Combining Intravoxel Incoherent Motion Diffusion Weighted Imaging and Texture Analysis for a Nomogram to Predict Early Treatment Response to Concurrent Chemoradiotherapy in Cervical Cancer Patients

Abstract

This study aimed to predict early treatment response to concurrent chemoradiotherapy (CCRT) by combining intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) with texture analysis (TA) for cervical cancer patients and to develop a nomogram for estimating the risk of residual tumor. Ninty-three cervical cancer patients underwent conventional MRI and IVIM-DWI before CCRT. We conducted TA using T2WI. The patients were allocated to partial response (PR) and complete response (CR) groups on the basis of posttreatment MRI. Multivariate logistic regression analysis on IVIM-DWI parameters and texture features was employed to filter the independent predictors and construct the predictive nomogram. Its discrimination and calibration performances were estimated. Multivariate analysis on the IVIM-DWI parameters showed that D and f were independent predictors (OR = 4.029 and 0.889, resp.; $p<0.05$ ). However, the multivariate analysis on the texture features indicated that GLCM-correlation, GLRLM-LRE, and GLSZM-ZE were independent predictors (OR = 43.789, 9.774, and 23.738, resp.; $p<0.05$ ). The combination of IVIM-DWI parameters and texture features exhibited the highest predictive performance (AUC = 0.975). The nomogram to identify the patients with high-risk residual tumors exhibited an acceptable predictive performance and stability with a C-index of 0.953. Decision curve analysis demonstrated the clinical use of the nomogram. The results demonstrate that D, f, GLCM-correlation, GLRLM-LRE, and GLSZM-ZE were independent predictors for cervical cancer. The nomogram combining IVIM-DWI parameters and texture features makes it possible to identify cervical cancer patients at a high risk of residual tumor after CCRT.