Fig 1.
Flowchart showing patient enrolment and inclusion criteria.
The numbers of MR examinations available at each time point and number of calculated change rates are shown.
Fig 2.
Flowchart of treatment, MRI acquisition, and imaging processing.
CCRT = cervical cancer radiation therapy; IGBT = image-guided brachytherapy; EBRT = external beam radiotherapy; HR-CTV = high-risk clinical target volume; CDDP = cisplatin.
Table 1.
Summary of MRI acquisition protocols.
Table 2.
Clinical data and results of the univariate analyses.
Table 3.
Image parameters with high AUCs in all patients.
Table 4.
Mean and standard deviation (SD) in the change rate of kurtosis and glcm_ClusterShade in the recurrent and non-recurrent groups.
Fig 3.
Kaplan-Meier plots for all patients.
Log-rank p values were calculated. X axis: Time (years), Y axis: Disease-free survival (probability). Number of patients at risk is shown below. glcm = grey level co-occurrence matrix.
Fig 4.
Box-and-whisker plots of ADC kurtosis.
Box-and-whisker plots show trends in ADC kurtosis during the clinical course in the recurrent and non-recurrent groups. The mean value of kurtosis is indicated by the × symbol. Tumor ADC kurtosis tended to decrease towards the end of treatment as an overall trend in both groups. The decrease in kurtosis from the first to the third MRI was greater in the recurrent than in the non-recurrent group.
Table 5.
a. Dice similarity coefficient (DSC) scores (average and standard deviation) in the 1st–4th time points.
b. Intraclass correlation coefficients (ICC) values of the ADC kurtosis and the glcm_ClusterShade in the 1st–4th time points.
Fig 5.
a. Recurrent case. A 66-year-old patient with FIGO stage IIB squamous cell carcinoma experienced recurrence with distance lymph node metastasis in a year. An intra-tumoral T2WI hypointense area (arrow) with poor enhancement on T1WI was presumed to be necrosis. The necrotic area expanded on the following 2nd and 3rd scans. Although segmentation was performed to exclude necrosis, the decrease in kurtosis is conspicuous in the 2nd and 3rd scans. The sharpness of the histogram also decreases in the 2nd and 3rd scans, indicating decreasing kurtosis. b. Non-recurrent case. A 70-year-old patient with FIGO stage IIB squamous cell carcinoma had been followed up for more than two years without sign of recurrence. No apparent necrosis was observed in the tumor in the 2nd and 3rd scans. Kurtosis did not decrease, and there was no obvious decrease in histogram sharpness.