability, visualized cell cycle phase distribution, apoptotic features, and accumulation of cytoplasmic lipid droplets. Western blots were used to assess activation (by phosphorylation) of cytoplasmic phospholipase A2 (P-cPLA2) and expression of fatty acid synthase (FAS) at each stage.

Results: 24 h after exposure to paclitaxel, all lines showed &gt;65% mitotic arrest, and HeLa showed apoptosis as well. At 48 h HeLa cells progressed to apoptosis (due to mitotic catastrophe) while C33A and Me180 cells progressed beyond mitotic arrest to normal morphology or multinucleation indicating resistance. There was significant increase in saturated and unsaturated lipids at 24 h (mitotic arrest) followed by a further striking increase at 48 h in all lines, especially in the 5.3ppm peak (unsaturated) in HeLa at 48 h. Unsaturated lipids increased more than saturated lipids in all lines, triglycerides increase the most in HeLa cells. Resistant lines showed lower increased methylene / methyl (1.3 ppm / 0.9 ppm) ratio (from 1.3 to 2.8, 1.7 to 2.8 compared with 1.5 to 3.8 in HeLa cells at 48 h). The levels of P-cPLA2 and FAS were unchanged at 24 h followed by a drop at 48 h in HeLa cells. The percentage of cells displaying lipid droplets increased significantly at 24 and 48 h in all lines with increase in droplet size only in HeLa cells at 24 and 48 h. This implies that the larger droplets are associated with apoptosis but that smaller ones are less specific. Apoptotic cells showed 3-4 x the number of droplets compared to cells arrested in mitosis.

Conclusion: After exposure of cells to paclitaxel, increase in lipids on NMR results from increased visibility not synthesis (more droplets, FAS not increased). In apoptosis predominant increases are in unsaturated fatty acids in larger droplets, whereas paclitaxel resistant lines accumulate smaller droplets with significantly less triglycerides.

Acknowledgements: This work was funded by the EC FP6 Marie Curie Action: Early Stage Training (contact No. 020718). We also acknowledge the support received for the CRUK and EPSRC Cancer Imaging Centre in association with the MRC and Department of Health (England) (grant C1060/ A10334) and NHS Funding to the NIHR Biomedical Research Centre.

Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 50.

The effect of experimental conditions on the detection of spermine in cell extracts and tissues

The aim of this work was to investigate the effect of experimental conditions on the visibility of polyamines. In solution the chemical shift of the three groups of peaks (at approximately 1.8, 2.1 and 3.1 ppm) were found to be pH dependent. Relaxation times in aqueous solution at pH 7.0, 298 K and 11.74 T were measured to be: putrescine (T(1) = 2.49 s, T(2) = 2.07 s), spermidine (T(1) = 1.27 s, T(2) = 1.05 s) and spermine (T(1) = 1.02 s, T(2) = 0.82 s). Simple spin-echo sequences could not be used to measure T(2) as the spins also experience phase evolution from homonuclear coupling which imposes a modulation on the T(2) decay curve. This modulation is eliminated by using CPMG sequences with an echo spacing of <500 micros. Relaxation times for spermine in solution in presence of metal ions and protein showed that metal ions had little effect on T(2); however, addition of 15 mg/ml bovine serum albumin reduced T(2) of spermine (0.41 s at 298 K and 0.19 s at 277 K) but was not as short as the T(2) of the polyamine peak in prostatic tissue (0.03 s at 277 K). The MR visibility of polyamines in prostate cell extracts, PC-3 xenograft (intact as well as extracted) and intact human prostatic tissues were investigated. Polyamines were not detected in methanol/chloroform extracts, but were visible in perchloric acid extracts of prostate tumour cells. No polyamines were detected in the HR MAS spectra of three samples of whole PC-3 xenograft tissue studied. In summary, the chemical shift of polyamine species is pH dependent, while protein binding causes peak broadening and reduction in T(2). Perchloric acid extraction improves visibility of intracellular polyamines, but whole tissue polyamines are not seen in xenografts without epithelial/ ductal structure.

Imaging metastatic bone disease from carcinoma of the prostate

Imaging bone metastases from prostate cancer presents several challenges. The lesions are usually sclerotic and appear late on the conventional X-ray. Bone scintigraphy is the mainstay of lesion detection, but is often not suitable for assessment of treatment response, particularly because of a ‘flare’ phenomenon after therapy. Magnetic resonance imaging is increasingly used in assessment, and newer techniques allow quantitation. In addition to ¹⁸F-fluorodeoxyglucose (¹⁸FDG), newer PET isotopes are also showing promise in lesion detection and response assessment. This article reviews the available imaging modalities for evaluating prostatic bony metastases, and links them to the underlying pathological changes within bone lesions.

Diffusion weighted imaging of the uterus: regional ADC variation with oral contraceptive usage and comparison with cervical cancer

BACKGROUND

There is growing interest in diffusion weighted magnetic resonance imaging (MRI) of cervical carcinoma but normal uterine appearances and effects of the oral contraceptive pill (OCP) have not been described.

PURPOSE

To establish apparent diffusion coefficient (ADC) values for normal regions of uterus, determine the effect of the OCP on these values, and compare them with ADCs from cervical cancer.

MATERIAL AND METHODS

Twenty-seven premenopausal women (19 taking the OCP) with cervical intraepithelial neoplasia (CIN) were studied with T2W and diffusion weighted MRI (DW-MRI). Regions of interest were drawn on ADC maps by visual matching with T2W images on different zones of the uterus and values compared between women not taking and taking the OCP. A further group of 25 women with clinically obvious tumors of the cervix were also studied with T2W and DW-MRI and ADC values of tumor were compared with ADC values of cervical epithelium and stroma.

RESULTS

The ADC values of adjacent zones of the uterus and cervix were significantly different from one another (P<0.001). The junctional zone was seen as a band of restricted diffusion between endometrium and outer myometrium. The ADC value of the junctional zone of the uterus was significantly greater (P<0.001) in patients taking the OCP than those patients not taking the OCP. There was no significant affect of the OCP on the ADC values of other uterine zones.

CONCLUSION

The zonal anatomy of the uterus is well demonstrated by DW-MRI with hormonal effects secondary to the OCP affecting junctional zone alone. ADC of cervical tumor is significantly different to cervical epithelium and stroma indicating a role in cervical cancer detection and local staging.

Investigation of metabolite changes in the transition from pre-invasive to invasive cervical cancer measured using (1)H and (31)P magic angle spinning MRS of intact tissue

The aim of this study was to determine the metabolic changes in the transition from pre-invasive to invasive cervical cancer using high-resolution magic angle spinning (HR-MAS) MRS. Biopsy specimens were obtained from women with histologically normal cervix (n = 5), cervical intraepithelial neoplasia (CIN; mild, n = 5; moderate/severe, n = 40), and invasive cancer (n = 23). (1)H HR-MAS MRS data were acquired using a Bruker Avance 11.74 T spectrometer (Carr-Purcell-Meiboom-Gill sequence; TR = 4.8 s; TE = 135 ms; 512 scans; 41 min acquisition). (31)P HR-MAS spectra were obtained from the normal subjects and cancer patients only (as acetic acid applied before tissue sampling in patients with CIN impaired spectral quality) using a (1)H-decoupled pulse-acquire sequence (TR = 2.82 s; 2048 scans; 96 min acquisition). Peak assignments were based on values reported in the literature. Peak areas were measured using the AMARES algorithm. Estimated metabolite concentrations were compared between patient diagnostic categories and tissue histology using independent samples t tests. Comparisons based on patient category at diagnosis showed significantly higher estimated concentrations of choline (P = 0.0001) and phosphocholine (P = 0.002) in tissue from patients with cancer than from patients with high-grade dyskaryosis, but no differences between non-cancer groups. Division by histology of the sample also showed increases in choline (P = 0.002) and phosphocholine (P = 0.002) in cancer compared with high-grade CIN tissue. Phosphoethanolamine was increased in cancer compared with normal tissue (P = 0.0001). Estimated concentrations of alanine (P = 0.01) and creatine (P = 0.008) were significantly reduced in normal tissue from cancer patients compared with normal tissue from non-cancer patients. The estimated concentration of choline was significantly increased in CIN tissue from cancer patients compared with CIN tissue from non-cancer patients (P = 0.0001). Estimated concentrations of choline-containing metabolites increased from pre-invasive to invasive cervical cancer. Concurrent metabolite depletion occurs in normal tissue adjacent to cancer tissue.

Diffusion-weighted magnetic resonance imaging: a potential non-invasive marker of tumour aggressiveness in localized prostate cancer

AIM

To evaluate diffusion-weighted magnetic resonance imaging (DW-MRI) as a marker for disease aggressiveness by comparing tumour apparent diffusion coefficients (ADCs) between patients with low- versus higher-risk localized prostate cancer.

METHOD

Forty-four consecutive patients classified as low- [n = 26, stageT1/T2a, Gleason score < or = 6, prostate-specific antigen (PSA)< 10 (group 1)] or intermediate/high- [n = 18, stage > or = T2b and/or Gleason score > or = 7, and/or PSA > 10 (group 2)] risk, who subsequently were monitored with active surveillance or started neoadjuvant hormone and radiotherapy, respectively, underwent endorectal MRI. T2-weighted (T2W) and DW images (5 b values, 0-800 s/mm(2)) were acquired and isotropic ADC maps generated. Regions of interest (ROIs) on T2W axial images [around whole prostate, central gland (CG), and tumour] were transferred to ADC maps. Tumour, CG, and peripheral zone (PZ = whole prostate minus CG and tumour) ADCs (fast component from b = 0-100 s/mm(2), slow component from b = 100-800 s/mm(2)) were compared.

RESULTS

T2W-defined tumour volume medians, and quartiles were 1.2 cm(3), 0.7 and 3.3 cm(3) (group 1); and 6 cm(3), 1.3 and 16.5 cm(3) (group 2). There were significant differences in both ADC(fast) (1778 +/- 264 x 10(-6) versus 1583 +/- 283 x 10(-6) mm(2)/s, p = 0.03) and ADC(slow) (1379 +/- 321 x 10(-6) versus 1196 +/- 158 x 10(-6) mm(2)/s, p = 0.001) between groups. Tumour volume (p = 0.002) and ADC(slow) (p = 0.005) were significant differentiators of risk group.

CONCLUSION

Significant differences in tumour ADCs exist between patients with low-risk, and those with higher-risk localized prostate cancer. DW-MRI merits further study with respect to clinical outcomes.

Gliomatosis peritonei: MRI appearances and its potential role in follow up

Gliomatosis peritonei is a rare complication of ovarian teratomas characterized by peritoneal implants of glial tissue. Glial tissue in such cases is usually low grade although there have been cases of malignant evolution described. There is no clear guidance as to how often and for how long these patients should be followed up. There are clear dose implications when performing multiple CT scans. We present a case of immature ovarian teratoma complicated by the development of low grade gliomatosis peritonei. The MRI appearances are presented and described, and we discuss the potential role of MRI in the follow up of such cases.

Combined Use of Diffusion-Weighted MRI and 1H MR Spectroscopy to Increase Accuracy in Prostate Cancer Detection

OBJECTIVE

The objective of our study was to establish the sensitivity and specificity for prostate cancer detection using a combined 1H MR spectroscopy and diffusion-weighted MRI approach.

SUBJECTS AND METHODS

Forty-two men (mean age +/- SD, 69.3 +/- 4.7 years) with prostate cancer were studied using endorectal T2-weighted imaging, 2D chemical shift imaging (CSI), and isotropic apparent diffusion coefficient (ADC) maps. Regions of interest (ROIs) were drawn around the entire gland, central gland, and peripheral zone tumor, diagnostically defined as low signal intensity on T2-weighted images within a sextant that was biopsy-positive for tumor. Lack of susceptibility artifact on a gradient-echo B0 map through the slice selected for CSI and no high signal intensity on external array T1-weighted images confirmed the absence of significant hemorrhage after biopsy. CSI voxels were classified as nonmalignant or as tumor (ROI included > or = 30% or > or = 70% tumor). Choline-citrate (Cho/Cit) ratios and average ADCs were calculated for every voxel. A plot of Cho/Cit ratios versus ADCs yielded a line of best separation of tumor voxels from nonmalignant voxels. Receiver operating characteristic (ROC) curves were plotted for Cho/Cit ratios alone, ADCs alone, and a combination of the two.

RESULTS

The Cho/Cit ratios were significantly higher (p < 0.001) and the ADCs were significantly lower (p < 0.006) in tumor-containing voxels than in non-tumor-containing voxels. When voxels containing 30% or more tumor were considered positive, the area under the ROC curves using combined MR spectroscopy and ADC (0.81) was similar to that of Cho/Cit alone (0.79) and better than ADC alone (0.66). When voxels containing 70% or more tumor were considered positive and cutoffs to achieve a 90%-or-greater sensitivity chosen, a combination of Cho/Cit and ADC achieved a significant improvement in specificity compared with Cho/Cit alone (p < 0.0001) or ADC alone (p < 0.0001).

CONCLUSION

When voxels containing > or = 70% tumor are considered positive, the combined use of MR spectroscopy and diffusion-weighted MRI increases the specificity for prostate cancer detection while retaining the sensitivity compared with MR spectroscopy alone or diffusion-weighted MRI alone.

Design and development of a prototype endocavitary probe for high-intensity focused ultrasound delivery with integrated magnetic resonance imaging

PURPOSE

To integrate a high intensity focused ultrasound (HIFU) transducer with an MR receiver coil for endocavitary MR-guided thermal ablation of localized pelvic lesions.

MATERIALS AND METHODS

A hollow semicylindrical probe (diameter 3.2 cm) with a rectangular upper surface (7.2 cm x 3.2 cm) was designed to house a HIFU transducer and enable acoustic contact with an intraluminal wall. The probe was distally rounded to ease endocavitary insertion and was proximally tapered to a 1.5-cm diameter cylindrical handle through which the irrigation tubes (for transducer cooling) and electrical connections were passed. MR compatibility of piezoceramic and piezocomposite transducers was assessed using gradient-echo (GRE) sequences. The radiofrequency (RF) tuning of identical 6.5 cm x 2.5 cm rectangular receiver coils on the upper surface of the probe was adjusted to compensate for the presence of the conductive components of the HIFU transducers. A T1-weighted (T1-W) sliding window dual-echo GRE sequence monitored phase changes in the focal zone of each transducer. High-intensity (2400 W/cm(-2)), short duration (<1.5 seconds) exposures produced subtherapeutic temperature rises.

RESULTS

For T1-W images, signal-to-noise ratio (SNR) improved by 40% as a result of quartering the conductive surface of the piezoceramic transducer. A piezocomposite transducer showed a further 28% improvement. SNRs for an endocavitary coil in the focal plane of the HIFU trans-ducer (4 cm from its face) were three times greater than from a phased body array coil. Local shimming improved uniformity of phase images. Phase changes were detected at subtherapeutic exposures.

CONCLUSION

We combined a HIFU transducer with an MR receiver coil in an endocavitary probe. SNRs were improved by quartering the conductive surface of the piezoceramic. Further improvement was achieved with a piezocomposite transducer. A phase change was seen on MR images during both subtherapeutic and therapeutic HIFU exposures.

Diffusion-weighted magnetic resonance imaging and its application to cancer

Diffusion-weighted magnetic resonance imaging (DW-MRI) provides image contrast through measurement of the diffusion properties of water within tissues. Application of diffusion sensitising gradients to the MR pulse sequence allows water molecular displacement over distances of 1–20 μm to be recognised. Diffusion can be predominantly unidirectional (anisotropic) or not (isotropic). Combining images obtained with different amounts of diffusion weighting provides an apparent diffusion coefficient (ADC) map. In cancer imaging DW-MRI has been used to distinguish brain tumours from peritumoural oedema. It is also increasingly exploited to differentiate benign and malignant lesions in liver, breast and prostate where increased cellularity of malignant lesions restricts water motion in a reduced extracellular space. It is proving valuable in monitoring treatment where changes due to cell swelling and apoptosis are measurable as changes in ADC at an earlier stage than subsequent conventional radiological response indicators.

Cervical cancer: value of an endovaginal coil magnetic resonance imaging technique in detecting small volume disease and assessing parametrial extension

BACKGROUND

Estimation of tumor volume by endovaginal magnetic resonance (MR) imaging is a better indicator of prognosis than FIGO stage in women with cervical cancer treated by standard modalities. However, the introduction of fertility conserving surgical techniques makes fresh demands upon imaging of these small tumors.

OBJECTIVE

To determine the sensitivity and specificity of endovaginal MRI in detecting small volume disease and assessing parametrial extension in uterine cervical cancer by comparing the findings with those at radical hysterectomy in order to establish its role in guiding the surgical decision-making process preoperatively.

METHODS

A retrospective study was performed in 119 patients who underwent endovaginal and external phased array MR imaging at 0.5 T or 1.5 T before radical hysterectomy. Tumor presence within the cervix and parametrial extension was noted on the endovaginal images. Histopathological findings were correlated with MR imaging results for all patients.

RESULTS

The sensitivity and specificity for detecting tumor by endovaginal MR imaging in the 119 patients were 96.9 and 59.0%, respectively. Thirty-six percent of tumors were <or=1 cm(3) in volume. For these, sensitivity and specificity for tumor detection were 87% and 65% respectively. For evaluation of parametrial status, sensitivity was 80%, and specificity was 91.3%. A cut-off MRI tumor volume of 5.2 cm(3) predicted histologically confirmed lymph node metastases with a sensitivity of 78.6% and specificity of 72.5%.

CONCLUSION

Endovaginal magnetic resonance imaging has high sensitivity in the preoperative staging of uterine cervical cancer even for tumors <or=1 cm(3). It is an invaluable technique in planning fertility-conserving or radical surgical treatment of early stage cervical cancer.

Borderline tumors of the ovary: CT and MRI features and tumor markers in differentiation from stage I disease

OBJECTIVE

We sought to describe MDCT and MRI features and tumor marker levels that differentiate borderline ovarian tumors from stage I ovarian tumors.

CONCLUSION

Borderline ovarian tumors are complex masses with imaging features similar to stage I tumors. The thickness of septations and the size of solid components are significantly larger in stage I tumors, and these features may be helpful for predicting likelihood of invasive tumors. However, neither feature allows confident differentiation of borderline tumors from stage I disease.

Use of neoadjuvant chemotherapy prior to radical hysterectomy in cervical cancer: monitoring tumour shrinkage and molecular profile on magnetic resonance and assessment of 3-year outcome

The objective of this study is to assess tumour response to neoadjuvant chemotherapy prior to radical hysterectomy in cervical cancer using magnetic resonance (MR) to monitor tumour volume and changes in molecular profile and to compare the survival to that of a control group. Eligibility included Stage Ib-IIb previously untreated cervical tumours >10 cm(3). Neoadjuvant chemotherapy in 22 patients (methotrexate 300 mg x m(-2) (with folinic acid rescue), bleomycin 30 mg x m(-2), cisplatin 60 mg m(-2)) was repeated twice weekly for three courses and followed by radical hysterectomy. Post-operative radiotherapy was given in 14 cases. A total of 23 patients treated either with radical surgery or chemoradiotherapy over the same time period comprised the nonrandomised control group. MR scans before and after neoadjuvant chemotherapy and in the control group documented tumour volume on imaging and metabolites on in vivo spectroscopy. Changes were compared using a paired t-test. Survival was calculated using the Kaplan-Meier method. There were no significant differences between the neoadjuvant chemotherapy and control groups in age (mean, s.d. 43.3+/-10, 44.7+/-8.5 years, respectively, P=0.63) or tumour volume (medians, quartiles 35.8, 17.8, 57.7 cm(3) vs 23.0, 15.0, 37.0 cm(3), respectively, P=0.068). The reduction in tumour volume post-chemotherapy (median, quartiles 7.5, 3.0, 19.0 cm(3)) was significant (P=0.002). The reduction in -CH(2) triglyceride approached significance (P=0.05), but other metabolites were unchanged. The 3-year survival in the chemotherapy group (49.1%) was not significantly different from the control group (46%, P=0.94). There is a significant reduction in tumour volume and -CH(2) triglyceride levels after neoadjuvant chemotherapy, but there is no survival advantage.