Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Association between High Diffusion-Weighted Imaging-Derived Functional Tumor Burden of Peritoneal Carcinomatosis and Overall Survival in Patients with Advanced Ovarian Carcinoma

  • He An (Department of Diagnostic Imaging, Sun Yat-sen University Cancer Centre) ;
  • Jose AU Perucho (Department of Diagnostic Radiology, University of Hong Kong) ;
  • Keith WH Chiu (Department of Diagnostic Radiology, University of Hong Kong) ;
  • Edward S Hui (Department of Rehabilitation Sciences, The Hong Kong Polytechnic University) ;
  • Mandy MY Chu (Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong) ;
  • Siew Fei Ngu (Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong) ;
  • Hextan YS Ngan (Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong) ;
  • Elaine YP Lee (Department of Diagnostic Radiology, University of Hong Kong)
  • Received : 2021.06.28
  • Accepted : 2022.03.10
  • Published : 2022.05.01
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Abstract

Objective: To investigate the association between functional tumor burden of peritoneal carcinomatosis (PC) derived from diffusion-weighted imaging (DWI) and overall survival in patients with advanced ovarian carcinoma (OC). Materials and Methods: This prospective study was approved by the local research ethics committee, and informed consent was obtained. Fifty patients (mean age ± standard deviation, 57 ± 12 years) with stage III-IV OC scheduled for primary or interval debulking surgery (IDS) were recruited between June 2016 and December 2021. DWI (b values: 0, 400, and 800 s/mm2) was acquired with a 16-channel phased-array torso coil. The functional PC burden on DWI was derived based on K-means clustering to discard fat, air, and normal tissue. A score similar to the surgical peritoneal cancer index was assigned to each abdominopelvic region, with additional scores assigned to the involvement of critical sites, denoted as the functional peritoneal cancer index (fPCI). The apparent diffusion coefficient (ADC) of the largest lesion was calculated. Patients were dichotomized by immediate surgical outcome into high- and low-risk groups (with and without residual disease, respectively) with subsequent survival analysis using the Kaplan-Meier curve and log-rank test. Multivariable Cox proportional hazards regression was used to evaluate the association between DWI-derived results and overall survival. Results: Fifteen (30.0%) patients underwent primary debulking surgery, and 35 (70.0%) patients received neoadjuvant chemotherapy followed by IDS. Complete tumor debulking was achieved in 32 patients. Patients with residual disease after debulking surgery had reduced overall survival (p = 0.043). The fPCI/ADC was negatively associated with overall survival when accounted for clinicopathological information with a hazard ratio of 1.254 for high fPCI/ADC (95% confidence interval, 1.007-1.560; p = 0.043). Conclusion: A high DWI-derived functional tumor burden was associated with decreased overall survival in patients with advanced OC.

Keywords

Acknowledgement

Health and Medical Research Fund, Hong Kong (No. 03143616 and 06171706) supported this project. Dr. Elaine YP Lee is the primary investigator for these funds.

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