Whole Tumor Apparent Diffusion Coefficient Histogram in Assessment of Treatment Response in Locally Advanced Cervical Cancer

Wahdan. N, Diagnostic Radiology Department, Ministry of Health, EgyptFollow
Wahba. H, Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Samir. S, Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Dina. G. Abdelzaher, Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Subject Area

Radiodiagnosis

Article Type

Original Study

Abstract

Purpose:

We aimed to determine the prognostic value of whole-tumor ADC histogram analysis in predicting therapeutic outcomes for patients undergoing concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC).

Methods:

This prospective, single-institution study enrolled 40 women (mean age 53.8 ± 11.4 years) with pathologically confirmed LACC (FIGO stages IIB–IVA). Pelvic MRI including diffusion-weighted imaging (DWI) was performed at baseline and after CCRT. Whole-tumor regions of interest (ROIs) were manually delineated on ADC maps to extract histogram parameters (mean, minimum, maximum ADC, skewness, and kurtosis). Using RECIST 1.1 criteria, patients were classified as responders (complete or partial response) or non-responders (stable or progressive disease). Diagnostic performance of absolute ADC values and percentage changes (%) was assessed via receiver operating characteristic (ROC) curves.

Results:

Responders exhibited significantly lower baseline ADCmin than non-responders (0.43 ± 0.25 vs. 0.67 ± 0.29 × 10⁻³ mm²/s; p = 0.013). The percentage change in ADCmean was also significantly greater in responders (26.61% vs. −1.15%; p = 0.013), as were the percentage changes in ADCmin, ADCmax, and mean ADC (all p < 0.05). ROC analysis demonstrated that baseline ADCmin was the strongest predictor of treatment response; a threshold of ≤ 0.63 × 10⁻³ mm²/s yielded 95.65% sensitivity (AUC = 0.809). All other ADC parameter changes were statistically significant predictors but showed lower AUC values.

Conclusion:

Whole-tumor ADC histogram analysis provides a valuable quantitative biomarker for assessing CCRT response in LACC. A low pretreatment ADCmin is a highly sensitive indicator of favorable response, while percentage changes in ADC metrics enable dynamic monitoring of treatment efficacy.

Recommended Citation

N, Wahdan.; H, Wahba.; S, Samir.; and Abdelzaher, Dina. G. (2026) "Whole Tumor Apparent Diffusion Coefficient Histogram in Assessment of Treatment Response in Locally Advanced Cervical Cancer," Mansoura Medical Journal: Vol. 55 : Iss. 5 , Article 4.
Available at: https://doi.org/10.58775/2735-3990.1538