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Cancer Imaging

Open Access

Pre-treatment ADC histogram-analysis at whole body diffusion-weighted MRI predicts disease free survival in ovarian cancer

  • K Michielsen1Email author,
  • I Vergote2,
  • F Amant2,
  • K Leunen2,
  • S Dymarkowski1,
  • F De Keyzer1 and
  • V Vandecaveye1
Cancer Imaging201515(Suppl 1):S5

Published: 2 October 2015


Apparent Diffusion CoefficientDisease Free SurvivalFigo StageHistogram AnalysisDebulking Surgery


To prospectively evaluate the predictive value of pre-treatment histogram analysis of apparent diffusion coefficients (ADC) at whole body diffusion-weighted imaging (WB-DWI/MRI) for patient outcome in primary ovarian cancers.


Institutional review board approval and informed consent were obtained for this prospective study. Forty-four women diagnosed with FIGO stage III or IV ovarian carcinoma underwent 3-Tesla WB-DWI/MRI using 2 b-values (b=0-1000 s/mm2), T2-weighted and contrast-enhanced T1-weighted sequences prior to treatment. The primary tumour was delineated using semi-automated software and was analysed by using an ADC histogram approach: mean and median ADC, standard deviation (SD), coefficient of variation (CoV, SD/mean), kurtosis and skewness were calculated. Kaplan-Meier with log-rank statistics were used to correlate baseline ADC parameters to disease free survival (DFS). Effects of confounding patients- and tumour-related factors were taken into consideration using Cox proportional hazard model.


5 patients underwent primary- and 39 interval debulking surgery completing 6 cycles of platinum-based chemotherapy. Survival analyses showed that lower CoV was associated with significantly longer DFS (median ± SD; 19±2 months for CoV<0.2601 versus 12±1 months for CoV>0.2601; p=0.002). After multivariable analysis, CoV remained an independent prognostic biomarker for DFS (p=0.003) when taking patient’s age, FIGO stage, tumour grade and cancer antigen (CA)-125 level into consideration as clinical prognostic factors.


In this pilot study, pre-treatment ADC histogram analysis of primary ovarian cancer using the CoV was an independent predictive marker of DFS suggesting a correlation between tumour heterogeneity and treatment resistance. Further research should elucidate the correlation with overall survival.

Authors’ Affiliations

Department of Radiology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium
Department of Obstetrics and Gynaecology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium


© Michielsen et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.