Texture analysis versus conventional MRI prognostic factors in predicting tumor response to neoadjuvant chemotherapy in patients with locally advanced cancer of the uterine cervix

Abstract

IntroductionTo determine the performance of texture analysis and conventional MRI parameters in predicting tumoral response to neoadjuvant chemotherapy and to assess whether a relationship exists between texture tissue heterogeneity and histological type of uterine cervix cancer.Method and materialsTwenty-eight patients with local advanced cervical cancer (FIGO IB2-IIIB), underwent MRI before chemotherapy. Texture analysis parameters were quantified on T2-weighted sequences, as well as the maximum diameter expressed in mm. ADC values were obtained on the ADC map. Statistical analysis included unpaired t test and ROC curve.ResultsNo statistical correlation was found between conventional parameters and response to NACT. Mean and skewness showed a strong correlation with the histological type: Adenocarcinomas presented higher mean and skewness values (69.8\u2009±\u200910.5 and 0.55\u2009±\u20090.19) in comparison with squamous cell carcinomas. Using a cutoff value\u2009≥\u200929 for mean it was possible to differentiate the two histological types with a sensitivity of 100% and a specificity of 81%. Kurtosis showed a positive correlation with tumor response to NACT resulting higher in responders (v.m. 5.7\u2009±\u20091.1) in comparison with non-responders (2.3\u2009±\u20090.5). The optimal Kurtosis cutoff value for the identification of non-responders tumors was\u2009≤\u20093.7 with a sensitivity of 92% and a specificity of 75%.ConclusionTexture analysis applied to T2-weighted images of uterine cervical cancer exceeded the role of conventional prognostic factors in predicting tumoral response; moreover, they showed a potential role to differentiate histological tumor types.