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Nougaret S, Gormly K, Lambregts DMJ, Reinhold C, Goh V, Korngold E, Denost Q, Brown G. MRI of the Rectum: A Decade into DISTANCE, Moving to DISTANCED. Radiology 2025; 314:e232838. [PMID: 39772798 DOI: 10.1148/radiol.232838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
Over the past decade, advancements in rectal cancer research have reshaped treatment paradigms. Historically, treatment for locally advanced rectal cancer has focused on neoadjuvant long-course chemoradiotherapy, followed by total mesorectal excision. Interest in organ preservation strategies has been strengthened by the introduction of total neoadjuvant therapy with improved rates of complete clinical response. The administration of systemic induction chemotherapy and consolidation chemoradiotherapy in the neoadjuvant setting has introduced a new dimension to the treatment landscape and patients now face a more intricate decision-making process, given the expanded therapeutic options. This complexity underlines the importance of shared decision-making and brings to light the crucial role of radiologists. MRI, especially high-spatial-resolution T2-weighted imaging, is heralded as the reference standard for rectal cancer management because of its exceptional ability to provide staging and prognostic insights. A key evolution in MRI interpretation for rectal cancer is the transition from the DISTANCE mnemonic to the more encompassing DISTANCED-DIS, distal tumor boundary; T, T stage; A, anal sphincter complex; N, nodal status; C, circumferential resection margin; E, extramural venous invasion; D, tumor deposits. This nuanced shift in the mnemonic captures a wider range of diagnostic indicators. It also emphasizes the escalating role of radiologists in steering well-informed decisions in the realm of rectal cancer care.
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Affiliation(s)
- Stephanie Nougaret
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Kirsten Gormly
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Doenja M J Lambregts
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Caroline Reinhold
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Vicky Goh
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Elena Korngold
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Quentin Denost
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Gina Brown
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
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Chuong MD, Palm RF, Tjong MC, Hyer DE, Kishan AU. Advances in MRI-Guided Radiation Therapy. Surg Oncol Clin N Am 2023; 32:599-615. [PMID: 37182995 DOI: 10.1016/j.soc.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Image guidance for radiation therapy (RT) has evolved over the last few decades and now is routinely performed using cone-beam computerized tomography (CBCT). Conventional linear accelerators (LINACs) that use CBCT have limited soft tissue contrast, are not able to image the patient's internal anatomy during treatment delivery, and most are not capable of online adaptive replanning. RT delivery systems that use MRI have become available within the last several years and address many of the imaging limitations of conventional LINACs. Herein, the authors review the technical characteristics and advantages of MRI-guided RT as well as emerging clinical outcomes.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, 8900 North Kendall Drive, Miami, FL 33176, USA.
| | - Russell F Palm
- Department of Radiation Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Michael C Tjong
- Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Daniel E Hyer
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, 1338 S Hope Street, Los Angeles, CA 90015, USA
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Gao PF, Lu N, Liu W. MRI VS. FDG-PET for diagnosis of response to neoadjuvant therapy in patients with locally advanced rectal cancer. Front Oncol 2023; 13:1031581. [PMID: 36741013 PMCID: PMC9890074 DOI: 10.3389/fonc.2023.1031581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
Aim In this study, we aimed to compare the diagnostic values of MRI and FDG-PET for the prediction of the response to neoadjuvant chemoradiotherapy (NACT) of patients with locally advanced Rectal cancer (RC). Methods Electronic databases, including PubMed, Embase, and the Cochrane library, were systematically searched through December 2021 for studies that investigated the diagnostic value of MRI and FDG-PET in the prediction of the response of patients with locally advanced RC to NACT. The quality of the included studies was assessed using QUADAS. The pooled sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), and the area under the ROC (AUC) of MRI and FDG-PET were calculated using a bivariate generalized linear mixed model, random-effects model, and hierarchical regression. Results A total number of 74 studies with recruited 4,105 locally advanced RC patients were included in this analysis. The pooled sensitivity, specificity, PLR, NLR, and AUC for MRI were 0.83 (95% CI: 0.77-0.88), 0.85 (95% CI: 0.79-0.89), 5.50 (95% CI: 4.11-7.35), 0.20 (95% CI: 0.14-0.27), and 0.91 (95% CI: 0.88-0.93), respectively. The summary sensitivity, specificity, PLR, NLR and AUC for FDG-PET were 0.81 (95% CI: 0.77-0.85), 0.75 (95% CI: 0.70-0.80), 3.29 (95% CI: 2.64-4.10), 0.25 (95% CI: 0.20-0.31), and 0.85 (95% CI: 0.82-0.88), respectively. Moreover, there were no significant differences between MRI and FDG-PET in sensitivity (P = 0.565), and NLR (P = 0.268), while the specificity (P = 0.006), PLR (P = 0.006), and AUC (P = 0.003) of MRI was higher than FDG-PET. Conclusions MRI might superior than FGD-PET for the prediction of the response of patients with locally advanced RC to NACT.
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Affiliation(s)
- Peng Fei Gao
- Department of Traditional Chinese medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Na Lu
- Department of Radiology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Wen Liu
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China,*Correspondence: Wen Liu,
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Ingle M, Blackledge M, White I, Wetscherek A, Lalondrelle S, Hafeez S, Bhide S. Quantitative analysis of diffusion weighted imaging in rectal cancer during radiotherapy using a magnetic resonance imaging integrated linear accelerator. Phys Imaging Radiat Oncol 2022; 23:32-37. [PMID: 35756883 PMCID: PMC9214864 DOI: 10.1016/j.phro.2022.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/16/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Magnetic resonance imaging integrated linear accelerator (MR-Linac) platforms enable acquisition of diffusion weighted imaging (DWI) during treatment providing potential information about treatment response. Obtaining DWI on these platforms is technically different from diagnostic magnetic resonance imaging (MRI) scanners. The aim of this project was to determine feasibility of obtaining DWI and calculating apparent diffusion coefficient (ADC) parameters longitudinally in rectal cancer patients on the MR-Linac. Materials and methods Nine patients undergoing treatment on MR-Linac had DWI acquired using b-values 0, 30, 150, 500 s/mm2. Gross tumour volume (GTV) and normal tissue was delineated on DWI throughout treatment and median ADC was calculated using an in-house tool (pyOsirix ®). Results Seven out of nine patients were included in the analysis; all demonstrated downstaging at follow-up. A total of 63 out of 70 DWI were analysed (7 excluded due to poor image quality). An increasing trend of ADC median for GTV (1.15 × 10-3 mm2/s interquartile range (IQ): 1.05-1.17 vs 1.59 × 10-3 mm2/s IQ: 1.37 - 1.64; p = 0.0156), correlating to treatment response. In comparison ADC median for normal tissue remained the same between first and last fraction (1.61 × 10-3 mm2/s IQ: 1.56-1.71 vs 1.67 × 10-3 mm2/s IQ: 1.37-2.00; p = 0.9375). Conclusions DWI assessment in rectal cancer patients on MR-Linac is feasible. Initial results provide foundations for further studies to determine DWI use for treatment adaptation in rectal cancer.
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Affiliation(s)
- Manasi Ingle
- The Royal Marsden Hospital NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Matthew Blackledge
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Ingrid White
- Guys and St Thomas NHS Trust, Great Maze Pond, London SE1 9RT, UK
| | - Andreas Wetscherek
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Susan Lalondrelle
- The Royal Marsden Hospital NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Shaista Hafeez
- The Royal Marsden Hospital NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Shreerang Bhide
- The Royal Marsden Hospital NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
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Wang J, Chen J, Zhou R, Gao Y, Li J. Machine learning-based multiparametric MRI radiomics for predicting poor responders after neoadjuvant chemoradiotherapy in rectal Cancer patients. BMC Cancer 2022; 22:420. [PMID: 35439946 PMCID: PMC9017030 DOI: 10.1186/s12885-022-09518-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/08/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate and validate multiparametric magnetic resonance imaging (MRI)-based machine learning classifiers for early identification of poor responders after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). METHODS Patients with LARC who underwent nCRT were included in this retrospective study (207 patients). After preprocessing of multiparametric MRI, radiomics features were extracted and four feature selection methods were used to select robust features. The selected features were used to build five machine learning classifiers, and 20 (four feature selection methods × five machine learning classifiers) predictive models for the screening of poor responders were constructed. The predictive models were evaluated according to the area under the curve (AUC), F1 score, accuracy, sensitivity, and specificity. RESULTS Eighty percent of all predictive models constructed achieved an AUC of more than 0.70. A predictive model using a support vector machine classifier with the minimum redundancy maximum relevance (mRMR) selection method followed by the least absolute shrinkage and selection operator (LASSO) selection method showed superior prediction performance, with an AUC of 0.923, an F1 score of 88.14%, and accuracy of 91.03%. The predictive performance of the constructed models was not improved by ComBat compensation. CONCLUSIONS In rectal cancer patients who underwent neoadjuvant chemoradiotherapy, machine learning classifiers with radiomics features extracted from multiparametric MRI were able to accurately discriminate poor responders from good responders. The techniques should provide additional information to guide patient-tailored treatment.
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Affiliation(s)
- Jia Wang
- Department of Ultrasound, Qingdao Women and Children Hospital, Shandong, Qingdao, China
| | - Jingjing Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shandong, Qingdao, China
| | - Ruizhi Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shandong, Qingdao, China
| | - Yuanxiang Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shandong, Qingdao, China
| | - Jie Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shandong, Qingdao, China.
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Azamat S, Karaman Ş, Azamat IF, Ertaş G, Kulle CB, Keskin M, Sakin RND, Bakır B, Oral EN, Kartal MG. Complete Response Evaluation of Locally Advanced Rectal Cancer to Neoadjuvant Chemoradiotherapy Using Textural Features Obtained from T2 Weighted Imaging and ADC Maps. Curr Med Imaging 2022; 18:1061-1069. [PMID: 35240976 DOI: 10.2174/1573405618666220303111026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prediction of pathological responses for locally advanced rectal cancer using magnetic resonance imaging (MRI) after neoadjuvant chemoradiotherapy (CRT) is a challenging task for radiologists, as residual tumor cells can be mistaken for fibrosis. Texture analysis of MR images has been proposed to understand the underlying pathology. OBJECTIVE This study aimed to assess the responses of lesions to CRT in patients with locally advanced rectal cancer using the first-order textural features of MRI T2-weighted imaging (T2-WI) and apparent diffusion coefficient (ADC) maps. METHODS Forty-four patients with locally advanced rectal cancer (median age: 57 years) who underwent MRI before and after CRT were enrolled in this retrospective study. The first-order textural parameters of tumors on T2-WI and ADC maps were extracted. The textural features of lesions in pathologic complete responders were compared to partial responders using Student's t- or Mann-Whitney U tests. A comparison of textural features before and after CRT for each group was performed using the Wilcoxon rank sum test. Receiver operating characteristic curves were calculated to detect the diagnostic performance of the ADC. RESULTS Of the 44 patients evaluated, 22 (50%) were placed in a partial response group and 50% were placed in a complete response group. The ADC changes of the complete responders were statistically more significant than those of the partial responders (P = 0.002). Pathologic total response was predicted with an ADC cut-off of 1310 x 10-6 mm2/s, with a sensitivity of 72%, a specificity of 77%, and an accuracy of 78.1% after neoadjuvant CRT. The skewness of the T2-WI before and after neoadjuvant CRT showed a significant difference in the complete response group compared to the partial response group (P = 0.001 for complete responders vs. P = 0.482 for partial responders). Also, relative T2-WI signal intensity in the complete response group was statistically lower than that of the partial response group after neoadjuvant CRT (P = 0.006). CONCLUSION As a result of the conversion of tumor cells to fibrosis, the skewness of the T2-WI before and after neoadjuvant CRT was statistically different in the complete response group compared to the partial response group, and the complete response group showed statistically lower relative T2-WI signal intensity than the partial response group after neoadjuvant CRT. Additionally, the ADC cut-off value of 1310 × 10-6 mm2/s could be used as a marker for complete response along with absolute ADC value changes within this dataset.
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Affiliation(s)
- Sena Azamat
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
- Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Şule Karaman
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ibrahim Fethi Azamat
- Department of General Surgery, Faculty of Medicine, Koc University, Istanbul, Turke
| | - Gokhan Ertaş
- Biomedical Engineering Department, Yeditepe University, Istanbul, Turkey
| | - Cemil Burak Kulle
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Metin Keskin
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Barış Bakır
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ethem Nezih Oral
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Merve Gulbiz Kartal
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Fernandes MC, Gollub MJ, Brown G. The importance of MRI for rectal cancer evaluation. Surg Oncol 2022; 43:101739. [PMID: 35339339 PMCID: PMC9464708 DOI: 10.1016/j.suronc.2022.101739] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 12/19/2022]
Abstract
Magnetic resonance imaging (MRI) has gained increasing importance in the management of rectal cancer over the last two decades. The role of MRI in patients with rectal cancer has expanded beyond the tumor-node-metastasis (TNM) system in both staging and restaging scenarios and has contributed to identifying "high" and "low" risk features that can be used to tailor and personalize patient treatment; for instance, selecting the patients for neoadjuvant chemoradiation (NCRT) before the total mesorectal excision (TME) surgery based on risk of recurrence. Among those features, the status of the circumferential resection margin (CRM), extramural vascular invasion (EMVI), and tumor deposits (TD) have stood out. Moreover, MRI also has played a role in surgical planning, especially when the tumor is located in the low rectum, when the relationship between tumor and the anal canal is important to choose the best surgical approach, and in cases of locally advanced or recurrent tumors invading adjacent pelvic organs that may require more complex surgeries such as pelvic exenteration. As approaches using organ preservation emerge, including transanal local excision and "watch-and-wait", MRI may help in the patient selection for those treatments, follow up, and detection of tumor regrowth. Additionally, potential MRI-based prognostic and predictive biomarkers, such as quantitative and semi-quantitative metrics derived from functional sequences like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE), and radiomics, are under investigation. This review provides an overview of the current role of MRI in rectal cancer in staging and restaging and highlights the main areas under investigation and future perspectives.
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Munk NE, Bondeven P, Pedersen BG. Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature. Acta Radiol 2021; 64:20-31. [PMID: 34928715 DOI: 10.1177/02841851211065925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The diagnostic performance of magnetic resonance imaging (MRI) modalities and/or endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy (nCRT) is unclear. PURPOSE To summarize existing evidence on the diagnostic performance of diffusion-weighted MRI, perfusion-weighted MRI, T2-weighted MR tumor regression grade, and/or endoscopy for assessing complete tumor response after nCRT. MATERIAL AND METHODS MEDLINE and Embase databases were searched. The PRISMA guidelines were followed. Sensitivity, specificity, negative predictive, and positive predictive values were retrieved from included studies. RESULTS In total, 81 studies were eligible for inclusion. Evidence suggests that combined use of MRI and endoscopy tends to improve the diagnostic performance compared to single imaging modality. The positive predictive value of a complete response varies substantially between studies. There is considerable heterogeneity between studies. CONCLUSION Combined re-staging tends to improve diagnostic performance compared to single imaging modality, but the vast majority of studies fail to offer true clinical value due to the study heterogeneity.
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Affiliation(s)
| | - Peter Bondeven
- Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Bodil Ginnerup Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Tavakoli AA, Dreher C, Mlynarska A, Kuder TA, Gnirs R, Schlemmer HP, Bickelhaupt S. Pancreatic imaging using diffusivity mapping - Influence of sequence technique on qualitative and quantitative analysis. Clin Imaging 2021; 83:33-40. [PMID: 34953309 DOI: 10.1016/j.clinimag.2021.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare image quality of an optimized diffusion weighted imaging (DWI) sequence with advanced post-processing and motion correction (advanced-EPI) to a standard DWI protocol (standard-EPI) in pancreatic imaging. MATERIALS AND METHODS 62 consecutive patients underwent abdominal MRI at 1.5 T were included in this retrospective analysis of data collected as part of an IRB approved study. All patients received a standard-EPI and an advanced-EPI DWI with advanced post-processing and motion correction. Two blinded radiologists evaluated the parameters image quality, detail of parenchyma, sharpness of boundaries and discernibility from adjacent structures on b = 900 s/mm2 images using a Likert-like scale. Segmentation of pancreatic head, body and tail were obtained and apparent diffusion coefficient (ADC) was calculated separately for each region. Apparent tissue-to-background ratio (TBR) was calculated at b = 50 s/mm2 and at b = 900 s/mm2. RESULTS The advanced-EPI yielded significantly higher scores for pancreatic parameters of image quality, detail level of parenchyma, sharpness of boundaries and discernibility from adjacent structures in comparison to standard-EPI (p < 0.001 for all, kappa = [0.46,0.71]) and was preferred in 96% of the cases when directly compared. ADC of the pancreas was 7% lower in advanced-EPI (1.236 ± 0.152 vs. 1.146 ± 0.126 μm2/ms, p < 0.001). ADC in the pancreatic tail was significantly lower for both sequences compared to head and body (all p < 0.001). There was comparable TBR for both sequences at b = 50 s/mm2 (standard-EPI: 19.0 ± 5.9 vs. advanced-EPI: 19.0 ± 6.4, p = 0.96), whereas at b = 900 s/mm2, TBR was 51% higher for advanced-EPI (standard-EPI: 7.1 ± 2.5 vs. advanced-EPI: 10.8 ± 5.1, p < 0.001). CONCLUSION An advanced DWI sequence might increase image quality for focused imaging of the pancreas and providing improved parenchymal detail levels compared to a standard DWI.
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Affiliation(s)
- Anoshirwan Andrej Tavakoli
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Constantin Dreher
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Anna Mlynarska
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Tristan Anselm Kuder
- German Cancer Research Center (DKFZ), Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Regula Gnirs
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Heinz-Peter Schlemmer
- German Cancer Research Center (DKFZ), Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Sebastian Bickelhaupt
- German Cancer Research Center (DKFZ), Medical Imaging and Radiology - Cancer Prevention, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; University Hospital Erlangen, Institute of Radiology, Maximiliansplatz 3, 91054 Erlangen, Germany.
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10
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Hellwig K, Ellmann S, Eckstein M, Wiesmueller M, Rutzner S, Semrau S, Frey B, Gaipl US, Gostian AO, Hartmann A, Iro H, Fietkau R, Uder M, Hecht M, Bäuerle T. Predictive Value of Multiparametric MRI for Response to Single-Cycle Induction Chemo-Immunotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma. Front Oncol 2021; 11:734872. [PMID: 34745957 PMCID: PMC8567752 DOI: 10.3389/fonc.2021.734872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022] Open
Abstract
Objectives To assess the predictive value of multiparametric MRI for treatment response evaluation of induction chemo-immunotherapy in locally advanced head and neck squamous cell carcinoma. Methods Twenty-two patients with locally advanced, histologically confirmed head and neck squamous cell carcinoma who were enrolled in the prospective multicenter phase II CheckRad-CD8 trial were included in the current analysis. In this unplanned secondary single-center analysis, all patients who received contrast-enhanced MRI at baseline and in week 4 after single-cycle induction therapy with cisplatin/docetaxel combined with the immune checkpoint inhibitors tremelimumab and durvalumab were included. In week 4, endoscopy with representative re-biopsy was performed to assess tumor response. All lesions were segmented in the baseline and restaging multiparametric MRI, including the primary tumor and lymph node metastases. The volume of interest of the respective lesions was volumetrically measured, and time-resolved mean intensities of the golden-angle radial sparse parallel-volume-interpolated gradient-echo perfusion (GRASP-VIBE) sequence were extracted. Additional quantitative parameters including the T1 ratio, short-TI inversion recovery ratio, apparent diffusion coefficient, and dynamic contrast-enhanced (DCE) values were measured. A model based on parallel random forests incorporating the MRI parameters from the baseline MRI was used to predict tumor response to therapy. Receiver operating characteristic (ROC) curves were used to evaluate the prognostic performance. Results Fifteen patients (68.2%) showed pathologic complete response in the re-biopsy, while seven patients had a residual tumor (31.8%). In all patients, the MRI-based primary tumor volume was significantly lower after treatment. The baseline DCE parameters of time to peak and wash-out were significantly different between the pathologic complete response group and the residual tumor group (p < 0.05). The developed model, based on parallel random forests and DCE parameters, was able to predict therapy response with a sensitivity of 78.7% (95% CI 71.24–84.93) and a specificity of 78.6% (95% CI 67.13–87.48). The model had an area under the ROC curve of 0.866 (95% CI 0.819–0.914). Conclusions DCE parameters indicated treatment response at follow-up, and a random forest machine learning algorithm based on DCE parameters was able to predict treatment response to induction chemo-immunotherapy.
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Affiliation(s)
| | - Stephan Ellmann
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Marco Wiesmueller
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Sandra Rutzner
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Udo S Gaipl
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Antoniu Oreste Gostian
- Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany.,Department of Otolaryngology - Head & Neck Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Heinrich Iro
- Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany.,Department of Otolaryngology - Head & Neck Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Markus Hecht
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Tobias Bäuerle
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg (CCC ER-EMN), Erlangen, Germany
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11
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Xu Q, Xu Y, Sun H, Jiang T, Xie S, Ooi BY, Ding Y. MRI Evaluation of Complete Response of Locally Advanced Rectal Cancer After Neoadjuvant Therapy: Current Status and Future Trends. Cancer Manag Res 2021; 13:4317-4328. [PMID: 34103987 PMCID: PMC8179813 DOI: 10.2147/cmar.s309252] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/08/2021] [Indexed: 12/29/2022] Open
Abstract
Complete tumor response can be achieved in a certain proportion of patients with locally advanced rectal cancer, who achieve maximal response to neoadjuvant therapy (NAT). For these patients, a watch-and-wait (WW) or nonsurgical strategy has been proposed and is becoming widely practiced in order to avoid unnecessary surgical complications. Therefore, a non-invasive, reliable diagnostic tool for accurately evaluating complete tumor response is needed. Magnetic resonance imaging (MRI) plays a crucial role in both primary staging and restaging tumor response to NAT in rectal cancer without relying on resected specimen. In recent years, numerous efforts have been made to research the value of MRI in predicting and evaluating complete response in rectal cancer. Current MRI evaluation is mainly based on morphological and functional images. Morphologic MRI yields high soft tissue resolution, multiplanar images, and provides detailed depictions of rectal cancer and its surrounding structures. Functional MRI may help to distinguish residual tumor from fibrosis, therefore improving the diagnostic performance of morphologic MRI in identifying complete tumor response. Both morphologic and functional MRI have several promising parameters that may help accurately evaluate and/or predict complete response of rectal cancer. However, these parameters still have limitations and the results remain inconsistent. Recent development of new techniques, such as textural analysis, radiomics analysis and deep learning, demonstrate great potential based on MRI-derived parameters. This article aimed to review and help better understand the strengths, limitations, and future trends of these MRI-derived methods in evaluating complete response in rectal cancer.
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Affiliation(s)
- Qiaoyu Xu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Tao Jiang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Bee Yen Ooi
- Department of Radiology, Hospital Seberang Jaya, Penang, Malaysia
| | - Yi Ding
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
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12
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Chen K, She HL, Wu T, Hu F, Li T, Luo LP. Comparison of percentage changes in quantitative diffusion parameters for assessing pathological complete response to neoadjuvant therapy in locally advanced rectal cancer: a meta-analysis. Abdom Radiol (NY) 2021; 46:894-908. [PMID: 32975646 DOI: 10.1007/s00261-020-02770-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic performance of percentage changes in apparent diffusion coefficient (∆ADC%) and slow diffusion coefficient (∆D%) for assessing pathological complete response (pCR) to neoadjuvant therapy in patients with locally advanced rectal cancer (LARC). METHODS A systematic search in PubMed, EMBASE, the Web of Science, and the Cochrane Library was performed to retrieve related original studies. For each parameter (∆ADC% and ∆D%), we pooled the sensitivity, specificity and calculated the area under summary receiver operating characteristic curve (AUROC) values. Meta-regression and subgroup analyses were performed to explore heterogeneity among the studies on ∆ADC%. RESULTS 15 original studies (804 patients with 805 lesions, 15 studies on ∆ADC%, 4 of the studies both on ∆ADC% and ∆D%) were included. pCR was observed in 213 lesions (26.46%). For the assessment of pCR, the pooled sensitivity, specificity and AUROC of ∆ADC% were 0.83 (95% confidence intervals [CI] 0.76, 0.89), 0.74 (95% CI 0.66, 0.81), 0.87 (95% CI 0.83, 0.89), and ∆D% were 0.70 (95% CI 0.52, 0.84), 0.81 (95% CI 0.65, 0.90), 0.81 (95% CI 0.77, 0.84), respectively. In the four studies on the both metrics, ∆ADC% yielded an equivalent diagnostic performance (AUROC 0.80 [95% CI 0.76, 0.83]) to ∆D%, but lower than in the studies (n = 11) only on ∆ADC% (AUROC 0.88 [95% CI 0.85, 0.91]). Meta-regression and subgroup analyses showed no significant factors affecting heterogeneity. CONCLUSIONS Our meta-analysis confirms that ∆ADC% could reliably evaluate pCR in patients with LARC after neoadjuvant therapy. ∆D% may not be superior to ∆ADC%, which deserves further investigation.
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Affiliation(s)
- Kai Chen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, 613 Huangpu Street, Guangzhou, 510630, China
- Department of Radiology, Affiliated Hospital of Xiangnan University (Clinical College), 25 Renmin West Road, Chenzhou, 423000, China
| | - Hua-Long She
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, 613 Huangpu Street, Guangzhou, 510630, China
- Department of Radiology, Affiliated Hospital of Xiangnan University (Clinical College), 25 Renmin West Road, Chenzhou, 423000, China
| | - Tao Wu
- Department of Radiology, Affiliated Hospital of Xiangnan University (Clinical College), 25 Renmin West Road, Chenzhou, 423000, China
| | - Fang Hu
- College of Medical Imaging and Medical Examination, Xiangnan University, 25 Renmin West Road, Chenzhou, 423000, China
| | - Tao Li
- College of Medical Imaging and Medical Examination, Xiangnan University, 25 Renmin West Road, Chenzhou, 423000, China.
| | - Liang-Ping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, 613 Huangpu Street, Guangzhou, 510630, China.
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13
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Fischer J, Eglinton TW, Richards SJ, Frizelle FA. Predicting pathological response to chemoradiotherapy for rectal cancer: a systematic review. Expert Rev Anticancer Ther 2021; 21:489-500. [PMID: 33356679 DOI: 10.1080/14737140.2021.1868992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Pathological complete response (pCR) rates of approximately 20% following neoadjuvant long-course chemoradiotherapy for rectal cancer have given rise to non-operative or watch-and-wait (W&W) management. To improve outcomes there has been significant research into predictors of response. The goal is to optimize selection for W&W, avoid chemoradiotherapy in those who won't benefit and improve treatment to maximize the clinical complete response (cCR) rate and the number of patients who can be considered for W&W.Areas covered: A systematic review of articles published 2008-2018 and indexed in PubMed, Embase or Medline was performed to identify predictors of pathological response (including pCR and recognized tumor regression grades) to fluoropyrimidine-based chemoradiotherapy in patients who underwent total mesorectal excision for rectal cancer. Evidence for clinical, biomarker and radiological predictors is discussed as well as potential future directions.Expert opinion: Our current ability to predict the response to chemoradiotherapy for rectal cancer is very limited. cCR of 40% has been achieved with total neoadjuvant therapy. If neoadjuvant treatment for rectal cancer continues to improve it is possible that the treatment for rectal cancer may eventually parallel that of anal squamous cell carcinoma, with surgery reserved for the minority of patients who don't respond to chemoradiotherapy.
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Affiliation(s)
- Jesse Fischer
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, North Shore Hospital, Auckland, New Zealand
| | - Tim W Eglinton
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Simon Jg Richards
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, The Royal Melbourne Hospital, Melbourne, Australia
| | - Frank A Frizelle
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
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14
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Di Re AM, Sun Y, Sundaresan P, Hau E, Toh JWT, Gee H, Or M, Haworth A. MRI radiomics in the prediction of therapeutic response to neoadjuvant therapy for locoregionally advanced rectal cancer: a systematic review. Expert Rev Anticancer Ther 2021; 21:425-449. [PMID: 33289435 DOI: 10.1080/14737140.2021.1860762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The standard of care for locoregionally advanced rectal cancer is neoadjuvant therapy (NA CRT) prior to surgery, of which 10-30% experience a complete pathologic response (pCR). There has been interest in using imaging features, also known as radiomics features, to predict pCR and potentially avoid surgery. This systematic review aims to describe the spectrum of MRI studies examining high-performing radiomic features that predict NA CRT response.Areas covered: This article reviews the use of pre-therapy MRI in predicting NA CRT response for patients with locoregionally advanced rectal cancer (T3/T4 and/or N1+). The primary outcome was to identify MRI radiomic studies; secondary outcomes included the power and the frequency of use of radiomic features.Expert opinion: Advanced models incorporating multiple radiomics categories appear to be the most promising. However, there is a need for standardization across studies with regards to; the definition of NA CRT response, imaging protocols, and radiomics features incorporated. Further studies are needed to validate current radiomics models and to fully ascertain the value of MRI radiomics in the response prediction for locoregionally advanced rectal cancer.
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Affiliation(s)
- Angelina Marina Di Re
- Colorectal Department, Westmead Hospital, Cnr Hawkesbury, Westmead, NSW.,School of Physics, University of Sydney, Camperdown, NSW, Australia
| | - Yu Sun
- School of Physics, University of Sydney, Camperdown, NSW, Australia
| | - Purnima Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Cnr Hawkesbury, Westmead, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Eric Hau
- Radiation Oncology Network, Western Sydney Local Health District, Cnr Hawkesbury, Westmead, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Centre for Cancer Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - James Wei Tatt Toh
- Colorectal Department, Westmead Hospital, Cnr Hawkesbury, Westmead, NSW.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Centre for Cancer Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Harriet Gee
- Radiation Oncology Network, Western Sydney Local Health District, Cnr Hawkesbury, Westmead, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Michelle Or
- Radiation Oncology Network, Western Sydney Local Health District, Cnr Hawkesbury, Westmead, NSW, Australia
| | - Annette Haworth
- School of Physics, University of Sydney, Camperdown, NSW, Australia
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15
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Cancer Detection and Quantification of Treatment Response Using Diffusion-Weighted MRI. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Hao Y, An R, Xue Y, Li F, Wang H, Zheng J, Fan L, Liu J, Fan H, Yin H. Prognostic value of tumoral and peritumoral magnetic resonance parameters in osteosarcoma patients for monitoring chemotherapy response. Eur Radiol 2020; 31:3518-3529. [PMID: 33146792 PMCID: PMC8043923 DOI: 10.1007/s00330-020-07338-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023]
Abstract
Objectives To evaluate parameters of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as early imaging indicators of tumor histologic response to pre-operative neoadjuvant chemotherapy and as probable prognostic factors for event-free survival (EFS) and overall survival in osteosarcoma (OS) in both tumoral and peritumoral areas. Methods Thirty-four OS patients who received three courses of neoadjuvant chemotherapy followed by surgery during 2014–2018 were enrolled in this study. All patients underwent baseline and post-chemotherapy DWI and DCE-MRI. Lesion region was defined as the tumoral area and peritumoral area. Parameters of apparent diffusion coefficient, capacity transfer constant (Ktrans), elimination rate constant, extravascular extracellular space volume ratio (Ve), and initial area under the curve as well as corresponding differences between pre- and post-chemotherapy in lesion regions were evaluated. Receiver operating characteristic analysis was used to evaluate the diagnostic performance of these parameters. The associations of all parameters with tumor histologic response, EFS, and overall survival were also calculated. Results In the tumor area, moderate evidence was found that post-Ktrans was lower in responders as compared with that in poor responders (p = 0.04, false discovery rate [FDR] corrected), and ΔKtrans exhibited significant between-groups differences (p = 0.04, Bonferroni corrected; or p = 0.006, FDR corrected). Weak evidence for the between-groups difference was found in the Ve in the peritumoral area (p = 0.025 before treatment and p = 0.021 after treatment, uncorrected). Furthermore, lower post-Ktrans in the tumoral area and lower pre-Ve in the peritumoral area were significant prognostic indicators for longer EFS (p = 0.002, p = 0.026) and overall survival (p = 0.003, p = 0.023). Conclusions In OS, DWI and DCE-MRI parameters in both tumoral and peritumoral areas can reflect the chemotherapy response and prognosticate EFS and overall survival. Key Points • Peritumoral MRI parameters can reflect the chemotherapy response in OS patients. • Peritumoral MRI parameters can predict EFS and overall survival in OS patients. • MRI parameters may be predictive factors for evaluating chemotherapy efficacy and EFS.
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Affiliation(s)
- Yuewen Hao
- Department of Radiology, Xi'an Children's Hospital, Xi'an, Shaanxi, China.,Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Rui An
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yingsen Xue
- Department of Orthopaedic Surgery, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Fan Li
- Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hong Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jianmin Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Linni Fan
- Department of Pathology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jixin Liu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Hongbin Fan
- Department of Orthopaedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
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17
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Magnetic Resonance of Rectal Cancer Response to Therapy: An Image Quality Comparison between 3.0 and 1.5 Tesla. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9842732. [PMID: 33102603 PMCID: PMC7576357 DOI: 10.1155/2020/9842732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023]
Abstract
Purpose To evaluate signal intensity (SI) differences between 3.0 T and 1.5 T on T2-weighted (T2w), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) in rectal cancer pre-, during, and postneoadjuvant chemoradiotherapy (CRT). Materials and Methods 22 patients with locally advanced rectal cancer were prospectively enrolled. All patients underwent T2w, DWI, and ADC pre-, during, and post-CRT on both 3.0 T MRI and 1.5 T MRI. A radiologist drew regions of interest (ROIs) of the tumor and obturator internus muscle on the selected slice to evaluate SI and relative SI (rSI). Additionally, a subanalysis evaluating the SI before and after-CRT (∆SI pre-post) in complete responder patients (CR) and nonresponder patients (NR) on T2w, DWI, and ADC was performed. Results Significant differences were observed for T2w and DWI on 3.0 T MRI compared to 1.5 T MRI pre-, during, and post-CRT (all P < 0.001), whereas no significant differences were reported for ADC among all controls (all P > 0.05). rSI showed no significant differences in all the examinations for all sequences (all P > 0.05). ∆SI showed significant differences between 3.0 T and 1.5 T MRI for DWI-∆SI in CR and NR (188.39 ± 166.90 vs. 30.45 ± 21.73 and 169.70 ± 121.87 vs. 22.00 ± 31.29, respectively, all P 0.02) and ADC-∆SI for CR (−0.58 ± 0.27 vs. −0.21 ± 0.24P value 0.02), while no significant differences were observed for ADC-∆SI in NR and both CR and NR for T2w-∆SI. Conclusion T2w-SI and DWI-SI showed significant differences for 3.0 T compared to 1.5 T in all three controls, while ADCSI showed no significant differences in all three controls on both field strengths. rSI was comparable for 3.0 T and 1.5 T MRI in rectal cancer patients; therefore, rectal cancer patients can be assessed both at 3.0 T MRI and 1.5 T MRI. However, a significant DWI-∆SI and ADC-∆SI on 3.0 T in CR might be interpreted as a better visual assessment in discriminating response to therapy compared to 1.5 T. Further investigations should be performed to confirm future possible clinical application.
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18
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Attenberger UI, Tavakoli A, Stocker D, Stieb S, Riesterer O, Turina M, Schoenberg SO, Pilz L, Reiner CS. Reduced and standard field-of-view diffusion weighted imaging in patients with rectal cancer at 3 T-Comparison of image quality and apparent diffusion coefficient measurements. Eur J Radiol 2020; 131:109257. [PMID: 32947092 DOI: 10.1016/j.ejrad.2020.109257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare a zoomed EPI-DWI (z-EPI) with a standard EPI-DWI (s-EPI) in the primary diagnostics of rectal cancer and assess its potential of reduced image artifacts. METHOD 22 therapy-naïve patients with rectal cancer underwent rectal MRI at a 3 T-system. The protocols consisted of a z-EPI DWI and s-EPI DWI sequence. Images were assessed by two independent and experienced readers regarding overall image quality and artifacts on a 5-point Likert scale, as well as overall sequence preference. In a lesion-based analysis, tumor and lymph node detection were rated on a 4-point Likert scale. Apparent diffusion coefficient (ADC) measurements were performed. RESULTS Overall Image quality score for z-EPI and s-EPI showed no statistically significant differences (p = 0.80/0.54, reader 1/2) with a median score of 4 ("good" image quality) for both sequences. The image quality preference rank for z-EPI and s-EPI was given the category 'no preference' in 64 % (reader 1) and 50 % (reader 2). Most artifact-related scores (susceptibility, motion and distortion) did not show reproducible significant differences between z-EPI and s-EPI. The two sequences exhibited comparable, mostly good and excellent quality scores for tumor and lymph node detection (p = 0.19-0.99). ADC values were significantly lower for z-EPI than for s-EPI (p = 0.001/0.002, reader 1/2) with good agreement of ADC measurements between both readers. CONCLUSION Our data showed comparable image quality and lesion detection for the z-EPI and the s-EPI sequence in MRI of rectal cancer, whereas the mean ADC of the tumor was significantly lower in z-EPI compared to s-EPI.
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Affiliation(s)
- U I Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany.
| | - A Tavakoli
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Germany.
| | - D Stocker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - S Stieb
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - O Riesterer
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - M Turina
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
| | - S O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany.
| | - L Pilz
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - C S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
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Yang L, Xia C, Liu D, Fang X, Pan X, Ma L, Wu B. The role of readout-segmented echo-planar imaging-based diffusion-weighted imaging in evaluating tumor response of locally advanced rectal cancer after neoadjuvant chemoradiotherapy. Acta Radiol 2020; 61:1155-1164. [PMID: 31924105 DOI: 10.1177/0284185119897354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Accurate assessment of tumor response in rectal cancer could help individualize treatment. PURPOSE To evaluate the role of diffusion-weighted imaging (DWI) based on readout-segmented echo-planar imaging (rs-EPI) in assessing tumor response after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC). MATERIAL AND METHODS Sixty-three patients with LARC who received neoadjuvant CRT and surgery were enrolled retrospectively. They all underwent pre- and post-CRT magnetic resonance examinations, including DWI using rs-EPI. According to pathological results, patients were grouped as pathological complete responder (pCR, n = 16) and non-pCR (n = 47). Visual assessment of residual tumor and whole-tumor histogram analysis of pre- and post-CRT apparent diffusion coefficient (ADC) map was performed by two radiologists; tumor volume on ADC map was also recorded. RESULTS Overall inter-observer agreement was good for histogram analysis (ICC = 0.543-0.999). Tumor volume reduction rate on ADC map showed no significant difference between the two groups (P = 0.468). Post-CRT mean, quantile values, and their percentage changes were higher in the pCR group (all P < 0.001). Post-CRT mean value had a good diagnostic power in selecting pCR (AUC = 0.855), with a cut-off value of 1.345 × 10-3 mm2/s, yielding a sensitivity of 83%, specificity of 81.3%. Post-CRT 95% quantile value had the highest AUC (AUC = 0.868) among quantile values, and a higher specificity (87.5% vs. 81.3%) than mean value with comparable overall diagnostic performance (P = 0.563). Visual assessment showed a sensitivity of 85.1%, specificity of 68.8% in selecting pCR. CONCLUSION Quantitative ADC value of rs-EPI DWI could reliably evaluate tumor response in patients with LARC. Post-CRT 95% quantile ADC value could help mean value to more accurately identify pCR.
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Affiliation(s)
- Lanqing Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Dan Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xin Fang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xuelin Pan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Ling Ma
- GE Healthcare, Shanghai, PR China
| | - Bing Wu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Jiménez de los Santos ME, Reyes-Pérez JA, Sandoval-Nava RM, Villalobos-Juárez JL, Villaseñor-Navarro Y, Vela-Sarmiento I, Sollozo-Dupont I. The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer. Acta Radiol Open 2020; 9:2058460120957295. [PMID: 32974055 PMCID: PMC7495679 DOI: 10.1177/2058460120957295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/18/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Apparent diffusion coefficient (ADC) values achieve promising results in treatment response prediction in patients with several types of cancers. PURPOSE To determine whether ADC values predict neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC). MATERIAL AND METHODS Forty-four patients with LARC who underwent magnetic resonance imaging scans before and after nCRT followed by delayed surgery were enrolled retrospectively. The sample was distributed as follows: responders (R), n = 8; and non-responders (Non-R), n = 36. Three markers of treatment response were considered: post-nCRT measures; ΔADC; and Δ%ADC. Statistical analysis included a Wilcoxon test, a Mann-Whitney U test, and a receiver operating characteristic (ROC) analysis in order to evaluate the diagnostic accuracy for each ADC value marker to differentiate between R and Non-R. RESULTS Both minimum and mean ADC values were significantly higher after nCRT in the R group, while non-significant differences between basal and control ADC values were found in the non-R group. In addition, ΔADC and Δ%ADC exhibited increased values after nCRT in R when compared with non-R. ROC analysis revealed the following diagnostic performance parameters: post-nCRT: ADCmin = 1.05 × 10-3 mm2/s (sensitivity 61.1% and specificity 66.7%), ADCmean = 1.50 × 10-3 mm2/s (sensitivity 72.2% and specificity 83.3%), ΔADC: ADCmin = 0.35 (sensitivity 66.7% and specificity 83.3%), ADCmean = 0.50 (sensitivity 72% and specificity 83%); and Δ%ADC: ADCmin = 44% (sensitivity 66.7% and specificity 83.3%) and ADCmean = 60% (sensitivity 83% and specificity 99%). CONCLUSION Our findings suggest that post-treatment rectal tumor ADC values, as well changes between pre- and post-treatment values, may be biomarkers for predicting treatment response in patients with LARC who underwent nCRT.
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21
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Peng Y, Xu C, Hu X, Shen Y, Hu D, Kamel I, Li Z. Reduced Field-of-View Diffusion-Weighted Imaging in Histological Characterization of Rectal Cancer: Impact of Different Region-of-Interest Positioning Protocols on Apparent Diffusion Coefficient Measurements. Eur J Radiol 2020; 127:109028. [DOI: 10.1016/j.ejrad.2020.109028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/11/2020] [Accepted: 04/14/2020] [Indexed: 01/21/2023]
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Improved Liver Diffusion-Weighted Imaging at 3 T Using Respiratory Triggering in Combination With Simultaneous Multislice Acceleration. Invest Radiol 2020; 54:744-751. [PMID: 31335634 DOI: 10.1097/rli.0000000000000594] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study was to retrospectively compare optimized respiratory-triggered diffusion-weighted imaging with simultaneous multislice acceleration (SMS-RT-DWI) of the liver with a standard free-breathing echo-planar DWI (s-DWI) protocol at 3 T with respect to the imaging artifacts inherent to DWI. MATERIALS AND METHODS Fifty-two patients who underwent a magnetic resonance imaging study of the liver were included in this retrospective study. Examinations were performed on a 3 T whole-body magnetic resonance system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). In all patients, both s-DWI and SMS-RT-DWI of the liver were obtained. Images were qualitatively evaluated by 2 independent radiologists with regard to overall image quality, liver edge sharpness, sequence-related artifacts, and overall scan preference. For quantitative evaluation, signal-to-noise ratio was measured from signal-to-noise ratio maps. The mean apparent diffusion coefficient (ADC) was measured in each liver quadrant. The Wilcoxon rank-sum test was used for analysis of the qualitative parameters and the paired Student t test for quantitative parameters. RESULTS Overall image quality, liver edge sharpness, and sequence-related artifacts of SMS-RT-DWI received significantly better ratings compared with s-DWI (P < 0.05 for all). For 90.4% of the examinations, both readers overall preferred SMS-RT-DWI to s-DWI. Acquisition time for SMS-RT-DWI was 34% faster than s-DWI. Signal-to-noise ratio values were significantly higher for s-DWI at b50 but did not statistically differ at b800, and they were more homogenous for SMS-RT-DWI, with a significantly lower standard deviation at b50. Mean ADC values decreased from the left to right hepatic lobe as well as from cranial to caudal for s-DWI. With SMS-RT-DWI, mean ADC values were homogeneous throughout the liver. CONCLUSIONS Optimized, multislice, respiratory-triggered DWI of the liver at 3 T substantially improves image quality with a reduced scan acquisition time compared with s-DWI.
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Kok END, Eppenga R, Kuhlmann KFD, Groen HC, van Veen R, van Dieren JM, de Wijkerslooth TR, van Leerdam M, Lambregts DMJ, Heerink WJ, Hoetjes NJ, Ivashchenko O, Beets GL, Aalbers AGJ, Nijkamp J, Ruers TJM. Accurate surgical navigation with real-time tumor tracking in cancer surgery. NPJ Precis Oncol 2020; 4:8. [PMID: 32285009 PMCID: PMC7142120 DOI: 10.1038/s41698-020-0115-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
In the past decades, image-guided surgery has evolved rapidly. In procedures with a relatively fixed target area, like neurosurgery and orthopedics, this has led to improved patient outcomes. In cancer surgery, intraoperative guidance could be of great benefit to secure radical resection margins since residual disease is associated with local recurrence and poor survival. However, most tumor lesions are mobile with a constantly changing position. Here, we present an innovative technique for real-time tumor tracking in cancer surgery. In this study, we evaluated the feasibility of real-time tumor tracking during rectal cancer surgery. The application of real-time tumor tracking using an intraoperative navigation system is feasible and safe with a high median target registration accuracy of 3 mm. This technique allows oncological surgeons to obtain real-time accurate information on tumor location, as well as critical anatomical information. This study demonstrates that real-time tumor tracking is feasible and could potentially decrease positive resection margins and improve patient outcome.
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Affiliation(s)
- Esther N D Kok
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Roeland Eppenga
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Koert F D Kuhlmann
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harald C Groen
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ruben van Veen
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jolanda M van Dieren
- 2Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas R de Wijkerslooth
- 2Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique van Leerdam
- 2Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- 3Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter J Heerink
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nikie J Hoetjes
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Oleksandra Ivashchenko
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geerard L Beets
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arend G J Aalbers
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jasper Nijkamp
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Theo J M Ruers
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,4Faculty TNW, Group Nanobiophysics, Twente University, Enschede, 7522 NB The Netherlands
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Fu J, Zhong X, Li N, Van Dams R, Lewis J, Sung K, Raldow AC, Jin J, Qi XS. Deep learning-based radiomic features for improving neoadjuvant chemoradiation response prediction in locally advanced rectal cancer. Phys Med Biol 2020; 65:075001. [PMID: 32092710 DOI: 10.1088/1361-6560/ab7970] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Radiomic features achieve promising results in cancer diagnosis, treatment response prediction, and survival prediction. Our goal is to compare the handcrafted (explicitly designed) and deep learning (DL)-based radiomic features extracted from pre-treatment diffusion-weighted magnetic resonance images (DWIs) for predicting neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC). 43 Patients receiving nCRT were included. All patients underwent DWIs before nCRT and total mesorectal excision surgery 6-12 weeks after completion of nCRT. Gross tumor volume (GTV) contours were drawn by an experienced radiation oncologist on DWIs. The patient-cohort was split into the responder group (n = 22) and the non-responder group (n = 21) based on the post-nCRT response assessed by postoperative pathology, MRI or colonoscopy. Handcrafted and DL-based features were extracted from the apparent diffusion coefficient (ADC) map of the DWI using conventional computer-aided diagnosis methods and a pre-trained convolution neural network, respectively. Least absolute shrinkage and selection operator (LASSO)-logistic regression models were constructed using extracted features for predicting treatment response. The model performance was evaluated with repeated 20 times stratified 4-fold cross-validation using receiver operating characteristic (ROC) curves and compared using the corrected paired t-test. The model built with handcrafted features achieved the mean area under the ROC curve (AUC) of 0.64, while the one built with DL-based features yielded the mean AUC of 0.73. The corrected paired t-test on AUC showed P-value < 0.05. DL-based features extracted from pre-treatment DWIs achieved significantly better classification performance compared with handcrafted features for predicting nCRT response in patients with LARC.
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Affiliation(s)
- Jie Fu
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, United States of America
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Gürses B, Böge M, Altınmakas E, Balık E. Multiparametric MRI in rectal cancer. ACTA ACUST UNITED AC 2020; 25:175-182. [PMID: 31063142 DOI: 10.5152/dir.2019.18189] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
MRI has a pivotal role in both pretreatment staging and posttreatment evaluation of rectal cancer. The accuracy of MRI in pretreatment staging is higher compared with posttreatment evaluation. This occurs due to similar signal intensities of tumoral and posttreatment fibrotic, necrotic, and inflamed tissue. This limitation occurs with conventional MRI of the rectum with morphologic sequences. There is a need towards increasing the accuracy of MRI, especially for posttreatment evaluation. The term multiparametric MRI implies addition of functional sequences, namely, diffusion and perfusion to the routine protocol. This review summarizes the technique, potential implications and previously published studies about multiparametric MRI of rectal cancer.
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Affiliation(s)
- Bengi Gürses
- Department of Radiology, Koç University School of Medicine, İstanbul, Turkey
| | - Medine Böge
- Department of Radiology, Koç University School of Medicine, İstanbul, Turkey
| | - Emre Altınmakas
- Department of Radiology, Koç University School of Medicine, İstanbul, Turkey
| | - Emre Balık
- Department of General Surgery, Koç University School of Medicine, İstanbul, Turkey
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Krdzalic J, Maas M, Gollub MJ, Beets-Tan RGH. Guidelines for MR imaging in rectal cancer: Europe versus United States. Abdom Radiol (NY) 2019; 44:3498-3507. [PMID: 31605186 DOI: 10.1007/s00261-019-02251-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to compare and contrast recently published guidelines for staging and reporting of MR imaging in rectal cancer from the European Society of Gastrointestinal and Abdominal Radiology and the North American Society of Abdominal Radiology. These guidelines were assessed on the presence of consensus and disagreement. Items were compared by two reviewers, and items with agreement and disagreement between the guidelines were identified and are presented in the current paper. Differences between guidelines are discussed to offer insights in practice variations between both continents and among expert centers, which to some extent may explain the differences between guidelines.
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Affiliation(s)
- J Krdzalic
- Department of Radiology, Zuyderland Medical Center, PO Box 5500, 6130MB, Heerlen/Sittard, The Netherlands
| | - M Maas
- Department of Radiology, The Netherlands Cancer Institute, PO Box 90203, 1006BE, Amsterdam, The Netherlands.
| | - M J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - R G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, PO Box 90203, 1006BE, Amsterdam, The Netherlands
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Locally advanced rectal cancer: qualitative and quantitative evaluation of diffusion-weighted magnetic resonance imaging in restaging after neoadjuvant chemo-radiotherapy. Abdom Radiol (NY) 2019; 44:3664-3673. [PMID: 31004202 DOI: 10.1007/s00261-019-02012-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the added value of qualitative and quantitative evaluation of diffusion-weighted magnetic resonance imaging (DWI) in locally advanced rectal cancer (LARC) restaging after neoadjuvant chemo-radiotherapy (CRT). MATERIALS AND METHODS A retrospective study was performed of 21 patients with LARC treated with CRT. All patients were evaluated with 1.5 T conventional magnetic resonance imaging (MRI) and DWI (0-1000 s/mm²) before starting therapy and after neoadjuvant CRT. All included patients underwent surgery after CRT: the histopathological evaluation of surgical specimens represented the reference standard for local staging after neoadjuvant therapy. The qualitative analysis was carried out by two operators in consensus, who reviewed the conventional MR image set [T1-weighted and T2-weighted morphological sequences + dynamic contrast-enhanced sequences (DCE)] and the combined set of conventional and DW images. For the quantitative analysis, the apparent diffusion coefficient (ADC) values were measured at each examination. For each lesion, the mean ADC value (ADCpre and ADCpost) and the ΔADC (ADCpost - ADCpre) were calculated, and values of the three groups of response [complete response (pCR), partial response (pPR), stable disease (pSD)] were compared. RESULTS In LARC restaging, conventional MRI showed a sensitivity of 80% and a specificity of 50%, with a total diagnostic capacity of 71.40%, while by adding DWI sensitivity increased to 100%, specificity to 67%, and total diagnostic capacity to 90.40%. ΔADC correlates with treatment response and a cutoff of 1.35 × 10-3 mm²/s predicts the pCR with a sensitivity of 93.3% and a specificity of 83.3%. CONCLUSIONS Adding DWI to conventional sequences may improve MRI capability to evaluate tumor response to CRT. The quantitative DWI assessment is promising, but larger studies are required.
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Bian H, Liu F, Chen S, Li G, Song Y, Sun M, Dong H. Intravoxel incoherent motion diffusion-weighted imaging evaluated the response to concurrent chemoradiotherapy in patients with cervical cancer. Medicine (Baltimore) 2019; 98:e17943. [PMID: 31725650 PMCID: PMC6867768 DOI: 10.1097/md.0000000000017943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To evaluate the application of multiple b values diffusion-weighted imaging based on biexponential signal decay model to predict the response to concurrent chemoradiotherapy in cervical cancer patients.This prospective study enrolled 28 patients (mean age: 50.89 ± 10.70 years) with cervical cancer confirmed by biopsy who received concurrent chemoradiotherapy. Pelvic magnetic resonance scans were performed 2 weeks before, 7 days and 21 days after the initiation of therapy, and 1 month after the end of the treatment. Diffusion-weighted imaging with b values of 0, 50, 450, and 850 s/mm were performed, and tumor volume, means of tumor apparent diffusion coefficient (ADC)min, ADCmean, ADCslow, ADCfast, and Ffast were measured.Pretreatment ADCmin and ADCslow of good outcome group were significantly higher than those of poor outcome group (P < .05). At the 7th day of the treatment, Ffast and its change rate of good outcome group were significantly higher than those of poor outcome group (P < .05). At the 7th day and 21st day of the treatment, Ffast showed a slowly increasing tendency with no significant difference compared with pretreatment value in poor outcome group (P < .05). One month post-treatment, only ADCslow change rate was significantly higher in good outcome group than that in poor outcome group.Intravoxel incoherent motion-related ADC values could be utilized to better predict the outcome of cervical cancer chemoradiotherapy.
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Affiliation(s)
| | | | - Sha Chen
- Department of Ultrasound, Cangzhou Central Hospital, Cangzhou, Hebei, China
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MRI for Restaging Locally Advanced Rectal Cancer: Detailed Analysis of Discrepancies With the Pathologic Reference Standard. AJR Am J Roentgenol 2019; 213:1081-1090. [PMID: 31386575 DOI: 10.2214/ajr.19.21383] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE. The purpose of this study was to analyze causes of discrepancies between restaging MRI and pathologic findings in the assessment of morphologic indicators of tumor response in patients with rectal cancer who have undergone neoadjuvant treatment. MATERIALS AND METHODS. MRI and pathologic data from 57 consecutively registered patients who underwent neoadjuvant treatment and total mesorectal excision between August 2015 and July 2018 were retrospectively analyzed. The sensitivity and specificity of restaging MRI in determining tumor regression grade, T category, N category, circumferential resection margin, and extramural vascular invasion were calculated with pathologic results as the reference standard. One-by-one comparisons between MRI and pathologic findings were conducted to identify causes of discrepancies. RESULTS. The sensitivity of MRI in determining tumor regression grades 3-5 was 77.1%; T3 and T4 category, 100.0%; node-positive disease, 75.0%; circumferential resection margin, 87.5%; and extramural vascular invasion, 91.7%. The specificity values were 72.7%, 62.5%, 70.7%, 85.7%, and 64.4%. Overstaging was mainly caused by misinterpretation of fibrotic areas as residual tumor. Inflammatory cell infiltration could appear as high signal intensity in fibrotic areas on DW images, an appearance similar to that of residual tumor. Edematous mucosa and submucosa adjacent to the tumor and muscularis propria could also be mistaken for residual tumor because of their intermediate signal intensity on T2-weighted MR images. CONCLUSION. MRI was prone to overstaging of disease. Discrepancies between MRI and pathologic findings were mainly caused by misinterpretation of fibrosis. Inflammatory cell infiltration, pure mucin, edematous mucosa and submucosa adjacent to the tumor, and muscularis propria could also be misinterpreted as residual tumor.
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Liu S, Wen L, Hou J, Nie S, Zhou J, Cao F, Lu Q, Qin Y, Fu Y, Yu X. Predicting the pathological response to chemoradiotherapy of non-mucinous rectal cancer using pretreatment texture features based on intravoxel incoherent motion diffusion-weighted imaging. Abdom Radiol (NY) 2019; 44:2689-2698. [PMID: 31030244 DOI: 10.1007/s00261-019-02032-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the performance of the mean parametric values and texture features based on intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) on identifying pathological complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). METHODS Pretreatment IVIM-DWI was performed on 41 LARC patients receiving nCRT in this prospective study. The values of IVIM-DWI parameters (apparent diffusion coefficient, ADC; pure diffusion coefficient, D; pseudo-diffusion coefficient, D* and perfusion fraction, f), the first-order, and gray-level co-occurrence matrix (GLCM) texture features were compared between the pCR (n = 9) and non-pathological responder (non-pCR, n = 32) groups. Receiver operating characteristic (ROC) curves in univariate and multivariate logistic regression analysis were generated to determine the efficiency for identifying pCR. RESULTS The values of IVIM-DWI parameters and first-order texture features did not show significant differences between the pCR and non-pCR groups. The pCR group had lower Contrast and DifVarnc values extracted from the ADC, D, and D* maps, respectively, as well as lower CorrelatD value. Higher CorrelatD*, Correlatf, SumAvergADC, and SumAvergD values were observed in the pCR group. The area under the ROC curve (AUC) values for the individual predictors in univariate analysis ranged from 0.698 to 0.837, with sensitivities from 43.75% to 87.50% and specificities from 66.67 to 100.00%. In multivariate analysis, CorrelatD* (P < 0.001), DifVarncADC (P = 0.024), and DifVarncD (P < 0.001) were the independent predictors to pCR, with an AUC of 0.986, a sensitivity of 93.75%, and a specificity of 100.00%. CONCLUSION Pretreatment GLCM analysis based on IVIM-DWI may be a potential approach to identify the pathological response of LARC.
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Affiliation(s)
- Siye Liu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, 283 Tongzipo Road, Yuelu District, Changsha, 410006, Hunan, People's Republic of China
| | - Lu Wen
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, 283 Tongzipo Road, Yuelu District, Changsha, 410006, Hunan, People's Republic of China
| | - Jing Hou
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, 283 Tongzipo Road, Yuelu District, Changsha, 410006, Hunan, People's Republic of China
| | - Shaolin Nie
- Department of Colorectal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410006, Hunan, People's Republic of China
| | - Jumei Zhou
- Department of Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410006, Hunan, People's Republic of China
| | - Fang Cao
- Department of Pathology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410006, Hunan, People's Republic of China
| | - Qiang Lu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, 283 Tongzipo Road, Yuelu District, Changsha, 410006, Hunan, People's Republic of China
| | - Yuhui Qin
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, 283 Tongzipo Road, Yuelu District, Changsha, 410006, Hunan, People's Republic of China
| | - Yi Fu
- Department of Medical Service, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410006, Hunan, People's Republic of China
| | - Xiaoping Yu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, 283 Tongzipo Road, Yuelu District, Changsha, 410006, Hunan, People's Republic of China.
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Value of High-Resolution DWI in Combination With Texture Analysis for the Evaluation of Tumor Response After Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer. AJR Am J Roentgenol 2019; 212:1279-1286. [PMID: 30860889 DOI: 10.2214/ajr.18.20689] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE. The purpose of this study is to determine the performance of the apparent diffusion coefficient (ADC) value calculated from high-resolution DWI using readout-segmented echo-planar imaging (rs-EPI) and to assess the texture parameters of T2-weighted MR images in identifying pathologic complete response (pCR) after patients with locally advanced rectal cancer (LARC) undergo preoperative chemoradiotherapy (CRT). MATERIALS AND METHODS. A total of 76 patients with LARC who underwent preoperative CRT and subsequent surgery were enrolled in the study retrospectively. All patients underwent post-CRT MRI, which included acquisition of a DWI sequence with use of the rs-EPI technique. The histopathologic tumor regression grade was the reference standard. Patients were subdivided into pCR and non-pCR groups. Two radiologists independently drew whole-tumor ROIs on DW images and T2-weighted MR images to calculate the mean ADC value and first-order texture parameters. RESULTS. Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC], 0.79-0.993) for imaging analysis. Calculated from high-resolution DWI, the mean post-CRT ADC value was significantly higher in the pCR group (p < 0.001). The pCR group also showed lower uniformity (p < 0.001) of the T2-weighted image. The mean ADC value and uniformity were significantly correlated with the tumor regression grade. The mean ADC value was a good indicator for differentiating pCR from absence of pCR (ROC AUC value, 0.912). Uniformity (ROC AUC value, 0.776) showed a moderate ability to identify pCR. Combining the mean ADC value and uniformity yielded an ROC AUC value comparable to that of the mean ADC value (p = 0.125). CONCLUSION. Mean post-CRT ADC values calculated from high-resolution DWI using rs-EPI could effectively select for patients with LARC who have a pCR after preoperative CRT. First-order texture parameters of T2-weighted MR images could also identify patients with pCR by reflecting tumor heterogeneity, even though they could not significantly improve the diagnostic performance.
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Cheng B, Yu J. Predictive value of diffusion-weighted MR imaging in early response to chemoradiotherapy of esophageal cancer: a meta-analysis. Dis Esophagus 2019; 32:5054272. [PMID: 30010733 DOI: 10.1093/dote/doy065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The results of diffusion-weighted MR imaging (DW-MRI) in predicting early response to chemoradiotherapy in patients with esophageal cancer varied in different studies. We performed this meta-analysis to evaluate the predictive values of DW-MRI and compare the diagnostic efficacy of different apparent diffusion coefficients (ADCs). A comprehensive literature search was performed to identify relevant articles published before November 2017. The quality of study was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under receiver operating characteristic curve of ADC values were calculated to determine the diagnostic performance. Seven studies with a total of 236 patients were included. The pooled sensitivity, specificity, DOR, and area under curve were 93% (95% CI 77%-98%), 85% (95% CI 72%-93%), 78 (95% CI 15-401), and 0.91 (95% CI 0.89-0.94), respectively, for the ▵ADC; and 75% (95% CI 62%-84%), 90% (95% CI 67%-97%), 26 (95% CI 6-110), and 0.85 (95% CI 0.82-0.88), respectively, for the post-ADC. For pre-ADC, meta-analysis was not performed because of conflicting results. In conclusions, our results demonstrate that DW-MRI has good performance for evaluating the response to chemoradiation therapy in patients with esophageal cancer. ▵ADC and post-ADC are promising reliable and valuable predictors.
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Affiliation(s)
- B Cheng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - J Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
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Borggreve AS, Goense L, Brenkman HJF, Mook S, Meijer GJ, Wessels FJ, Verheij M, Jansen EPM, van Hillegersberg R, van Rossum PSN, Ruurda JP. Imaging strategies in the management of gastric cancer: current role and future potential of MRI. Br J Radiol 2019; 92:20181044. [PMID: 30789792 DOI: 10.1259/bjr.20181044] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Accurate preoperative staging of gastric cancer and the assessment of tumor response to neoadjuvant treatment is of importance for treatment and prognosis. Current imaging techniques, mainly endoscopic ultrasonography (EUS), computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), have their limitations. Historically, the role of magnetic resonance imaging (MRI) in gastric cancer has been limited, but with the continuous technical improvements, MRI has become a more potent imaging technique for gastrointestinal malignancies. The accuracy of MRI for T- and N-staging of gastric cancer is similar to EUS and CT, making MRI a suitable alternative to other imaging strategies. There is limited evidence on the performance of MRI for M-staging of gastric cancer specifically, but MRI is widely used for diagnosing liver metastases and shows potential for diagnosing peritoneal seeding. Recent pilot studies showed that treatment response assessment as well as detection of lymph node metastases and systemic disease might benefit from functional MRI (e.g. diffusion weighted imaging and dynamic contrast enhancement). Regarding treatment guidance, additional value of MRI might be expected from its role in better defining clinical target volumes and setup verification with MR-guided radiation treatment.
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Affiliation(s)
- Alicia S Borggreve
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands.,2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Lucas Goense
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands.,2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Hylke J F Brenkman
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Stella Mook
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Gert J Meijer
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Frank J Wessels
- 3 Department of Radiology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Marcel Verheij
- 4 Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL) , Amsterdam , Netherlands
| | - Edwin P M Jansen
- 4 Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL) , Amsterdam , Netherlands
| | - Richard van Hillegersberg
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Peter S N van Rossum
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Jelle P Ruurda
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
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Schurink NW, Lambregts DMJ, Beets-Tan RGH. Diffusion-weighted imaging in rectal cancer: current applications and future perspectives. Br J Radiol 2019; 92:20180655. [PMID: 30433814 DOI: 10.1259/bjr.20180655] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This review summarizes current applications and clinical utility of diffusion-weighted imaging (DWI) for rectal cancer and in addition provides a brief overview of more recent developments (including intravoxel incoherent motion imaging, diffusion kurtosis imaging, and novel postprocessing tools) that are still in more early stages of research. More than 140 papers have been published in the last decade, during which period the use of DWI have slowly moved from mainly qualitative (visual) image interpretation to increasingly advanced methods of quantitative analysis. So far, the largest body of evidence exists for assessment of tumour response to neoadjuvant treatment. In this setting, particularly the benefit of DWI for visual assessment of residual tumour in post-radiation fibrosis has been established and is now increasingly adopted in clinics. Quantitative DWI analysis (mainly the apparent diffusion coefficient) has potential, both for response prediction as well as for tumour prognostication, but protocols require standardization and results need to be prospectively confirmed on larger scale. The role of DWI for further clinical tumour and nodal staging is less well-defined, although there could be a benefit for DWI to help detect lymph nodes. Novel methods of DWI analysis and post-processing are still being developed and optimized; the clinical potential of these tools remains to be established in the upcoming years.
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Affiliation(s)
- Niels W Schurink
- 1 Radiology, Netherlands Cancer Institute , Amsterdam , The Netherlands.,2 GROW School for Oncology and Developmental Biology , Maastricht , The Netherlands
| | | | - Regina G H Beets-Tan
- 1 Radiology, Netherlands Cancer Institute , Amsterdam , The Netherlands.,2 GROW School for Oncology and Developmental Biology , Maastricht , The Netherlands
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35
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Nishie A, Asayama Y, Ishigami K, Ushijima Y, Takayama Y, Okamoto D, Fujita N, Tsurumaru D, Togao O, Sagiyama K, Manabe T, Oki E, Kubo Y, Hida T, Hirahashi-Fujiwara M, Keupp J, Honda H. Amide proton transfer imaging to predict tumor response to neoadjuvant chemotherapy in locally advanced rectal cancer. J Gastroenterol Hepatol 2019; 34:140-146. [PMID: 29900583 DOI: 10.1111/jgh.14315] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/28/2018] [Accepted: 06/02/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The amount of proteins and peptides can be estimated with amide proton transfer (APT) imaging. Previous studies demonstrated the usefulness of APT imaging to predict tumor malignancy. We determined whether APT imaging can predict the tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC). METHODS Seventeen patients with LARC who underwent a pretherapeutic magnetic resonance examination including APT imaging and NAC (at least two courses) were enrolled. The APT-weighted imaging (WI) signal intensity (SI) (%) was defined as magnetization transfer ratio asymmetry (MTRasym ) at the offset of 3.5 ppm. Each tumor was histologically evaluated for the degree of degeneration and necrosis and then classified as one of five histological Grades (0, none; 1a, less than 1/3; 1b, 1/3 to 2/3; 2, more than 2/3; 3, all). We compared the mean APTWI SIs of the tumors between the Grade 0/1a/1b (low-response group) and Grade 2/3 (high-response group) by Student's t-test. We used receiver operating characteristics curves to determine the diagnostic performance of the APTWI SI for predicting the tumor response. RESULTS The mean APTWI SI of the low-response group (n = 12; 3.05 ± 1.61%) was significantly higher than that of the high-response group (n = 5; 1.14 ± 1.13%) (P = 0.029). The area under the curve for predicting the tumor response using the APTWI SI was 0.87. When ≥2.75% was used as an indicator of low-response status, 75% sensitivity and 100% specificity of the APTWI SI were obtained. CONCLUSION Pretherapeutic APT imaging can predict the tumor response to NAC in patients with LARC.
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Affiliation(s)
- Akihiro Nishie
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
| | - Yoshiki Asayama
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
| | | | - Yukihisa Takayama
- Department of Radiology Informatics and Network, Kyushu University, Fukuoka, Japan
| | - Daisuke Okamoto
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
| | | | - Osamu Togao
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
| | - Tatsuya Manabe
- Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Yuichiro Kubo
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Hida
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Minako Hirahashi-Fujiwara
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Hiroshi Honda
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
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Magnetic resonance imaging in locally advanced rectal cancer: quantitative evaluation of the complete response to neoadjuvant therapy. Pol J Radiol 2018; 83:e600-e609. [PMID: 30800199 PMCID: PMC6384410 DOI: 10.5114/pjr.2018.81156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 09/13/2018] [Indexed: 02/01/2023] Open
Abstract
Purpose To assess the diagnostic performance of diffusion-weighted imaging (DWI) for the discrimination of complete responder (CR) from the non-complete responder (n-CR) in patients with locally advanced rectal cancer (LARC) undergoing chemotherapy and radiation (CRT). Material and methods Between December 2009 and January 2014, 32 patients (33 lesions: one patient had two synchronous lesions) were enrolled in this retrospective study. All patients underwent a pre- and post-CRT conventional MRI study completed with DWI. For both data sets (T2-weighted and DWI), the pre- and post-CRT tumour volume (VT2; VDWI) and the tumour volume reduction ratio (ΔV%) were determined as well as pre- and post-CRT apparent diffusion coefficient (ADC) and ADC change (ΔADC%). Histopathological findings were the standard of reference. Receiver operating characteristic (ROC) curves were generated to compare performance of T2-weighted and DWI volumetry, as well as ADC. Results The area under the ROC curve (AUC) revealed a good accuracy of pre- and post-CRT values of VT2 (0.86; 0.91) and VDWI (0.82; 1.00) as well as those of ΔVT2% (0.84) and ΔVDWI% (1.00) for the CR assessment, with no statistical difference. The AUC of pre- and post-CRT ADC (0.53; 0.54) and that of ΔADC% (0.58) were significantly lower. Conclusions Both post-CRT VDWI and ΔVDWI% (AUC = 1) are very accurate for the assessment of the CR, in spite of no significant differences in comparison to the conventional post-CRT VT2 (AUC = 0.91) and ΔVT2% (AUC = 0.84). On the contrary, both ADC and ΔADC% values are not reliable.
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Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017. Abdom Radiol (NY) 2018; 43:2893-2902. [PMID: 29785540 DOI: 10.1007/s00261-018-1642-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To propose guidelines based on an expert-panel-derived unified approach to the technical performance, interpretation, and reporting of MRI for baseline and post-treatment staging of rectal carcinoma. METHODS A consensus-based questionnaire adopted with permission and modified from the European Society of Gastrointestinal and Abdominal Radiologists was sent to a 17-member expert panel from the Rectal Cancer Disease-Focused Panel of the Society of Abdominal Radiology containing 268 question parts. Consensus on an answer was defined as ≥ 70% agreement. Answers not reaching consensus (< 70%) were noted. RESULTS Consensus was reached for 87% of items from which recommendations regarding patient preparation, technical performance, pulse sequence acquisition, and criteria for MRI assessment at initial staging and restaging exams and for MRI reporting were constructed. CONCLUSION These expert consensus recommendations can be used as guidelines for primary and post-treatment staging of rectal cancer using MRI.
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The impact of the mesorectal apparent diffusion coefficient value on surgical difficulty in laparoscopic anterior resection for rectal cancer. Surg Today 2018; 49:239-244. [PMID: 30341539 DOI: 10.1007/s00595-018-1727-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/22/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE We aimed to clarify the impact of the apparent diffusion coefficient (ADC) value of the mesorectum from preoperative magnetic resonance imaging (MRI) on surgical difficulty in laparoscopic anterior resection (Lap-AR) for rectal cancer. METHODS In total, 67 patients who had undergone curative Lap-AR for rectal cancer in our hospital from January 2008 to March 2015 and had preoperative MRI findings available were included. We randomly calculated the average ADC in three regions of the mesorectum at the level of the upper edge of the superior border of the femur. Univariate and multivariate analyses were performed to evaluate the correlation between the patients' clinicopathological characteristics, including the ADC value and short-term surgical outcomes. RESULTS The univariate analysis revealed that a lower ADC value was associated with a significantly increased operative blood loss (p = 0.008) and prolonged operative time (p < 0.001). The multivariate analysis adjusted for the body mass index, anal verge, tumor location, covering stoma, clinical T factor and conversion revealed that the ADC value was an independent risk factor for a prolonged operative time (R2 = 0.6003, p < 0.001). Furthermore, the multivariate analysis adjusted for the body mass index, anal verge, covering stoma, clinical T factor and conversion revealed that the ADC value was an independent risk factor for an increased blood loss (R2 = 0.4345, p = 0.008). CONCLUSION A lower ADC value of the mesorectum might be a predictor of surgical difficulty in Lap-AR for rectal cancer.
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MRI-Based Apparent Diffusion Coefficient for Predicting Pathologic Response of Rectal Cancer After Neoadjuvant Therapy: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:W205-W216. [PMID: 30240291 DOI: 10.2214/ajr.17.19135] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the use of apparent diffusion coefficient (ADC) during DWI for predicting complete pathologic response of rectal cancer after neoadjuvant therapy. MATERIALS AND METHODS A systematic review of available literature was conducted to retrieve studies focused on the identification of complete pathologic response of locally advanced rectal cancer after neoadjuvant chemoradiation, through the assessment of ADC evaluated before, after, or both before and after treatment, as well as in terms of the difference between pretreatment and posttreatment ADC. Pooled mean pretreatment ADC, posttreatment ADC, and Δ-ADC (calculated as posttreatment ADC minus pretreatment ADC divided by pretreatment ADC and multiplied by 100) in complete responders versus incomplete responders were calculated. For each parameter, we also pooled sensitivity and specificity and calculated the area under the summary ROC curve. RESULTS We found 10 prospective and eight retrospective studies. Overall, pathologic complete response was observed in 22.2% of patients. Pooled mean pretreatment ADC in complete responders was 0.84 × 10-3 mm2/s versus 0.89 × 10-3 mm2/s in incomplete responders (p = 0.33). Posttreatment ADC values were 1.51 × 10-3 mm2/s and 1.29 × 10-3 mm2/s, in complete and incomplete responders, respectively (p = 0.00001). The Δ-ADC percentages were also significantly higher in complete responders than in incomplete responders (59.7% vs 29.7%, respectively, p = 0.016). Pooled sensitivity, specificity, and AUC were 0.743, 0.755, and 0.841 for pretreatment ADC; 0.800, 0.737, and 0.782 for posttreatment ADC; and 0.832, 0.806, and 0.895 for Δ-ADC. CONCLUSION Use of ADC during DWI is a promising technique for assessment of results of neoadjuvant treatment of rectal cancer.
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Nishie A, Takayama Y, Asayama Y, Ishigami K, Ushijima Y, Okamoto D, Fujita N, Tsurumaru D, Togao O, Manabe T, Oki E, Kubo Y, Hida T, Hirahashi-Fujiwara M, Keupp J, Honda H. Amide proton transfer imaging can predict tumor grade in rectal cancer. Magn Reson Imaging 2018; 51:96-103. [DOI: 10.1016/j.mri.2018.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/28/2018] [Accepted: 04/28/2018] [Indexed: 01/28/2023]
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Imaging predictors of treatment outcomes in rectal cancer: An overview. Crit Rev Oncol Hematol 2018; 129:153-162. [DOI: 10.1016/j.critrevonc.2018.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/26/2018] [Accepted: 06/13/2018] [Indexed: 12/14/2022] Open
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Delli Pizzi A, Cianci R, Genovesi D, Esposito G, Timpani M, Tavoletta A, Pulsone P, Basilico R, Gabrielli D, Rosa C, Caravatta L, Di Tommaso M, Caulo M, Filippone A. Performance of diffusion-weighted magnetic resonance imaging at 3.0T for early assessment of tumor response in locally advanced rectal cancer treated with preoperative chemoradiation therapy. Abdom Radiol (NY) 2018; 43:2221-2230. [PMID: 29332248 DOI: 10.1007/s00261-018-1457-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of the article is to determine whether changes in apparent diffusion coefficient (ADC) values of locally advanced rectal cancer (LARC) obtained 2 weeks after the beginning of chemoradiation therapy (CRT) allow to predict treatment response and whether correlate with tumor histopathologic response. METHODS Forty-three patients receiving CRT for LARC and 3.0T magnetic resonance imaging with diffusion-weighted sequences before treatment, 2 weeks during, and 8 weeks post the completion of CRT were included. ADC values were calculated at each time point and percentage of ADC changes at 2 weeks (ΔADC during) and 8 weeks (ΔADC post) were assessed. Data were correlated to surgical results and histopathologic tumor regression grade (TRG), according to Mandard's classification. ADC values and ΔADCs of complete responders (CR; TRG1) and non-complete responders (non-CR; TRG 2-5) were compared. Receiver-operating characteristic curve (ROC) analysis was used to assess diagnostic accuracy of ΔADC for differentiating CR from non-CR. The correlation with TRG was investigated using Spearman's rank test. RESULTS ΔADC during and ΔADC post were significantly higher in CR (33.9% and 57%, respectively) compared to non-CR (13.5% and 2.2%, respectively) group (p = 0.006 and p < 0.001, respectively). ROC analysis revealed the following diagnostic performances: ΔADC during: AUC 0.78 (0.08), p = 0.004, cut-off 20.6% (sensitivity 75% and specificity 76.5%); ΔADC post: AUC 0.94 (0.04), p ≤ 0.001, cut-off 22% (sensitivity 95% and specificity 82.4%). Significant moderate and good negative correlation was found between ΔADC during and ΔADC post and TRG (r = - 0.418, p = 0.007; r = - 694, p ≤ 0.001, respectively). CONCLUSION ΔADC at 2 weeks after the beginning of CRT is a reliable tool to early assess treatment response.
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Affiliation(s)
- Andrea Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.
- ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy.
| | - Roberta Cianci
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | | | - Gianluigi Esposito
- Ospedale "Pesenti Fenaroli", Via Mazzini, 88 24022, Alzano Lombardo (BG), Italy
| | - Mauro Timpani
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Alessandra Tavoletta
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Pierluigi Pulsone
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Raffaella Basilico
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Daniela Gabrielli
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Consuelo Rosa
- Radiation Oncology Unit, SS Annunziata Hospital, Chieti, Italy
| | | | | | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
- ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy
| | - Antonella Filippone
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
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Gollub MJ, Hotker AM, Woo KM, Mazaheri Y, Gonen M. Quantitating whole lesion tumor biology in rectal cancer MRI: taking a lesson from FDG-PET tumor metrics. Abdom Radiol (NY) 2018; 43:1575-1582. [PMID: 29159523 PMCID: PMC5960599 DOI: 10.1007/s00261-017-1389-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the value of novel whole tumor metrics in DWI-MRI and DCE-MRI of rectal cancer treatment assessment. MATERIALS AND METHODS This retrospective study included 24 uniformly treated patients with rectal adenocarcinoma who underwent MRI including diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) sequences, before and after chemoradiotherapy. Two experienced readers independently measured tumor volume and apparent diffusion coefficient (ADC) on DWI-MRI and tumor volume and transfer constant K trans on DCE-MRI. In addition, we explored and defined Total Lesion Diffusion (TLD) as Total DWI tumor volume multiplied by mean volumetric ADC and Total Lesion Perfusion (TLP) as the total DCE tumor volume multiplied by the mean volumetric K trans. These metrics were correlated with histopathologic percent tumor regression in the resected specimen (%TR). Inter-reader agreement was assessed using the concordance correlation coefficient (CCC). RESULTS For both readers, post-treatment TLP revealed comparable correlations with %TR compared with K trans (reader 1; Spearman's rho = - 0.36 vs. - 0.32, reader 2; Spearman's rho = - 0.32 vs. - 0.28). In addition, TLP afforded the highest inter-reader agreement at post-treatment among TLP, DCE vol, and K trans (CCC: 0.64 vs. 0.36 vs. 0.35). Post-treatment TLD showed similar correlation with %TR as DWI volume in reader 1 and superior correlation with %TR for reader 2 (reader 1; Spearman's rho - 0.56 vs. - 0.57, reader 2; Spearman's rho - 0.59 vs. - 0.45). CONCLUSION The novel tumor metrics TLD and TLP revealed similar results to established metrics for correlation with tumor response with equivalent or superior inter-reader agreements and we recommend that these be studied in larger trials.
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Affiliation(s)
- Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Andreas M Hotker
- Department of Diagnostic and Interventional Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Kaitlin M Woo
- Department of Biostatistics and Medical Informatics, University of Wisconsin, K6/446 Clinical Sciences Center 600 Highland Avenue, Madison, WI, 53792-4675, USA
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Kozumi M, Ota H, Yamamoto T, Umezawa R, Matsushita H, Ishikawa Y, Takahashi N, Matsuura T, Takase K, Jingu K. Oesophageal squamous cell carcinoma: histogram-derived ADC parameters are not predictive of tumour response to chemoradiotherapy. Eur Radiol 2018; 28:4296-4305. [PMID: 29725833 PMCID: PMC6132721 DOI: 10.1007/s00330-018-5439-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 12/13/2022]
Abstract
Objectives To evaluate correlations between tumour response to definitive chemoradiotherapy (CRT) in oesophageal squamous cell carcinoma (SCC) and histogram-derived apparent diffusion coefficient (ADC) parameters on diffusion-weighted MR images. Methods Forty patients with clinical T3–4 oesophageal SCC underwent concurrent CRT. MR examination at 3 T was performed 1–3 days prior to CRT. Readout-segmented echo-planar diffusion imaging was used to acquire ADC maps. Pre- and post-treatment CT examinations were performed. Histogram parameters (mean, 10th, 25th, 50th, 75th, 90th percentiles, skewness and kurtosis) of the ADC values were compared with post-treatment disease status based on RECIST and the tumour regression ratio. Results None of the ADC parameters showed significant correlation with post-treatment status (range of Spearman’s ρ values − 0.19 to 0.14, range of p values 0.22–0.47) or tumour regression ratio (range of Spearman’s ρ values − 0.045 to 0.18, range of p values 0.26–0.96). Neither progression-free survival (PFS) (p = 0.17) nor overall survival (OS) (p = 0.15) was significantly different between the two groups corresponding to the lower (< median) and upper arms (≥ median) of the mean ADC values. Conclusions Histogram-derived pretreatment ADC parameters were not predictive imaging biomarkers for tumour response to CRT in patients with oesophageal SCC. Key Points • Apparent diffusion coefficient (ADC) values are derived from diffusion-weighted MR imaging. • High-resolution diffusion-weighted images are generated by readout-segmented echo-planar diffusion imaging. • Readout-segmented echo-planar diffusion-weighted imaging enabled evaluation of ADC parameters. • Pretreatment ADC parameters do not predict chemoradiotherapy response in patients with oesophageal carcinoma. Electronic supplementary material The online version of this article (10.1007/s00330-018-5439-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maiko Kozumi
- Department of Radiology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, Japan.
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Tomonori Matsuura
- Department of Radiology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
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Delli Pizzi A, Basilico R, Cianci R, Seccia B, Timpani M, Tavoletta A, Caposiena D, Faricelli B, Gabrielli D, Caulo M. Rectal cancer MRI: protocols, signs and future perspectives radiologists should consider in everyday clinical practice. Insights Imaging 2018; 9:405-412. [PMID: 29675627 PMCID: PMC6108973 DOI: 10.1007/s13244-018-0606-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 12/18/2022] Open
Abstract
Abstract Magnetic resonance imaging (MRI) allows to non-invasively evaluate rectal cancer staging and to assess the presence of “prognostic signs” such as the distance from the anorectal junction, the mesorectal fascia infiltration and the extramural vascular invasion. Moreover, MRI plays a crucial role in the assessment of treatment response after chemo-radiation therapy, especially considering the growing interest in the new conservative policy (wait and see, minimally invasive surgery). We present a practical overview regarding the state of the art of the MRI protocol, the main signs that radiologists should consider for their reports during their clinical activity and future perspectives. Teaching Points • MRI protocol for rectal cancer staging and re-staging. • MRI findings that radiologists should consider for reports during everyday clinical activity. • Perspectives regarding the development of latest technologies.
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Affiliation(s)
- Andrea Delli Pizzi
- ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy.
| | - Raffaella Basilico
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Roberta Cianci
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Barbara Seccia
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Mauro Timpani
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Alessandra Tavoletta
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Daniele Caposiena
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Barbara Faricelli
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Daniela Gabrielli
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Massimo Caulo
- ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy
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Li W, Jiang Z, Guan Y, Chen Y, Huang X, Liu S, He J, Zhou Z, Ge Y. Whole-lesion Apparent Diffusion Coefficient First- and Second-Order Texture Features for the Characterization of Rectal Cancer Pathological Factors. J Comput Assist Tomogr 2018; 42:642-647. [PMID: 29613992 DOI: 10.1097/rct.0000000000000731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to explore the value of whole-volume apparent diffusion coefficient (ADC) features in characterizing pathologic features of rectal cancer. METHODS A total of 50 patients who were diagnosed with rectal cancer via biopsy underwent 3-T pretreatment diffusion-weighted imaging. Apparent diffusion coefficient features, including mean, 10th-90th percentile, Entropy and Entropy(H), derived from whole-lesion volumes were compared between pathologic T1-2 and T3 stages, perineural invasion (PNI) present and absent, lymphangiovascular invasion present and absent, and pathological N0 and N+ stage groups. RESULTS Entropy and Entropy(H) were significantly lower in rectal cancers at T1-2 stages than T3. The 90th percentile of rectal cancers with PNI was significantly lower than that of those without PNI. All P < 0.05. CONCLUSIONS Whole-lesion ADC Entropy and Entropy(H) have potential in evaluating different T stages, and 90th percentile can be helpful for determining PNI presence of rectal cancers.
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Affiliation(s)
| | | | | | | | | | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Xu Q, Xu Y, Sun H, Chan Q, Shi K, Song A, Wang W. Quantitative intravoxel incoherent motion parameters derived from whole-tumor volume for assessing pathological complete response to neoadjuvant chemotherapy in locally advanced rectal cancer. J Magn Reson Imaging 2017; 48:248-258. [PMID: 29281151 DOI: 10.1002/jmri.25931] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many locally advanced rectal cancer (LARC) patients can benefit from neoadjuvant chemotherapy (NACT), with some achieving a pathological complete response (pCR). However, there is limited research reporting on the value of intravoxel incoherent motion (IVIM) in monitoring pCR in patients with LARC. PURPOSE To identify whether IVIM parameters derived from whole-tumor volume (WTV) before and after NACT could accurately assess pCR in patients with LARC. STUDY TYPE Prospective patient control study. POPULATION Fifty-one patients with LARC before and after NACT, prior to surgery. FIELD STRENGTH/SEQUENCE IVIM-diffusion imaging at 3T. ASSESSMENT Apparent diffusion coefficient (ADC), slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion-related diffusion fraction (f) values were obtained on diffusion-weighted magnetic resonance images (DW-MRI) using WTV methods and calculated using a biexponential model before and after NACT. STATISTICAL TESTS DWI-derived ADC and IVIM-derived parameters and their percentage changes (ΔADC%, ΔD%, ΔD*%, and Δf%) were compared using independent-samples t-test and Mann-Whitney U-test between the pCR and non-pCR groups. The diagnostic performance of IVIM parameters and their percentage changes were evaluated using receiver operating characteristic curves. RESULTS Compared with the non-pCR group, the pCR group exhibited significantly lower pre-ADCmean (P = 0.003) and pre-D values (P = 0.024), and significantly higher post-f (P = 0.002), ΔADCmean % (P = 0.002), ΔD% (P = 0.001), and Δf% values (P = 0.017). Receiver operating characteristic curves showed that the pre-D value had the best specificity (95.12%) and accuracy (86.27%) in predicting the pCR status, and ΔD% had the highest area under the curve (0.832) in assessing the pCR response to NACT. DATA CONCLUSIONS The IVIM-derived D value is a promising tool in predicting the pCR status before therapy. The percentage changes in D values after therapy may help assess the pCR status prior to surgery. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
- Qiaoyu Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Queenie Chan
- Philips Healthcare, Shatin, New Territories, Hong Kong, China
| | | | - Aiping Song
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Wu Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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48
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Zhu HB, Zhang XY, Zhou XH, Li XT, Liu YL, Wang S, Sun YS. Assessment of pathological complete response to preoperative chemoradiotherapy by means of multiple mathematical models of diffusion-weighted MRI in locally advanced rectal cancer: A prospective single-center study. J Magn Reson Imaging 2017; 46:175-183. [PMID: 27981667 DOI: 10.1002/jmri.25567] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/10/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess stretched-exponential, mono-exponential and intravoxel incoherent motion (IVIM) models of diffusion-weighted MRI(DWI) in predicting pathological complete response (pCR) to neoadjuvant chemoradiotherapy (CRT) in rectal cancer patients. MATERIALS AND METHODS This prospective study recruited 98 consecutive patients with locally advanced rectal cancer who underwent 3 Tesla MR examination before, during and after CRT. The apparent diffusion coefficient (ADC), IVIM-derived parameters (D, f, and D*), and stretched-exponential model-derived parameters (DDC and α) were measured. The parameters and their corresponding changes during and after CRT were compared between pCR and non-pCR. Receiver-operating characteristic curve analysis was performed to evaluate the diagnostic performance. Coefficient of variations and intraclass correlation coefficient were calculated to assess reliability and agreement. RESULTS Nineteen patients achieved pCR while 79 did not. The pCR group had higher ADC and α (ADC2 and α2 ), and their changes (ΔADC2 , and Δα2 ) at the endpoint than non-pCR group. α2 and ADC2 yielded similar AUCs (P = 0.339), Δα2 and ΔADC2 yielded similar AUCs (P = 0.263) ADC and α presented substantial agreement, and α presented the minimum CV (5.0-7.0%). CONCLUSION ADC and α were useful for assessing pCR after CRT. α might be more useful because it demonstrated better diagnostic performance than IVIM-derived parameters and better reliability than ADC. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:175-183.
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Affiliation(s)
- Hai-Bin Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52, Beijing, China
| | - Xiao-Yan Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52, Beijing, China
| | - Xiao-Hong Zhou
- Center for Magnetic Research, Medical Hospital, University of Illinois Hospital, Chicago, Illinois, USA
| | - Xiao-Ting Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52, Beijing, China
| | - Yu-Liang Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52, Beijing, China
| | - Shuai Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52, Beijing, China
| | - Ying-Shi Sun
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52, Beijing, China
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Bassaneze T, Gonçalves JE, Faria JF, Palma RT, Waisberg J. Quantitative Aspects of Diffusion-weighted Magnetic Resonance Imaging in Rectal Cancer Response to Neoadjuvant Therapy. Radiol Oncol 2017; 51:270-276. [PMID: 28959163 PMCID: PMC5611991 DOI: 10.1515/raon-2017-0025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/01/2017] [Indexed: 02/01/2023] Open
Abstract
Background The aim of the study was to evaluate the added value of the apparent diffusion coefficient (ADC) of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with rectal cancer who received neoadjuvant chemoradiotherapy (CRT). The use of DW-MRI for response evaluation in rectal cancer still remains a widely investigated issue, as the accurate detection of pathologic complete response (pCR) is critical in making therapeutic decisions. Patients and methods Thirty-three patients with locally advanced rectal cancer were evaluated retrospectively by MRI in addition to diffusion-weighted images (DWI) and its ADC pre- and post-neoadjuvant CRT. These patients subsequently underwent curative-intent surgery. Tumor staging by MRI and ADC value were compared with histopathological findings of the surgical specimen. Results MRI in addition to DWI had a sensitivity of 96.1%, specificity of 71.4%, positive predictive value of 92.5%, and negative predictive value of 83.3% in the detection of pCR. The pre-CRT ADC alone could not reliably predict the pCR group. Post-CRT ADC cutoff value of 1.49 x 10−3 mm2/s had the highest accuracy and allowed a 16.7% increase in negative predictive value and 3.9% increase in sensitivity. Patients with pCR to neoadjuvant treatment differed from the other groups in their absolute values of post-CRT ADC (p < 0.01). Conclusions The use of post-CRT ADC increased the diagnostic performance of MRI in addition to DWI in predicting the final pathologic staging of rectal carcinoma.
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Affiliation(s)
- Thiago Bassaneze
- Department of Gastrointestinal Surgery, State Public Servant Hospital of São Paulo, São Paulo, Brazil
| | - José Eduardo Gonçalves
- Department of Gastrointestinal Surgery, State Public Servant Hospital of São Paulo, São Paulo, Brazil
| | | | - Rogério Tadeu Palma
- Department of Gastrointestinal Surgery, State Public Servant Hospital of São Paulo, São Paulo, Brazil.,Department of Gastrointestinal Surgery, ABC Medical School, Santo André, Brazil
| | - Jaques Waisberg
- Department of Gastrointestinal Surgery, State Public Servant Hospital of São Paulo, São Paulo, Brazil.,Department of Gastrointestinal Surgery, ABC Medical School, Santo André, Brazil
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Ma C, Li J, Boukar MB, Yang P, Wang L, Chen L, Su L, Qu J, Chen SY, Hao Q, Lu JP. Optimized ROI size on ADC measurements of normal pancreas, pancreatic cancer and mass-forming chronic pancreatitis. Oncotarget 2017; 8:99085-99092. [PMID: 29228754 PMCID: PMC5716794 DOI: 10.18632/oncotarget.18457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
Objectives To investigate the effects of region of interest (ROI) sizes on apparent diffusion coefficient (ADC) measurements for the differentiation of normal pancreas (NP), pancreatic ductal adenocarcinoma (PDAC) and mass-forming chronic pancreatitis (MFCP). Results There were no significant differences for the mean ADCs measured by 12 different-size ROIs for MFCP, or PDAC and NP (P = 0.858–1.0). With the increase of ROI size (≥ 55 mm2), ADCs of PDAC were significantly lower than those of NP (all P < 0.05), but there was no difference of the accuracy in ADC for differentiating the two groups only at a ROI size of 214 mm2. When ROI size was above 99 mm2, ADCs of MFCP were significantly lower than those of NP (all P < 0.05). There were no significant differences for any of the mean ADCs measured by 12 different-size ROIs between PDAC and MFCP (P > 0.05). Materials and Methods Diffusion-weighted imaging (DWI) was performed on 89 participants: 64 with PDAC, 7 with MFCP, as well as 18 healthy volunteers. ADC maps were created using mono-exponential model. A homemade software was used to measure the mean ADC values of 12 concentric round ROIs (areas: 15, 46, 55, 82, 99, 121, 134, 152, 161, 189, 214, 223, and 245 mm2) for the mass of lesions and the NP tissue. Conclusions In ADC measurements, the optimized ROI size is 214 mm2 for the differentiation of PDAC and NP; ROI size of ≥ 99 mm2 is recommended to differentiate between MFCP and NP. ADC was not useful for the differentiation of PDAC and MFCP.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Mbaiaoure Barak Boukar
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Panpan Yang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Li Su
- School of Pharmacy, Second Military Medical University, Shanghai, China
| | - Jianxun Qu
- GE Healthcare, MR Group, Shanghai, China
| | - Shi-Yue Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Qiang Hao
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Jian-Ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
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