Purpose: To evaluate the utility and comparative effectiveness of three five-point qualitative scoring systems for assessing response on PET-CT and MRI imaging individually and in combination, following curative-intent chemoradiotherapy (CRT) in locally advanced cervical cancer (LACC). Their performance in the prediction of subsequent patient outcomes was also assessed; Methods: Ninety-seven patients with histologically confirmed LACC treated with CRT using standard institutional protocols at a single centre who underwent PET-CT and MRI at staging and post treatment were identified retrospectively from an institutional database. The post-CRT imaging studies were independently reviewed, and response assessed using five-point scoring tools for T2WI, DWI, and FDG PET-CT. Patient characteristics, staging, treatment, and follow-up details including progression-free survival (PFS) and overall survival (OS) outcomes were collected. To compare diagnostic performance metrics, a two-proportion z-test was employed. A Kaplan–Meier analysis (Mantel–Cox log-rank) was performed. Results: The T2WI (p< 0.00001,p< 0.00001) and DWI response scores (p< 0.00001,p= 0.0002) had higher specificity and accuracy than the PET-CT. The T2WI score had the highest positive predictive value (PPV), while the negative predictive value (NPV) was consistent across modalities. The combined MR scores maintained high NPV, PPV, specificity, and sensitivity, and the PET/MR consensus scores showed superior diagnostic accuracy and specificity compared to the PET-CT score alone (p= 0.02926,p= 0.0083). The Kaplan–Meier analysis revealed significant differences in the PFS based on the T2WI (p< 0.001), DWI (p< 0.001), combined MR (p= 0.003), and PET-CT/MR consensus scores (p< 0.001) and in the OS for the T2WI (p< 0.001), DWI (p< 0.001), and combined MR scores (p= 0.031) between responders and non-responders. Conclusion: Post-CRT response assessment using qualitative MR scoring and/or consensus PET-CT and MRI scoring was a better predictor of outcome compared to PET-CT assessment alone. This requires validation in a larger prospective study but offers the potential to help stratify patient follow-up in the future.
目的：评估三种五点定性评分系统在局部晚期宫颈癌根治性放化疗后，单独及联合应用PET-CT和MRI评估疗效的效用与比较效果，并评估其对患者后续结局的预测性能。方法：从机构数据库中回顾性纳入97例经组织学确诊的局部晚期宫颈癌患者，均于单一中心按标准方案接受放化疗，并在分期及治疗后接受了PET-CT和MRI检查。对放化疗后的影像学资料进行独立审阅，并分别使用T2WI、DWI和FDG PET-CT的五点评分工具评估疗效。收集患者特征、分期、治疗及随访信息，包括无进展生存期和总生存期结局。采用双比例z检验比较诊断性能指标，并进行Kaplan-Meier分析。结果：T2WI和DWI疗效评分在特异性与准确性上均优于PET-CT。T2WI评分具有最高的阳性预测值，而阴性预测值在各模态间表现一致。联合MR评分保持了较高的阴性预测值、阳性预测值、特异性及敏感性，且PET/MR共识评分较单独PET-CT评分显示出更优的诊断准确性与特异性。Kaplan-Meier分析显示，基于T2WI、DWI、联合MR及PET-CT/MR共识评分，应答者与非应答者间的无进展生存期存在显著差异；基于T2WI、DWI及联合MR评分，总生存期亦存在显著差异。结论：与单独使用PET-CT评估相比，采用定性MR评分和/或PET-CT与MRI共识评分进行放化疗后疗效评估能更有效地预测患者结局。此结论尚需更大规模前瞻性研究验证，但为未来患者随访分层管理提供了潜在可能。
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