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Mariani I, Maino C, Giandola TP, Franco PN, Drago SG, Corso R, Talei Franzesi C, Ippolito D. Texture Analysis and Prediction of Response to Neoadjuvant Treatment in Patients with Locally Advanced Rectal Cancer. GASTROINTESTINAL DISORDERS 2024; 6:858-870. [DOI: 10.3390/gidisord6040060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2025] Open
Abstract
Background: The purpose of this study is to determine the relationship between the texture analysis extracted from preoperative rectal magnetic resonance (MR) studies and the response to neoadjuvant treatment. Materials and Methods: In total, 88 patients with rectal adenocarcinoma who underwent staging MR between 2017 and 2022 were retrospectively enrolled. After the completion of neoadjuvant treatment, they underwent surgical resection. The tumour regression grade (TRG) was collected. Patients with TRG 1–2 were classified as responders, while patients with TRG 3 to 5 were classified as non-responders. A texture analysis was conducted using LIFEx software (v 7.6.0), where T2-weighted MR sequences on oriented axial planes were uploaded, and a region of interest (ROI) was manually drawn on a single slice. Features with a Spearman correlation index > 0.5 have been discarded, and a LASSO feature selection has been applied. Selected features were trained using bootstrapping. Results: According to the TRG classes, 49 patients (55.8%) were considered responders, while 39 (44.2) were non-responders. Two features were associated with the responder class: GLCM_Homogeneity and Discretized Histo Entropy log 2. Regarding GLCM_Homogeneity, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were 0.779 (95% CIs = 0.771–0.816), 86% (80–90), and 67% (60–71). Regarding Discretized Histo Entropy log 2, we found 0.775 AUC (0.700–0.801), 80% sensitivity (74–83), and 63% specificity (58–69). Combining both radiomics features the radiomics signature diagnostic accuracy increased (AUC = 0.844). Finally, the AUC of 1000 bootstraps were 0.810. Conclusions: Texture analysis can be considered an advanced tool for determining a possible correlation between pre-surgical MR data and the response to neoadjuvant therapy.
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Affiliation(s)
- Ilaria Mariani
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Teresa Paola Giandola
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Paolo Niccolò Franco
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Silvia Girolama Drago
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy
- School of Medicine, University of Milano Bicocca, Via Cadore 33, 20090 Monza, Italy
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Drago SG, Maino C, Giandola TP, Franco PN, Corso R, Talei Franzesi C, Pecorelli A, Ippolito D. Correlations between Apparent Diffusion Coefficient (ADC) and Prognosis in Patients with Locally Advanced Rectal Cancer. Life (Basel) 2024; 14:1282. [PMID: 39459582 PMCID: PMC11509644 DOI: 10.3390/life14101282] [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: 08/23/2024] [Revised: 09/28/2024] [Accepted: 10/04/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND the aim of this study is to assess the performance of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values in predicting the response to neoadjuvant chemoradiation therapy (CRT) and outcome in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS ninety-four patients with magnetic resonance imaging (MRI) pre- and post-neoadjuvant treatment were retrospectively enrolled. Three regions of interest (ROIs) were manually drawn on three different slices of the tumor for every DWI sequence. ROIs were positioned to include only high signal areas and avoid artifacts or necrotic areas. ROIs were automatically copied onto the corresponding ADC maps and the system derived three different ADC values, distinguishing between mean, maximum, and minimum values, and the standard deviation (SD). Only mean ADC values were considered. After surgical intervention, pTNM and the Mandard tumor regression grade (TRG) were obtained. Patients with a TRG of 1-2 were classified as responders, while patients with a TRG from 3 to 5 were classified as non-responders. RESULTS no correlation was found between pre-ADC values and TRG classes, while post-ADC and ΔADC values showed a significant correlation with TRG classes (r = -0.285, p = 0.002 and r = -0.290, p = 0.019, respectively). Post-ADC values were statistically different between responders and non-responders (p = 0.019). When considering the relation between overall survival (OS) and ADC values, pre-ADC showed a negative correlation with OS (r = -0.381, p = 0.001), while a positive correlation was found between ΔADC values and OS (r = 0.323, p = 0.013). According to ΔADC values, the mean OS time between responders and non-responders showed a significant difference (p = 0.030). A statistical difference was found between TRG classes and OS (p = 0.038) and by dividing patients in responders and non-responders (p = 0.019). CONCLUSIONS the pre-ADC and ΔADC values could be used as useful predictors for patient prognosis, thus helping the treatment planning. On the other hand, the post-ADC values, thanks to their relationship with the TRG classes, could be the ideal tool to predict the histopathological response and plan a conservative approach to the treatment of rectal cancer.
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Affiliation(s)
- Silvia Girolama Drago
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB, Italy; (S.G.D.); (C.M.); (T.P.G.); (P.N.F.); (R.C.); (C.T.F.); (D.I.)
| | - Cesare Maino
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB, Italy; (S.G.D.); (C.M.); (T.P.G.); (P.N.F.); (R.C.); (C.T.F.); (D.I.)
| | - Teresa Paola Giandola
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB, Italy; (S.G.D.); (C.M.); (T.P.G.); (P.N.F.); (R.C.); (C.T.F.); (D.I.)
| | - Paolo Niccolò Franco
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB, Italy; (S.G.D.); (C.M.); (T.P.G.); (P.N.F.); (R.C.); (C.T.F.); (D.I.)
| | - Rocco Corso
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB, Italy; (S.G.D.); (C.M.); (T.P.G.); (P.N.F.); (R.C.); (C.T.F.); (D.I.)
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB, Italy; (S.G.D.); (C.M.); (T.P.G.); (P.N.F.); (R.C.); (C.T.F.); (D.I.)
| | - Anna Pecorelli
- Radiologia Addomino Pelvica Diagnostica e Interventistica IRCCS Azienda Ospedaliera Universitaria di Bologna Policlinico di Sant’Orsola, Via Pietro Albertoni 15, 40138 Bolonga, BO, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB, Italy; (S.G.D.); (C.M.); (T.P.G.); (P.N.F.); (R.C.); (C.T.F.); (D.I.)
- School of Medicine, University of Milano Bicocca, Via Cadore 33, 20090 Monza, MB, Italy
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Nougaret S, Rousset P, Lambregts DMJ, Maas M, Gormly K, Lucidarme O, Brunelle S, Milot L, Arrivé L, Salut C, Pilleul F, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Cotte E, Rouanet P, Catalano O, Denost Q, Tan RB, Frulio N, Hoeffel C. MRI restaging of rectal cancer: The RAC (Response-Anal canal-CRM) analysis joint consensus guidelines of the GRERCAR and GRECCAR groups. Diagn Interv Imaging 2023; 104:311-322. [PMID: 36949002 DOI: 10.1016/j.diii.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To develop guidelines by international experts to standardize data acquisition, image interpretation, and reporting in rectal cancer restaging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and experts' opinions were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts provided recommendations for reporting template and protocol for data acquisition were collected; responses were analysed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (if ≥ 80% consensus among experts) or uncertain (if < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer restaging with MRI.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology IRCM, Montpellier Cancer Research Institute, 34000 Montpellier, France; INSERM, U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, CHU Lyon-Sud, EMR 3738 CICLY, Université Claude-Bernard Lyon 1, 69495 Pierre-Benite, France
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Kirsten Gormly
- Jones Radiology, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne Université, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Sorbonne Université, 75013 Paris, France
| | - Celine Salut
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | | | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean-Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06000 Nice, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Onofrio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Quentin Denost
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33000 Bordeaux, France
| | - Regina Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Nora Frulio
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
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Pham TT, Lim S, Lin M. Predicting neoadjuvant chemoradiotherapy response with functional imaging and liquid biomarkers in locally advanced rectal cancer. Expert Rev Anticancer Ther 2022; 22:1081-1098. [PMID: 35993178 DOI: 10.1080/14737140.2022.2114457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Non-invasive predictive quantitative biomarkers are required to guide treatment individualization in patients with locally advanced rectal cancer (LARC) in order to maximise therapeutic outcomes and minimise treatment toxicity. Magnetic resonance imaging (MRI), positron emission tomography (PET) and blood biomarkers have the potential to predict chemoradiotherapy (CRT) response in LARC. AREAS COVERED This review examines the value of functional imaging (MRI and PET) and liquid biomarkers (circulating tumor cells (CTCs) and circulating tumor nucleic acid (ctNA)) in the prediction of CRT response in LARC. Selected imaging and liquid biomarker studies are presented and the current status of the most promising imaging (apparent diffusion co-efficient (ADC), Ktrans, SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and liquid biomarkers (circulating tumor cells (CTCs), circulating tumor nucleic acid (ctNA)) is discussed. The potential applications of imaging and liquid biomarkers for treatment stratification and a pathway to clinical translation are presented. EXPERT OPINION Functional imaging and liquid biomarkers provide novel ways of predicting CRT response. The clinical and technical validation of the most promising imaging and liquid biopsy biomarkers in multi-centre studies with harmonised acquisition techniques is required. This will enable clinical trials to investigate treatment escalation or de-escalation pathways in rectal cancer.
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Affiliation(s)
- Trang Thanh Pham
- South West Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Liverpool NSW Australia 2170.,Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool NSW Australia 2170.,Ingham Institute for Applied Medical Research, Liverpool NSW Australia 2170
| | - Stephanie Lim
- Ingham Institute for Applied Medical Research, Liverpool NSW Australia 2170.,Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown Australia 2560.,School of Medicine, Western Sydney University, Campbelltown, Sydney 2560
| | - Michael Lin
- South West Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Liverpool NSW Australia 2170.,School of Medicine, Western Sydney University, Campbelltown, Sydney 2560.,Department of Nuclear Medicine, Liverpool Hospital, Liverpool NSW Australia 2170
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Bellini D, Carbone I, Rengo M, Vicini S, Panvini N, Caruso D, Iannicelli E, Tombolini V, Laghi A. Performance of Machine Learning and Texture Analysis for Predicting Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer with 3T MRI. Tomography 2022; 8:2059-2072. [PMID: 36006071 PMCID: PMC9416446 DOI: 10.3390/tomography8040173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background: To evaluate the diagnostic performance of a Machine Learning (ML) algorithm based on Texture Analysis (TA) parameters in the prediction of Pathological Complete Response (pCR) to Neoadjuvant Chemoradiotherapy (nChRT) in Locally Advanced Rectal Cancer (LARC) patients. Methods: LARC patients were prospectively enrolled to undergo pre- and post-nChRT 3T MRI for initial loco-regional staging. TA was performed on axial T2-Weighted Images (T2-WI) to extract specific parameters, including skewness, kurtosis, entropy, and mean of positive pixels. For the assessment of TA parameter diagnostic performance, all patients underwent complete surgical resection, which served as a reference standard. ROC curve analysis was carried out to determine the discriminatory accuracy of each quantitative TA parameter to predict pCR. A ML-based decisional tree was implemented combining all TA parameters in order to improve diagnostic accuracy. Results: Forty patients were considered for final study population. Entropy, kurtosis and MPP showed statistically significant differences before and after nChRT in patients with pCR; in particular, when patients with Pathological Partial Response (pPR) and/or Pathological Non-Response (pNR) were considered, entropy and skewness showed significant differences before and after nChRT (all p < 0.05). In terms of absolute value changes, pre- and post-nChRT entropy, and kurtosis showed significant differences (0.31 ± 0.35, in pCR, −0.02 ± 1.28 in pPR/pNR, (p = 0.04); 1.87 ± 2.19, in pCR, −0.06 ± 3.78 in pPR/pNR (p = 0.0005); 107.91 ± 274.40, in pCR, −28.33 ± 202.91 in pPR/pNR, (p = 0.004), respectively). According to ROC curve analysis, pre-treatment kurtosis with an optimal cut-off value of ≤3.29 was defined as the best discriminative parameter, resulting in a sensitivity and specificity in predicting pCR of 81.5% and 61.5%, respectively. Conclusions: TA parameters extracted from T2-WI MRI images could play a key role as imaging biomarkers in the prediction of response to nChRT in LARC patients. ML algorithms can be used to efficiently combine all TA parameters in order to improve diagnostic accuracy.
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Affiliation(s)
- Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, “Sapienza” University of Rome—I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100 Latina, Italy
| | - Iacopo Carbone
- Department of Radiological Sciences, Oncology and Pathology, “Sapienza” University of Rome—I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100 Latina, Italy
- Correspondence: ; Tel.: +39-351836065
| | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, “Sapienza” University of Rome—I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100 Latina, Italy
| | - Simone Vicini
- Department of Radiological Sciences, Oncology and Pathology, “Sapienza” University of Rome—I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100 Latina, Italy
| | - Nicola Panvini
- Department of Radiological Sciences, Oncology and Pathology, “Sapienza” University of Rome—I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100 Latina, Italy
| | - Damiano Caruso
- Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza” University of Rome—Diagnostic Imaging Unit, Sant′Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Elsa Iannicelli
- Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza” University of Rome—Diagnostic Imaging Unit, Sant′Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza” University of Rome—Diagnostic Imaging Unit, Sant′Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
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Wichtmann BD, Albert S, Zhao W, Maurer A, Rödel C, Hofheinz RD, Hesser J, Zöllner FG, Attenberger UI. Are We There Yet? The Value of Deep Learning in a Multicenter Setting for Response Prediction of Locally Advanced Rectal Cancer to Neoadjuvant Chemoradiotherapy. Diagnostics (Basel) 2022; 12:1601. [PMID: 35885506 PMCID: PMC9317842 DOI: 10.3390/diagnostics12071601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
This retrospective study aims to evaluate the generalizability of a promising state-of-the-art multitask deep learning (DL) model for predicting the response of locally advanced rectal cancer (LARC) to neoadjuvant chemoradiotherapy (nCRT) using a multicenter dataset. To this end, we retrained and validated a Siamese network with two U-Nets joined at multiple layers using pre- and post-therapeutic T2-weighted (T2w), diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) maps of 83 LARC patients acquired under study conditions at four different medical centers. To assess the predictive performance of the model, the trained network was then applied to an external clinical routine dataset of 46 LARC patients imaged without study conditions. The training and test datasets differed significantly in terms of their composition, e.g., T-/N-staging, the time interval between initial staging/nCRT/re-staging and surgery, as well as with respect to acquisition parameters, such as resolution, echo/repetition time, flip angle and field strength. We found that even after dedicated data pre-processing, the predictive performance dropped significantly in this multicenter setting compared to a previously published single- or two-center setting. Testing the network on the external clinical routine dataset yielded an area under the receiver operating characteristic curve of 0.54 (95% confidence interval [CI]: 0.41, 0.65), when using only pre- and post-therapeutic T2w images as input, and 0.60 (95% CI: 0.48, 0.71), when using the combination of pre- and post-therapeutic T2w, DW images, and ADC maps as input. Our study highlights the importance of data quality and harmonization in clinical trials using machine learning. Only in a joint, cross-center effort, involving a multidisciplinary team can we generate large enough curated and annotated datasets and develop the necessary pre-processing pipelines for data harmonization to successfully apply DL models clinically.
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Affiliation(s)
- Barbara D. Wichtmann
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Steffen Albert
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (S.A.); (F.G.Z.)
| | - Wenzhao Zhao
- Data Analysis and Modeling, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical School Mannheim, Central Institute for Scientific Computing (IWR), Central Institute for Computer Engineering (ZITI), CZS Heidelberg Center for Model-Based AI, Heidelberg University, 69047 Heidelberg, Germany; (W.Z.); (J.H.)
| | - Angelika Maurer
- Clinical Functional Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany;
| | - Ralf-Dieter Hofheinz
- Department of Medicine III, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Jürgen Hesser
- Data Analysis and Modeling, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical School Mannheim, Central Institute for Scientific Computing (IWR), Central Institute for Computer Engineering (ZITI), CZS Heidelberg Center for Model-Based AI, Heidelberg University, 69047 Heidelberg, Germany; (W.Z.); (J.H.)
| | - Frank G. Zöllner
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (S.A.); (F.G.Z.)
| | - Ulrike I. Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, 53127 Bonn, Germany;
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Dynamic Contrast-enhanced Magnetic Resonance Imaging Evaluation of Whole Tumour Perfusion Heterogeneity Predicts Distant Disease-free Survival in Locally Advanced Rectal Cancer. Clin Oncol (R Coll Radiol) 2022; 34:561-570. [PMID: 35738953 DOI: 10.1016/j.clon.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/08/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022]
Abstract
AIMS To evaluate diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging for the prediction of disease-free survival (DFS) in patients with locally advanced rectal cancer. MATERIALS AND METHODS Patients with stage II or III rectal adenocarcinoma undergoing neoadjuvant chemoradiotherapy (CRT) and surgery were eligible. Patients underwent multi-parametric magnetic resonance imaging (diffusion-weighted imaging and dynamic contrast-enhanced) before CRT, during CRT (week 3) and after CRT (1 week prior to surgery). Whole tumour apparent diffusion coefficient (ADC) and Ktrans histogram quantiles (10th, 25th, 50th, 75th, 90th) were extracted for analysis. The associations between ADC and Ktrans at three timepoints with time to relapse were analysed as a continuous variable using a Cox proportional hazard model. RESULTS Thirty-three patients were included in this analysis. The median follow-up was 4.4 years. No patient had locoregional relapse. Nine patients developed distant metastases. The hazard ratios for after CRT Ktrans 10th (P = 0.035), 25th (P = 0.048), 50th (P = 0.046) and 75th (P = 0.045) quantiles were statistically significant for DFS. The best Ktrans cut-off point after CRT for predicting relapse was 28 × 10-3 mL/g/min (10th quantile), with a higher Ktrans value predicting distant relapse. The 4-year DFS probability was 0.93 for patients with after CRT Ktrans value ≤28 × 10-3 mL/g/min versus 0.45 for patients with after CRT Ktrans value >28 × 10-3 mL/g/min. ADC was not able to predict DFS. CONCLUSIONS Patients with higher Ktrans values after CRT (before surgery) in a histogram analysis of whole tumour heterogeneity had a significantly lower 4-year distant DFS and could be considered for more intense systemic therapy.
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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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9
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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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10
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Single-centre evaluation and staging of rectal carcinoma on a 3-Tesla magnetic resonance imaging and correlation with histological profile. Pol J Radiol 2021; 86:e217-e224. [PMID: 34093918 PMCID: PMC8147714 DOI: 10.5114/pjr.2021.105607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/16/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To assess magnetic resonance imaging (MRI) features of rectal carcinoma in correlation with pathology, and to evaluate the diagnostic accuracy of 3-Tesla MRI. Material and methods A total of 86 patients were included. 3T MR imaging was conducted pre-operatively, with imaging data correlated to pathology results. High-resolution, 2-dimensional, T2-weighted fast-spin echo sequences in the sagittal, axial, and coronal planes used to tumour staging. Diffusion-weighted images were used to increase the accuracy of tumour evaluation. Results Rectal carcinoma was staged as T3 in 45.3% of all patients (n = 39), without involvement of the mesorectal fascia in 31.4% (n = 27), and with a possible or obvious invasion in 14% of patients (n = 12). The diagnostic accuracy of 3T MRI was 97.6% for the T1 stage, 92.1% for T2, 89% for T3, and 90% for T4 tumours. MR-derived extramural vascular invasion (EMVI) was found in 16.2% (n = 14), with an estimated diagnostic accuracy of 95%. Diffusion-weighted images and apparent diffusion coefficient were estimated for the different histology types of rectal carcinoma. The average apparent diffusion coefficient for adenocarcinoma was 0.846 ± 0.17, for mucinous adenocarcinoma it was 1.17 ± 0.08, and for signet cell and squamous carcinomas it was 0.91 ± 0.11 and 0.796 ± 0.21 mm2/s, respectively. Conclusions 3T MRI enables high levels of diagnostic accuracy in local rectal carcinoma staging, including assessment of mesorectal fascia infiltration and EMVI-status with high accuracy.
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11
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Pham TT, Liney G, Wong K, Henderson C, Rai R, Graham PL, Borok N, Truong MX, Lee M, Shin JS, Hudson M, Barton MB. Multi-parametric magnetic resonance imaging assessment of whole tumour heterogeneity for chemoradiotherapy response prediction in rectal cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 18:26-33. [PMID: 34258404 PMCID: PMC8254202 DOI: 10.1016/j.phro.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/03/2021] [Accepted: 03/18/2021] [Indexed: 12/30/2022]
Abstract
Background and purpose Prediction of chemoradiotherapy response (CRT) in locally advanced rectal cancer would enable stratification of management. The purpose was to prospectively evaluate multi-parametric magnetic resonance imaging (MRI) assessment of tumour heterogeneity combining diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE) MRI for the prediction of CRT response in locally advanced rectal cancer. Materials and methods Patients with Stage II or III rectal adenocarcinoma undergoing neoadjuvant CRT and surgery underwent MRI (DWI and DCE) before, during (week 3), and after CRT (1 week before surgery). Patients with histopathology tumour regression grade (TRG) 0-1 were classified as responders, and TRG 2-3 were classified as non-responders. A whole tumour voxel-wise technique was used to produce apparent diffusion coefficient (ADC) and Ktrans (Tofts model) histograms derived from DWI and DCE-MRI, respectively. Logistic regression was used to predict response status for ADC and Ktrans quantiles. Results Thirty-three patients were included in this analysis; 16 responders, and 17 non-responders. On heterogeneity analysis, odds of being a responder were significantly higher after CRT (before surgery) for higher ADC 75th (p = 0.049) and ADC 90th (p = 0.034) percentile values. The Ktrans quantiles were lower in non-responders than responders before and during CRT, and higher after CRT although no significant association with response status was observed (p ≥ 0.10). Conclusions DWI-MRI after CRT (before surgery) incorporating a histogram analysis of whole tumour heterogeneity was predictive of CRT response in patients with locally advanced rectal cancer. DCE-MRI did not add value in response prediction. Clinical trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12616001690448.
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Affiliation(s)
- Trang Thanh Pham
- Ingham Institute for Applied Medical Research, South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, PO Box 3151, Liverpool, NSW 2170, Australia.,Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Gary Liney
- Ingham Institute for Applied Medical Research, South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, PO Box 3151, Liverpool, NSW 2170, Australia
| | - Karen Wong
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Christopher Henderson
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Robba Rai
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Petra L Graham
- Centre for Economic Impacts of Genomic Medicine, Macquarie Business School and Department of Mathematics and Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, Macquarie University, NSW 2109, Australia
| | - Nira Borok
- Department of Radiology, Liverpool Hospital, Sydney, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Minh Xuan Truong
- Department of Radiology, Liverpool Hospital, Sydney, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Mark Lee
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Joo-Shik Shin
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.,School of Medicine, Western Sydney University, Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Malcolm Hudson
- NHMRC Clinical Trials Centre, Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia
| | - Michael B Barton
- Ingham Institute for Applied Medical Research, South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, PO Box 3151, Liverpool, NSW 2170, Australia
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12
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T2-weighted, apparent diffusion coefficient and 18F-FDG PET histogram analysis of rectal cancer after preoperative chemoradiotherapy. Tech Coloproctol 2021; 25:569-577. [PMID: 33792823 PMCID: PMC8079287 DOI: 10.1007/s10151-021-02440-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/20/2021] [Indexed: 11/05/2022]
Abstract
Background The aim of our study was to investigate the correlation among T2-weighted (T2w) images, apparent diffusion coefficient (ADC) maps, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) images, histogram analysis and the pathological response in locally advanced rectal cancer (LARC) after preoperative chemoradiotherapy (pCRT). Methods Patients with LARC were prospectively enrolled between February 2015 and August 2018 and underwent PET/magnetic resonance imaging (MRI). MRI included T2w and diffusion-weighted imaging (DWI)-sequences. ADC maps and PET images were matched to the T2w images. Voxel-based standardized uptake values (SUVs,) ADC and T2w-signal-intensity values were collected from the volumes of interest (VOIs) and mean, skewness and kurtosis were calculated. Spearman’s correlation coefficient was applied to evaluate the correlation among the variables and tumor regression grade (TRG), T stage, N stage and fibrosis. Results Twenty-two patients with biopsy-proven LARC in the low or mid rectum were enrolled [17 males, mean age was 69 years (range 49–85 years)]. Seven patients experienced complete regression (TRG1). A significant positive correlation was found between SUV mean values (ρ = 0.480; p = 0.037) and TRG. No other significant correlations were found. Conclusions Histogram analysis of SUV values is a predictor of TRG in LARC.
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13
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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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14
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Haak HE, Maas M, Trebeschi S, Beets-Tan RGH. Modern MR Imaging Technology in Rectal Cancer; There Is More Than Meets the Eye. Front Oncol 2020; 10:537532. [PMID: 33117678 PMCID: PMC7578261 DOI: 10.3389/fonc.2020.537532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022] Open
Abstract
MR imaging (MRI) is now part of the standard work up of patients with rectal cancer. Restaging MRI has been traditionally used to plan the surgical approach. Its role has recently increased and been adopted as a valuable tool to assist the clinical selection of clinical (near) complete responders for organ preserving treatment. Recently several studies have addressed new imaging biomarkers that combined with morphological provides a comprehensive picture of the tumor. Diffusion-weighted MRI (DWI) has entered the clinics and proven useful for response assessment after chemoradiotherapy. Other functional (quantitative) MRI technologies are on the horizon including artificial intelligence modeling. This narrative review provides an overview of recent advances in rectal cancer (re)staging by imaging with a specific focus on response prediction and evaluation of neoadjuvant treatment response. Furthermore, directions are given for future research.
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Affiliation(s)
- Hester E Haak
- Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands.,Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Stefano Trebeschi
- Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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15
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Guan Z, Sun RJ, Cao WT, Zhang HM, Yu T, Yu XP, Zhang JX, Zhang XY, Li XT, Zhou ZY, Zhao XM, Wen L, Sun YS. Magnetic resonance imaging tumor response score (mrTRS) predicts therapeutic effect and prognosis of locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A prospective, multi-center study. Radiother Oncol 2020; 151:288-295. [PMID: 32890612 DOI: 10.1016/j.radonc.2020.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/25/2020] [Accepted: 08/30/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE The MRI-assessed tumor regression grade (mrTRG) is limited due to its subjectivity and poor consistency on pathological tumor regression grade (pTRG). A new MRI criterion was established to predict the prognosis of locally advanced rectal cancer (LARC). MATERIALS AND METHODS The new MRI criterion magnetic resonance imaging tumor response score (mrTRS) was based on the retrospective sample of 214 LARC patients (unpublished data). Subsequently, 878 LARC patients were enrolled for a prospective, multicenter study. Baseline and postoperative MRI were obtained, and imaging features were measured by collecting the pathological, clinical and follow-up data. Kaplan-Meier method with log-rank estimate and multivariate cox regression model was used to determine the prognosis of mrTRS in LARC patients with neoadjuvant chemoradiotherapy (NACRT). The predictive capability of 3-year prognosis between mrTRS and mrTRG was determined by time-dependent ROC curves. RESULTS The results demonstrated that mrTRS acted as an independent predictor of survival outcomes. mrTRS stratified by good and moderate responders showed significantly lower risk of death (HR = 0.04, 95%CI 0.01-0.31; HR = 0.35, 95%CI 0.23-0.52), distant metastasis (HR = 0.25, 95%CI 0.13-0.52; HR = 0.42, 95%CI 0.30-0.58), and local recurrence when compared with poor responders(HR = 0.01 95%CI 0.23-0.52;HR = 0.38, 95%CI 0.16-0.90). In contrast, no significant difference was observed among mrTRG stratified groups. Excellent and substantial interobserver agreement for mrTRS and mrTRG evaluation was observed (κ = 0.92 and 0.62), respectively. CONCLUSION mrTRS can serve as an effective predictor for assessing tumor regression grade in LARC patients with NACRT.
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Affiliation(s)
- Zhen Guan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rui-Jia Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wu-Teng Cao
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong-Mei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yu
- Department of Medical Imaging, Cancer Hospital of China Medical University, Shenyang, China; Department of Medical Imaging, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xiao-Ping Yu
- Department of Radiology, Hunan Cancer Hospital, Changsha, China
| | - Jian-Xin Zhang
- Department of MR and CT, Shanxi Province Tumor Hospital, The Third People Hospital of Shanxi Province, Taiyuan, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi-Yang Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin-Ming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Wen
- Department of Radiology, Hunan Cancer Hospital, Changsha, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China.
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16
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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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17
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MRI features and texture analysis for the early prediction of therapeutic response to neoadjuvant chemoradiotherapy and tumor recurrence of locally advanced rectal cancer. Eur Radiol 2020; 30:4201-4211. [PMID: 32270317 DOI: 10.1007/s00330-020-06835-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to evaluate the efficiency of imaging features and texture analysis (TA) based on baseline rectal MRI for the early prediction of therapeutic response to neoadjuvant chemoradiotherapy (nCRT) and tumor recurrence in patients with locally advanced rectal cancer (LARC). METHODS Consecutive patients with LARC who underwent rectal MRI between January 2014 and December 2015 and surgical resection after completing nCRT were retrospectively enrolled. Imaging features were analyzed, and TA parameters were extracted from the tumor volume of interest (VOI) from baseline rectal MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the optimal TA parameter cutoff values to stratify the patients. Logistic and Cox regression analyses were performed to assess the efficacy of each imaging feature and texture parameter in predicting tumor response and disease-free survival. RESULTS In total, 78 consecutive patients were enrolled. In the logistic regression, good treatment response was associated with lower tumor location (OR = 13.284, p = 0.012), low Conv_Min (OR = 0.300, p = 0.013) and high Conv_Std (OR = 3.174, p = 0.016), Shape_Sphericity (OR = 3.170, p = 0.015), and Shape_Compacity (OR = 2.779, p = 0.032). In the Cox regression, a greater risk of tumor recurrence was related to higher cT stage (HR = 5.374, p = 0.044), pelvic side wall lymph node positivity (HR = 2.721, p = 0.013), and gray-level run length matrix_long-run low gray-level emphasis (HR = 2.268, p = 0.046). CONCLUSIONS Imaging features and TA based on baseline rectal MRI could be valuable for predicting the treatment response to nCRT for rectal cancer and tumor recurrence. KEY POINTS • Imaging features and texture parameters of T2-weighted MR images of rectal cancer can help to predict treatment response and the risk for tumor recurrence. • Tumor location as well as conventional and shape indices of texture features can help to predict treatment response for rectal cancer. • Clinical T stage, positive pelvic side wall lymph nodes, and the high-order texture parameter, GLRLM_LRLGE, can help to predict tumor recurrence for rectal cancer.
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18
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Collard M, Lefevre JH. Ultimate Functional Preservation With Intersphincteric Resection for Rectal Cancer. Front Oncol 2020; 10:297. [PMID: 32195192 PMCID: PMC7066078 DOI: 10.3389/fonc.2020.00297] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022] Open
Abstract
The proximity of the very low rectum rectal cancer to the anal sphincter raises a specific problem: how and until when can we preserve the anal continence without compromising the oncological result of the tumor resection? In this situation, intersphincteric resection (ISR) offers an excellent alternative to abdominoperineal resection (APR), but the selection of patients for this option must be extremely precise. This complex choice justifies the simultaneous consideration of an oncological approach with a functional approach in order to provide a full benefit to the patient. When a circumferential resection margin of at least 1 mm can be performed with a distal resection margin of at least 1 cm with or without preoperative radiotherapy, ISR ensures a safety choice. The oncological results of ISR reported in the literature when performed properly found a 5-year disease-free survival of 80.2% with a local recurrence rate of only 5.8%. In parallel to this oncological evaluation, the expected post-operative functional outcome and the resulting quality of life must be properly assessed pre-operatively, since partial or total resection of the internal sphincter impacts significantly on the functional outcome. Based on data from the literature, this work reports the essential anatomical considerations and then the oncological and functional elements indispensables when an anal continence preservation is evoked for a tumor of the very low rectum. Finally, the precise selection criteria and the major surgical principles are outlined in order to guarantee the safety of this modern choice for the patient.
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Affiliation(s)
- Maxime Collard
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Jérémie H Lefevre
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
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19
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Prediction of efficacy of neoadjuvant chemoradiotherapy for rectal cancer: the value of texture analysis of magnetic resonance images. Abdom Radiol (NY) 2019; 44:3775-3784. [PMID: 30852633 DOI: 10.1007/s00261-019-01971-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To explore the clinical feasibility of predicting the efficacy of neoadjuvant chemoradiotherapy (nCRT) for rectal cancer on the basis of texture analysis (TA) of T2-weighted imaging (T2WI). METHODS The cohort for this prospective study comprised 136 patients with rectal cancer to be treated with nCRT, all of whom underwent three MR scans (pre-, early, and post-nCRT). Treatment efficacy was assessed on the basis of the outcomes of pathologic complete response (pCR) and non-pCR as determined by postoperative pathological examination. Extraction and analysis of texture features in T2WI of defined tumor regions were performed by AK software. Pre- and early-nCRT texture features were selected as potential predictors of outcomes by logistic regression analysis, and a prediction model for pCR was developed. A receiver operating characteristic (ROC) curve was used to assess the predictive power of texture features in pre- and early-nCRT images. RESULTS Univariate logistic regression analysis demonstrated that the pre-nCRT features of energy, entropy, and skewness, and early-nCRT features of variance, kurtosis, energy, and entropy were independent predictors of pCR. A prediction model incorporating these predictors was constructed by multivariate logistic regression, The AUCs of pre-nCRT, early, and combined models were 0.751, 0.831, and 0.873, respectively; the sensitivities 66, 71, and 75%, respectively; and the specificities 87.22, 86.11, and 91.67%, respectively. CONCLUSIONS TA of T2WI images can predict the efficacy of nCRT for rectal cancer, possibly providing a new marker of tumor biological response in clinical practice.
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20
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Pham TT, Stait-Gardner T, Lee CS, Barton M, Graham PL, Liney G, Wong K, Price WS. Correlation of ultra-high field MRI with histopathology for evaluation of rectal cancer heterogeneity. Sci Rep 2019; 9:9311. [PMID: 31249325 PMCID: PMC6597556 DOI: 10.1038/s41598-019-45450-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/04/2019] [Indexed: 01/22/2023] Open
Abstract
Current clinical MRI techniques in rectal cancer have limited ability to examine cancer stroma. The differentiation of tumour from desmoplasia or fibrous tissue remains a challenge. Standard MRI cannot differentiate stage T1 from T2 (invasion of muscularis propria) tumours. Diffusion tensor imaging (DTI) can probe tissue structure and organisation (anisotropy). The purpose of this study was to examine DTI-MRI derived imaging markers of rectal cancer stromal heterogeneity and tumour extent ex vivo. DTI-MRI at ultra-high magnetic field (11.7 tesla) was used to examine the stromal microstructure of malignant and normal rectal tissue ex vivo, and the findings were correlated with histopathology. Images obtained from DTI-MRI (A0, apparent diffusion coefficient and fractional anisotropy (FA)) were used to probe rectal cancer stromal heterogeneity. FA provided the best discrimination between cancer and desmoplasia, fibrous tissue and muscularis propria. Cancer had relatively isotropic diffusion (mean FA 0.14), whereas desmoplasia (FA 0.31) and fibrous tissue (FA 0.34) had anisotropic diffusion with significantly higher FA than cancer (p < 0.001). Tumour was distinguished from muscularis propria (FA 0.61) which was highly anisotropic with higher FA than cancer (p < 0.001). This study showed that DTI-MRI can assist in more accurately defining tumour extent in rectal cancer.
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Affiliation(s)
- Trang T Pham
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia. .,South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia. .,Ingham Institute for Applied Medical Research, Sydney, Australia.
| | - Timothy Stait-Gardner
- Nanoscale Organisation and Dynamics Group, Western Sydney University, Sydney, Australia
| | - Cheok Soon Lee
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,Department of Anatomical Pathology, Liverpool Hospital, Sydney, Australia
| | - Michael Barton
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Petra L Graham
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, Sydney, Australia
| | - Gary Liney
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Karen Wong
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - William S Price
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,Nanoscale Organisation and Dynamics Group, Western Sydney University, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
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21
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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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22
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Yang X, Xiao X, Lu B, Chen Y, Wen Z, Yu S. Perfusion-sensitive parameters of intravoxel incoherent motion MRI in rectal cancer: evaluation of reproducibility and correlation with dynamic contrast-enhanced MRI. Acta Radiol 2019; 60:569-577. [PMID: 30114928 DOI: 10.1177/0284185118791201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) acquires tumor perfusion information without injection of contrast medium, which is promising in tumor assessment. However, its consistency with dynamic contrast-enhanced MRI (DCE-MRI), a more widely used method for tumor perfusion evaluation, is not revealed in rectal cancer. PURPOSE In this study, we aimed to investigate the correlation of perfusion-sensitive parameters derived from IVIM-MRI with DCE-MRI and measurement reproducibility of IVIM-MRI parameters in rectal cancer. MATERIAL AND METHODS Forty-seven rectal cancer patients underwent IVIM-MRI with 16 b-values and DCE-MRI. The perfusion fraction ( f), pseudo-diffusion coefficient ( D*), and f· D* were measured by two radiologists independently and correlated with the transfer constant ( Ktrans), reflux constant ( kep), and extravascular extracellular fractional volume ( ve) obtained from DCE-MRI. RESULTS Pearson's correlation analyses of IVIM-MRI and DCE-MRI parameters showed fair to moderate correlation between f and Ktrans ( r = 0.461, P = 0.001), followed by f and kep ( r = 0.430, P = 0.003), f·D*, and Ktrans ( r = 0.425, P = 0.003), f·D*, and kep ( r = 0.384, P = 0.008). There was no significant correlation between ve and f, ve and D*, ve and f· D*, D* and Ktrans, and D* and kep. The reproducibility of IVIM-MRI measurements was moderate. For parameter f, intraclass correlation coefficient (ICC) = 0.71 (0.53-0.82), coefficient of variation (CV) = 13.05 ± 0.02%, limit of agreement (LoA) = -0.05-0.04; for parameter D*, ICC = 0.55 (0.32-0.72), CV = 20.28 ± 3.23%, LoA = -9.6-8.4. CONCLUSION Perfusion-sensitive parameters derived from IVIM-MRI correlated fairly to moderately with DCE-MRI in rectal cancer patients and showed moderate measurement reproducibility. IVIM-MRI supplements routine high-resolution MRI without contrast enhancement to provide information of tumor microcirculation.
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Affiliation(s)
- Xinyue Yang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Xiaojuan Xiao
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Baolan Lu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yan Chen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Ziqiang Wen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Shenping Yu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
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23
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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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24
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Lambregts DMJ, Boellaard TN, Beets-Tan RGH. Response evaluation after neoadjuvant treatment for rectal cancer using modern MR imaging: a pictorial review. Insights Imaging 2019; 10:15. [PMID: 30758688 PMCID: PMC6375095 DOI: 10.1186/s13244-019-0706-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation. MRI is one of the main tools used to assess response, but has difficulties in assessing response within areas of post-radiation fibrosis. Hence, MR sequences such as diffusion-weighted imaging are increasingly adopted in clinical MR protocols to improve the differentiation between tumor and fibrosis. In this pictorial review, we discuss the strengths and weaknesses of modern MR imaging, including functional imaging sequences such as diffusion-weighted MRI, for response evaluation after chemoradiation treatment and provide the main pearls and pitfalls for image interpretation.
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Affiliation(s)
- Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Thierry N Boellaard
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, The Netherlands
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25
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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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26
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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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27
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Sangster GP, Ballard DH, Nazar M, Tsai R, Donato M, D'Agostino HB. Multimodality Imaging Review of Anorectal and Perirectal Diseases With Histological, Endoscopic, and Operative Correlation, Part I: Anatomy and Neoplasms. Curr Probl Diagn Radiol 2018; 48:494-508. [PMID: 30172447 DOI: 10.1067/j.cpradiol.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/28/2022]
Abstract
A broad spectrum of pathology affects the rectum, anus, and perineum and understanding of its relevant anatomy is important in accurate reporting, particularly in rectal cancer. In this pictorial essay, correlative imaging, endoscopic, pathologic, and operative images are presented to illustrate normal anorectal anatomy and neoplastic conditions that affect the anus and rectum. A particular case-based focus is given to rectal adenocarcinoma with pelvic MR and surgical histopathology. Additionally, carcinoid tumor, gastrointestinal stromal tumor, condylomata acuminata, squamous cell carcinoma, melanoma, and metastatic disease about the rectum and anus are reviewed.
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Affiliation(s)
- Guillermo P Sangster
- Department of Radiology, Louisiana State University Health Shreveport, Shreveport, LA.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Miguel Nazar
- Department of Radiology, Hospital Aleman, Buenos Aires, Argentina
| | - Richard Tsai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Maren Donato
- Fundación Medica de Río Negro y Neuquén. Cipolletti, Río Negro, Argentina
| | - Horacio B D'Agostino
- Department of Radiology, Louisiana State University Health Shreveport, Shreveport, LA
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28
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Jia H, Shen X, Guan Y, Xu M, Tu J, Mo M, Xie L, Yuan J, Zhang Z, Cai S, Zhu J, Zhu Z. Predicting the pathological response to neoadjuvant chemoradiation using untargeted metabolomics in locally advanced rectal cancer. Radiother Oncol 2018; 128:548-556. [PMID: 30041962 DOI: 10.1016/j.radonc.2018.06.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/19/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE The present study aimed to identify a panel of potential metabolite biomarkers to predict tumor response to neoadjuvant chemo-radiation therapy (NCRT) in locally advanced rectal cancer (LARC). EXPERIMENTAL DESIGN Liquid chromatography-mass spectrometry (LC-MS)-based untargeted metabolomics was used to profile human serum samples (n = 106) from LARC patients treated with NCRT. The samples were collected from Fudan University Shanghai Cancer Center (FUSCC) from July 2014 to January 2016. Statistical methods, such as partial least squares (PLS) and Wilcoxon rank-sum test, were used to identify discriminative metabolites between NCRT-sensitive and NCRT-resistant patients according to their tumor regression grade (TRG). This trial is registered with Clinical Trials.gov, number NCT03149978. RESULTS A panel of metabolites was selected as potential predictive biomarkers of pathological response to NCRT. A total of 4810 metabolic peaks were detected, and 57 significantly dysregulated peaks were identified. These 57 metabolic peaks were used to differentiate patients using PLS in a dataset containing NCRT-sensitive (n = 56) and NCRT-resistant (n = 49) patients. The combination of 57 metabolic peaks had AUC values of 0.88, 0.81 and 0.84 in the prediction models using PLS, random forest, and support vector machine, respectively, suggesting that metabolomics has the potential ability to predict responses to NCRT. Furthermore, 15 metabolite biomarkers were identified and used to construct a logistic regression model and explore dysregulated metabolic pathways using untargeted metabolic profiling and data mining approaches. CONCLUSIONS A panel of metabolites has been identified to facilitate the prediction of tumor response to NCRT in LARC, which is promising for the generation of personalized treatment strategies for LARC patients.
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Affiliation(s)
- Huixun Jia
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, PR China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Xiaotao Shen
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, PR China; University of Chinese Academy of Sciences, Beijing, PR China
| | - Yun Guan
- Department of Oncology, Shanghai Medical College, Fudan University, PR China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, PR China
| | - Meimei Xu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, PR China; University of Chinese Academy of Sciences, Beijing, PR China
| | - Jia Tu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, PR China; University of Chinese Academy of Sciences, Beijing, PR China
| | - Miao Mo
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, PR China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Li Xie
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, PR China
| | - Jing Yuan
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, PR China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Zhen Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, PR China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, PR China
| | - Sanjun Cai
- Department of Oncology, Shanghai Medical College, Fudan University, PR China; Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, PR China
| | - Ji Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, PR China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, PR China.
| | - ZhengJiang Zhu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, PR China; University of Chinese Academy of Sciences, Beijing, PR China.
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García-Figueiras R, Baleato-González S, Padhani AR, Luna-Alcalá A, Marhuenda A, Vilanova JC, Osorio-Vázquez I, Martínez-de-Alegría A, Gómez-Caamaño A. Advanced Imaging Techniques in Evaluation of Colorectal Cancer. Radiographics 2018; 38:740-765. [PMID: 29676964 DOI: 10.1148/rg.2018170044] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Imaging techniques are clinical decision-making tools in the evaluation of patients with colorectal cancer (CRC). The aim of this article is to discuss the potential of recent advances in imaging for diagnosis, prognosis, therapy planning, and assessment of response to treatment of CRC. Recent developments and new clinical applications of conventional imaging techniques such as virtual colonoscopy, dual-energy spectral computed tomography, elastography, advanced computing techniques (including volumetric rendering techniques and machine learning), magnetic resonance (MR) imaging-based magnetization transfer, and new liver imaging techniques, which may offer additional clinical information in patients with CRC, are summarized. In addition, the clinical value of functional and molecular imaging techniques such as diffusion-weighted MR imaging, dynamic contrast material-enhanced imaging, blood oxygen level-dependent imaging, lymphography with contrast agents, positron emission tomography with different radiotracers, and MR spectroscopy is reviewed, and the advantages and disadvantages of these modalities are evaluated. Finally, the future role of imaging-based analysis of tumor heterogeneity and multiparametric imaging, the development of radiomics and radiogenomics, and future challenges for imaging of patients with CRC are discussed. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Roberto García-Figueiras
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Sandra Baleato-González
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Anwar R Padhani
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Antonio Luna-Alcalá
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Ana Marhuenda
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Joan C Vilanova
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Iria Osorio-Vázquez
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Anxo Martínez-de-Alegría
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Antonio Gómez-Caamaño
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
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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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Van Wickle JD, Paulson ES, Landry JC, Erickson BA, Hall WA. Adaptive radiation dose escalation in rectal adenocarcinoma: a review. J Gastrointest Oncol 2017; 8:902-914. [PMID: 29184696 DOI: 10.21037/jgo.2017.07.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Total mesorectal excision (TME) after neoadjuvant chemoradiotherapy (CRT) has offered superior control for patients with locally advanced rectal cancer, but can carry a quality of life cost. Fortunately, some patients achieve a complete response after CRT alone without the added morbidity caused by surgery. Efforts to increase fidelity of radiation treatment planning and delivery may allow for escalated doses of radiotherapy (RT) with limited off-target toxicity and elicit more pathological complete responses (pCR) to CRT thereby sparing more rectal cancer patients from surgery. In this review, methods of delivering escalated RT boost above 45-50.4 Gy are discussed including: 3D conformal, intensity-modulated radiotherapy (IMRT), and brachytherapy. Newly developed adaptive boost strategies and imaging modalities used in RT planning and response evaluation such as magnetic resonance imaging (MRI) and positron emission tomography (PET) are also discussed.
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Affiliation(s)
| | - Eric S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jerome C Landry
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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Lu W, Jing H, Ju-Mei Z, Shao-Lin N, Fang C, Xiao-Ping Y, Qiang L, Biao Z, Su-Yu Z, Ying H. Intravoxel incoherent motion diffusion-weighted imaging for discriminating the pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Sci Rep 2017; 7:8496. [PMID: 28819296 PMCID: PMC5561073 DOI: 10.1038/s41598-017-09227-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/17/2017] [Indexed: 02/07/2023] Open
Abstract
To investigate the usefulness of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in discriminating the pathological complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC), 42 patients underwent preoperative IVIM-DWI before (pre-nCRT) and after nCRT (post-nCRT). The values of pre-nCRT and post-nCRT IVIM-DWI parameters (ADC, D, D* and f), together with the percentage changes (∆% parametric value) induced by nCRT, were compared between the pCR (tumour regression grade [TRG] 4) and non-pCR (TRG 0, 1, 2 or 3) groups and between the GR (TRG 3 or 4) and PR (TRG 0, 1 or 2) groups based on the Dworak TRG system. After nCRT, the ADC and D values for LARC increased significantly (all P < 0.05). The TRG score revealed a positive correlation with pref (r = 0.357, P = 0.020), postD (r = 0.551, P < 0.001) and Δ%D (r = 0.605, P < 0.001). The pCR group (n = 10) had higher preD*, pref, postD, ∆%ADC and ∆%D values than the non-pCR group (n = 32) (all P < 0.05). The GR group (n = 15) exhibited higher postD, ∆%ADC and ∆%D values than the PR group (n = 27) (all P < 0.05). Based on ROC analysis, ∆%D had a higher area under the curve value than ∆%ADC (P = 0.009) in discriminating the pCR from non-pCR groups. In conclusion, IVIM-DWI may be helpful in identifying the pCR to nCRT for LARC and is more accurate than traditional DWI.
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Affiliation(s)
- Wen Lu
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China
| | - Hou Jing
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China
| | - Zhou Ju-Mei
- Department of Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China
| | - Nie Shao-Lin
- Department of Colorectal Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China
| | - Cao Fang
- Department of Pathology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, P.R. China
| | - Yu Xiao-Ping
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China.
| | - Lu Qiang
- Department of Diagnostic Radiology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China
| | - Zeng Biao
- Department of Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China
| | - Zhu Su-Yu
- Department of Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China
| | - Hu Ying
- Department of Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University, Changsha, 410013, Hunan, P.R. China.
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Fusco R, Petrillo M, Granata V, Filice S, Sansone M, Catalano O, Petrillo A. Magnetic Resonance Imaging Evaluation in Neoadjuvant Therapy of Locally Advanced Rectal Cancer: A Systematic Review. Radiol Oncol 2017; 51:252-262. [PMID: 28959161 PMCID: PMC5611989 DOI: 10.1515/raon-2017-0032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to present an update concerning several imaging modalities in diagnosis, staging and pre-surgery treatment response assessment in locally advanced rectal cancer (LARC). Modalities include: traditional morphological magnetic resonance imaging (MRI), functional MRI such as dynamic contrast enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI). A systematic review about the diagnostic accuracy in neoadjuvant therapy response assessment of MRI, DCE-MRI, DWI and Positron Emission Tomography/Computed Tomography (PET/CT) has been also reported. Methods Several electronic databases were searched including PubMed, Scopus, Web of Science, and Google Scholar. All the studies included in this review reported findings about therapy response assessment in LARC by means of MRI, DCE-MRI, DWI and PET/CT with details about diagnostic accuracy, true and false negatives, true and false positives. Forest plot and receiver operating characteristic (ROC) curves analysis were performed. Risk of bias and the applicability at study level were calculated. Results Twenty-five papers were identified. ROC curves analysis demonstrated that multimodal imaging integrating morphological and functional MRI features had the best accuracy both in term of sensitivity and specificity to evaluate preoperative therapy response in LARC. DCE-MRI following to PET/CT showed high diagnostic accuracy and their results are also more reliable than conventional MRI and DWI alone. Conclusions Morphological MRI is the modality of choice for rectal cancer staging permitting a correct assessment of the disease extent, of the lymph node involvement, of the mesorectal fascia and of the sphincter complex for surgical planning. Multimodal imaging and functional DCE-MRI may also help in the assessment of treatment response allowing to guide the surgeon versus conservative strategies and/or tailored approach such as “wait and see” policy.
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Affiliation(s)
- Roberta Fusco
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Mario Petrillo
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Vincenza Granata
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Salvatore Filice
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies, Università degli Studi di Napoli Federico II, Via Claudio, Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Antonella Petrillo
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
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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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Tang L, Sui Y, Zhong Z, Damen FC, Li J, Shen L, Sun Y, Zhou XJ. Non-Gaussian diffusion imaging with a fractional order calculus model to predict response of gastrointestinal stromal tumor to second-line sunitinib therapy. Magn Reson Med 2017. [PMID: 28643387 DOI: 10.1002/mrm.26798] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To demonstrate the clinical value of a non-Gaussian diffusion model using fractional order calculus (FROC) for early prediction of the response of gastrointestinal stromal tumor to second-line sunitinib targeted therapy. METHODS Fifteen patients underwent sunitinib treatment after imatinib resistance. Diffusion-weighted imaging with multiple b-values was performed before treatment (baseline) and 2 weeks (for early prediction of response) after initiating sunitinib treatment. Conventional MRI images at 12 weeks were used to determine the good and poor responders according to the modified Choi criteria for MRI. Diffusion coefficient D, fractional order parameter β (which correlates to intravoxel tissue heterogeneity), and a microstructural quantity µ were calculated using the FROC model. The FROC parameters and the longest diameter of the lesion, as well as their changes after 2 weeks of treatment, were compared between the good and poor responders. Additionally, the pretreatment FROC parameters were individually combined with the change in D (ΔD) using a logistic regression model to evaluate response to sunitinib treatment with a receiver operating characteristic analysis. RESULTS Forty-two good-responding and 32 poor-responding lesions were identified. Significant differences were detected in pretreatment β (0.67 versus 0.74, P = 0.011) and ΔD (45.7% versus 12.4%, P = 0.001) between the two groups. The receiver operating characteristic analysis showed that ΔD had a significantly higher predictive power than the tumor size change (area under the curve: 0.725 versus 0.580; 0.95 confidence interval). When ΔD was combined with pretreatment β, the area under the curve improved to 0.843 with a predictive accuracy of 75.7% (56 of 74). CONCLUSIONS The non-Gaussian FROC diffusion model showed clinical value in early prediction of gastrointestinal stromal tumor response to second-line sunitinib targeted therapy. The pretreatment FROC parameter β can increase the predictive accuracy when combined with the change in diffusion coefficient during treatment. Magn Reson Med 79:1399-1406, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Lei Tang
- Department of Radiology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research, Beijing, China.,Center for MR Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yi Sui
- Center for MR Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Zheng Zhong
- Center for MR Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frederick C Damen
- Center for MR Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jian Li
- Department of Gastroenterology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research, Beijing, China
| | - Lin Shen
- Department of Gastroenterology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research, Beijing, China
| | - Yingshi Sun
- Department of Radiology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research, Beijing, China
| | - Xiaohong Joe Zhou
- Center for MR Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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van Heeswijk MM, Lambregts DMJ, Maas M, Lahaye MJ, Ayas Z, Slenter JMGM, Beets GL, Bakers FCH, Beets-Tan RGH. Measuring the apparent diffusion coefficient in primary rectal tumors: is there a benefit in performing histogram analyses? Abdom Radiol (NY) 2017; 42:1627-1636. [PMID: 28160039 PMCID: PMC5486825 DOI: 10.1007/s00261-017-1062-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose The apparent diffusion coefficient (ADC) is a potential prognostic imaging marker in rectal cancer. Typically, mean ADC values are used, derived from precise manual whole-volume tumor delineations by experts. The aim was first to explore whether non-precise circular delineation combined with histogram analysis can be a less cumbersome alternative to acquire similar ADC measurements and second to explore whether histogram analyses provide additional prognostic information. Methods Thirty-seven patients who underwent a primary staging MRI including diffusion-weighted imaging (DWI; b0, 25, 50, 100, 500, 1000; 1.5 T) were included. Volumes-of-interest (VOIs) were drawn on b1000-DWI: (a) precise delineation, manually tracing tumor boundaries (2 expert readers), and (b) non-precise delineation, drawing circular VOIs with a wide margin around the tumor (2 non-experts). Mean ADC and histogram metrics (mean, min, max, median, SD, skewness, kurtosis, 5th–95th percentiles) were derived from the VOIs and delineation time was recorded. Measurements were compared between the two methods and correlated with prognostic outcome parameters. Results Median delineation time reduced from 47–165 s (precise) to 21–43 s (non-precise). The 45th percentile of the non-precise delineation showed the best correlation with the mean ADC from the precise delineation as the reference standard (ICC 0.71–0.75). None of the mean ADC or histogram parameters showed significant prognostic value; only the total tumor volume (VOI) was significantly larger in patients with positive clinical N stage and mesorectal fascia involvement. Conclusion When performing non-precise tumor delineation, histogram analysis (in specific 45th ADC percentile) may be used as an alternative to obtain similar ADC values as with precise whole tumor delineation. Histogram analyses are not beneficial to obtain additional prognostic information.
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Affiliation(s)
- Miriam M van Heeswijk
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology- Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Z Ayas
- Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jos M G M Slenter
- Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology- Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Frans C H Bakers
- Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology- Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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The value of diffusion kurtosis imaging in assessing pathological complete response to neoadjuvant chemoradiation therapy in rectal cancer: a comparison with conventional diffusion-weighted imaging. Oncotarget 2017; 8:75597-75606. [PMID: 29088894 PMCID: PMC5650449 DOI: 10.18632/oncotarget.17491] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/11/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives The aim of this study is to comprehensively evaluate the advantage of diffusion kurtosis imaging (DKI) in distinguishing pathological complete response (pCR) from non-pCR patients with locally advanced rectal cancer (LARC) after neoadjuvant chemoradiation therapy (CRT) in comparison to conventional diffusion-weighted imaging (DWI). Material and Methods Fifty-six consecutive patients diagnosed with LARC were prospectively enrolled and underwent pre- and post-CRT MRI on a 3.0 T MRI scanner. Apparent diffusion coefficient (ADC), mean diffusion (MD) and mean kurtosis (MK) values of the tumor were measured in pre- and post-CRT phases and then compared to histopathologic findings after total mesorectal excision (TME). Both Mann-Whitney U-test and Kruskal-Wallis test were used as statistical methods. Diagnostic performance was determined using receiver operating characteristic (ROC) curve analysis. Results For a total of 56 rectal lesions (pCR, n = 14; non-pCR, n = 42), the MKpre and MKpost values were much lower for the pCR patients (mean±SD, 0.72±0.09 and 0.56±0.06, respectively) than those for the non-pCR patients (0.89±0.11 and 0.68±0.08, respectively) (p < 0.001). The ADCpost and the change ratio of apparent diffusion coefficient (ADCratio) values was significantly higher for the pCR patients (mean±SD, 1.31±0.13 and 0.64±0.34, respectively) than for the non-pCR patients (1.12±0.16 and 0.33±0.27, respectively) (p < 0.001 and p = 0.001, respectively). In addition, the MDpost and the change ratio of mean diffusion (MDratio) (2.45±0.33 vs. 1.95±0.30, p < 0.001; 0.80±0.43 vs. 0.35±0.32, p < 0.001, respectively) also increased, whereas the ADCpre, MDpre and the change ratio of mean kurtosis (MKratio) of the pCR (0.82±0.11, 1.40±0.21, and 0.23±0.010, respectively) exhibited a neglectable difference with that of the non-pCR (p = 0.332, 0.269, and 0.678, respectively). The MKpost showed relatively high sensitivity (92.9%) and high specificity (83.3%) in comparison to other image indices. The area under the receiver operating characteristic curve (AUROC) that is available for the assessment of pCR using MKpost (0.908, cutoff value = 0.6196) were larger than other parameters and the overall accuracy of MKpost (85.7%) was the highest. Conclusions Both DKI and conventional DWI hold great potential in predicting treatment response to neoadjuvant chemoradiation therapy in rectal cancer. The DKI parameters, especially MKpost, showed a higher specificity than conventional DWI in assessing pCR and non-pCR in patients with LARC, but the pre-CRT ADC and MD are unreliable.
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Diffusion-weighted magnetic resonance imaging in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Eur J Surg Oncol 2017; 43:1324-1329. [PMID: 28363512 DOI: 10.1016/j.ejso.2017.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/09/2017] [Accepted: 03/15/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To analyze diffusion-weighted magnetic resonance imaging (DW-MRI) for treatment response assessment in locally advanced rectal cancer (LARC). PATIENTS AND METHODS Patients with histologically proven rectal adenocarcinoma, stage II-III disease, were enrolled and underwent surgery following neoadjuvant chemoradiotherapy (nCRT). All patients were referred for a DW-MRI protocol on a 3 Tesla MR-system, consisting of axial T2-weighted and DWI sequences prior (I), during (II) and after (III) nCRT. Corresponding apparent diffusion coefficient (ADC) values were calculated. RESULTS Between February 2011 and June 2015, 37 patients participated in the study. All patients completed programmed treatment. Overall, 11 patients (29.7%) had pathologic complete response (pCR). No correlation between the mean pre- (ADC-I), during (ADC-II), post- (ADC-III) ADC and the reduction in tumor size after nCRT was recorded. No substantial difference in the ADC distribution was found between pCR and no-pCR patients. The ADC-II level significantly increased in the pCR cases (T = 1.675; p < 0.05). CONCLUSION ADC value could be useful for discriminating between the pCR patients and the no-pCR patients. Further studies are necessary to identify the optimal MRI parameters combination to predict tumor response to nCRT. It is hoped that these data will provide the basis for a more solid scientific evidence.
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Pham TT, Liney GP, Wong K, Barton MB. Functional MRI for quantitative treatment response prediction in locally advanced rectal cancer. Br J Radiol 2017; 90:20151078. [PMID: 28055248 DOI: 10.1259/bjr.20151078] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Despite advances in multimodality treatment strategies for locally advanced rectal cancer and improvements in locoregional control, there is still a considerable variation in response to neoadjuvant chemoradiotherapy (CRT). Accurate prediction of response to neoadjuvant CRT would enable early stratification of management according to good responders and poor responders, in order to adapt treatment to improve therapeutic outcomes in rectal cancer. Clinical studies in diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI have shown promising results for the prediction of therapeutic response in rectal cancer. DWI allows for assessment of tumour cellularity. DCE-MRI enables evaluation of factors of the tumour microvascular environment and changes in perfusion in response to treatment. Studies have demonstrated that predictors of good response to CRT include lower tumour pre-CRT apparent diffusion coefficient (ADC), greater percentage increase in ADC during and post CRT, and higher pre-CRT Ktrans. However, the mean ADC and Ktrans values do not adequately reflect tumour heterogeneity. Multiparametric MRI using quantitative DWI and DCE-MRI in combination, and a histogram analysis technique can assess tumour heterogeneity and its response to treatment. This strategy has the potential to improve the accuracy of therapeutic response prediction in rectal cancer and warrants further investigation.
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Affiliation(s)
- Trang T Pham
- 1 Department of Radiation Oncology, Liverpool Hospital, Sydney, NSW, Australia.,2 Sydney West Radiation Oncology Network, Westmead, Blacktown and Nepean Hospitals, Sydney, NSW, Australia.,3 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,4 Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Gary P Liney
- 1 Department of Radiation Oncology, Liverpool Hospital, Sydney, NSW, Australia.,3 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,4 Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,5 Faculty of Radiation and Medical Physics, University of Wollongong, NSW, Australia
| | - Karen Wong
- 1 Department of Radiation Oncology, Liverpool Hospital, Sydney, NSW, Australia.,3 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,4 Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Michael B Barton
- 1 Department of Radiation Oncology, Liverpool Hospital, Sydney, NSW, Australia.,3 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,4 Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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Yu J, Xu Q, Song JC, Li Y, Dai X, Huang DY, Zhang L, Li Y, Shi HB. The value of diffusion kurtosis magnetic resonance imaging for assessing treatment response of neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Eur Radiol 2016; 27:1848-1857. [PMID: 27631106 DOI: 10.1007/s00330-016-4529-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the feasibility and value of diffusion kurtosis (DK) imaging in assessing treatment response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). METHODS Forty-one patients were included. All patients underwent pre- and post-CRT DCE-MRI on a 3.0-Tesla MRI scanner. Imaging indices (D app , K app and ADC values) were measured. Change value (∆X) and change ratio (r∆X) were calculated. Pathological tumour regression grade scores (Mandard) were the standard reference (good responders: pTRG 1-2; poor responders: pTRG 3-5). Diagnostic performance was compared using ROC analysis. RESULTS For the pre-CRT measurements, pre-D app-10th was significantly lower in the good responder group than that of the poor responder group (p = 0.036). For assessing treatment response to neoadjuvant CRT, pre-D app-10th resulted in AUCs of 0.753 (p = 0.036) with a sensitivity of 66.67 % and a specificity of 77.78 %. The r∆D app had a relatively high AUC (0.859) and high sensitivity (100 %) compared with other image indices. CONCLUSIONS DKI is feasible for selecting good responders for neoadjuvant CRT for LARC. KEY POINTS • LARC responded well after neoadjuvant chemoradiotherapy with lower pre-D app-10th . • LARC responded well with greater increases in mean ADC and D app . • The change ratio of D app (r∆D app ) had a relatively better diagnostic performance.
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Affiliation(s)
- Jing Yu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Qing Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Jia-Cheng Song
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Yan Li
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Xin Dai
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Dong-Ya Huang
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ling Zhang
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Yang Li
- Department of Pathology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.
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De Cecco CN, Ciolina M, Caruso D, Rengo M, Ganeshan B, Meinel FG, Musio D, De Felice F, Tombolini V, Laghi A. Performance of diffusion-weighted imaging, perfusion imaging, and texture analysis in predicting tumoral response to neoadjuvant chemoradiotherapy in rectal cancer patients studied with 3T MR: initial experience. Abdom Radiol (NY) 2016; 41:1728-35. [PMID: 27056748 DOI: 10.1007/s00261-016-0733-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the performance of texture analysis (TA), diffusion-weighted imaging, and perfusion MR (pMRI) in predicting tumoral response in patients treated with neoadjuvant chemoradiotherapy (CRT). METHODS 12 consecutive patients (8 females, 4 males, 63.2 ± 13.4 years) with rectal cancer were prospectively enrolled, and underwent pre-treatment 3T MRI. Treatment protocol consisted of neoadjuvant CRT with oxaliplatin and 5-fluorouracile. Unenhanced T2-weighted images TA (kurtosis), apparent diffusion coefficient (ADC), and pMRI parameters (Ktrans, Kep, Ve, IAUGC) were quantified by manually delineating a region of interest around the tumor outline. After CRT, all patients underwent complete surgical resection and the surgical specimen served as the gold standard. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminatory power of each quantitative parameter to predict complete response. RESULTS Pathological complete response (pCR) was reported in six patients and partial response (PR) in three patients. Three patients were classified as non-responders (NR). Pre-treatment kurtosis was significantly lower in the pCR sub-group in comparison with PR + NR (p = .01). Among ADC and pMRI parameters, only Ve was significantly lower in the pCR sub-group compared with PR + NR (p = .01). A significant negative correlation between kurtosis and ADC (r = -0.650, p = .022) was observed. Pre-treatment area under the ROC curves (AUC), to discriminate between pCR and PR + NR, was significantly higher for kurtosis (0.861, p = .001) and Ve (0.861, p = .003) compared to all other parameters. The optimal cutoff value for pre-treatment kurtosis and Ve was ≤0.19 (100% sensitivity, 67% specificity) and ≤0.311 (83% sensitivity, 83% specificity), respectively. CONCLUSION Pre-treatment kurtosis derived from T2w images and Ve from pMRI have the potential to act as imaging biomarkers of rectal cancer response to neoadjuvant CRT.
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Affiliation(s)
- Carlo N De Cecco
- Diagnostic Imaging Unit, Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Maria Ciolina
- Diagnostic Imaging Unit, Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
| | - Damiano Caruso
- Diagnostic Imaging Unit, Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
| | - Marco Rengo
- Diagnostic Imaging Unit, Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, University of Rome "Sapienza" - Polo Pontino, Latina, Italy
| | - Balaji Ganeshan
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, Sussex, United Kingdom
| | - Felix G Meinel
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Daniela Musio
- Department of Radiotherapy, University of Rome "Sapienza", Rome, Italy
| | | | | | - Andrea Laghi
- Diagnostic Imaging Unit, Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, University of Rome "Sapienza" - Polo Pontino, Latina, Italy.
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Foti PV, Privitera G, Piana S, Palmucci S, Spatola C, Bevilacqua R, Raffaele L, Salamone V, Caltabiano R, Magro G, Li Destri G, Milone P, Ettorre GC. Locally advanced rectal cancer: Qualitative and quantitative evaluation of diffusion-weighted MR imaging in the response assessment after neoadjuvant chemo-radiotherapy. Eur J Radiol Open 2016; 3:145-52. [PMID: 27489868 PMCID: PMC4959919 DOI: 10.1016/j.ejro.2016.06.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE to investigate the added value of qualitative and quantitative evaluation of diffusion weighted (DW) magnetic resonance (MR) imaging in response assessment after neoadjuvant chemo-radiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). METHODS 31 patients with LARC (stage ≥ T3) were enrolled in the study. All patients underwent conventional MRI and DWI before starting therapy and after neoadjuvant CRT. All patients underwent surgery; pathologic staging represented the reference standard. For qualitative analysis, two radiologists retrospectively reviewed conventional MR images and the combined set of conventional and DW MR images and recorded their confidence level with respect to complete response (ypCR). For quantitative analysis, tumor's apparent diffusion coefficient (ADC) values were measured at each examination. ADC pre-CRT, ADC post-CRT and Δ ADC post-ADC pre of the three groups of response (ypCR, partial response ypPR, stable disease ypSD) were compared. Receiver-operating characteristics (ROC) curve analysis was employed to investigate the discriminatory capability for ypCR, responders (ypCR, ypPR) and ypSD of each measure. RESULTS addition of DWI to conventional T2-weighted sequences improved diagnostic performance of MRI in the evaluation of ypCR. A low tumor ADC value in the pre-CRT examination, a high ADC value in the post-CRT examination, a high Δ ADC post-ADC pre [>0.3 (×10(-3) mm(2)/s)] were predictive of ypCR. CONCLUSIONS DW sequences improve MR capability to evaluate tumor response to CRT. Nevertheless, no functional MR technique alone seems accurate enough to safely select patients with ypCR.
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Affiliation(s)
- Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Giuseppe Privitera
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Sebastiano Piana
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Corrado Spatola
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Roberta Bevilacqua
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Luigi Raffaele
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Vincenzo Salamone
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Rosario Caltabiano
- Department G.F. Ingrassia-Institute of Pathology, University of Catania, Catania, Italy
| | - Gaetano Magro
- Department G.F. Ingrassia-Institute of Pathology, University of Catania, Catania, Italy
| | - Giovanni Li Destri
- Department G.F. Ingrassia-Unità Operativa Chirurgia Digerente Colorettale, University of Catania, Catania, Italy
| | - Pietro Milone
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Giovanni Carlo Ettorre
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
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Moon SJ, Cho SH, Kim GC, Kim WH, Kim HJ, Shin KM, Lee SM, Park JS, Choi GS, Kim SH. Complementary value of pre-treatment apparent diffusion coefficient in rectal cancer for predicting tumor recurrence. Abdom Radiol (NY) 2016; 41:1237-44. [PMID: 26830420 DOI: 10.1007/s00261-016-0648-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess the complementary prognostic value of pre-treatment tumor apparent diffusion coefficient (ADC) for the prediction of tumor recurrence in patients with rectal cancer. METHODS From March 2012 to March 2013, a total of 128 patients with mid/lower rectal cancer who underwent pre-treatment rectal MRI were enrolled in this retrospective study. Two radiologists in consensus evaluated conventional imaging features (Cimg) in pre-treatment rectal MRI: tumor height from anal verge (≤5 cm vs. >5 cm), T stage (high vs. low), the presence or absence of lymph node metastasis, mesorectal fascia invasion, and extramural venous invasion. The mean tumor ADC values (TumorADC) based on high b-value (0, 1000 × 10(-3) mm(2)/s) diffusion weight images were extracted. A multivariate Cox proportional hazard (CPH) regression was performed to evaluate the association of Cimg and TumorADC with the 3-year local recurrence (LR) rate. Predictive performance of two multivariate CPH models (Cimg only vs. Cimg + TumorADC) was compared using Harrell's c index (HCI). RESULTS TumorADC (Adjusted HR, 7.830; 95% CI 3.937-15.571) and high T stage (Adjusted HR, 8.039; 95% CI 2.405-26.874) were independently associated with the 3-year LR rate. The CPH model generated with T stage + TumorADC (HCI, 0.820; 95% CI 0.708-0.932) showed significantly higher HCI than that with T stage only (HCI, 0.742; 95% CI 0.594-0.889) (P = 0.009). CONCLUSIONS In patients with mid/lower rectal cancer, integrating TumorADC to Cimg increases predictive performance of the CPH model than that with Cimg alone for the prediction of LR within 3 years after surgery.
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Affiliation(s)
- Sung Jun Moon
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea.
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Won Hwa Kim
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Kyung-Min Shin
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - So Mi Lee
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, Dongsan Hospital, College of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea
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Diffusion-weighted MRI for Early Prediction of Treatment Response on Preoperative Chemoradiotherapy for Patients With Locally Advanced Rectal Cancer: A Feasibility Study. Ann Surg 2016; 263:522-8. [PMID: 26106836 DOI: 10.1097/sla.0000000000001311] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study investigates the predictive value of diffusion-weighted magnetic resonance imaging (DW-MRI) for good pathological response at different time points during and after preoperative chemoradiotherapy (CRT) in locally advanced rectal cancer. BACKGROUND Preoperative CRT followed by total mesorectal excision (TME) is the standard of care for locally advanced rectal cancer. The use of standard radical surgery in good treatment responders after CRT is being questioned. METHODS Patients with locally advanced rectal adenocarcinoma were treated with preoperative CRT followed by surgery. DW-MRI scans were performed before CRT, during the third week of CRT, 4 weeks post-CRT and presurgery. Tumor apparent diffusion coefficient (ADC) values were acquired from the DW-MRI scans. After surgery the pathological tumor regression grade was assessed according to the classification by Mandard et al [Cancer. 1994;73:2680-2686]. Patients with pathological complete or near-complete response (tumor regression grade 1-2) were classified as good responders (GRs). RESULTS Twenty-two patients participated of which 9 were GRs (41%). Pre-CRT ADC values were lower in good versus moderate/poor responders (P = 0.04). ADC values during CRT and four weeks post-CRT were higher in GR. ADC values presurgery did not differ between response groups. For all time points the relative ADC increase (ΔADC) compared to the ADC pre-CRT was higher in GR (P < 0.001). The ΔADC during CRT and four weeks post-CRT were the best predictive parameters for pathological good response. CONCLUSIONS This study shows that DW-MRI is feasible to select good treatment responders during preoperative CRT for locally advanced rectal cancer.
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Blazic IM, Lilic GB, Gajic MM. Quantitative Assessment of Rectal Cancer Response to Neoadjuvant Combined Chemotherapy and Radiation Therapy: Comparison of Three Methods of Positioning Region of Interest for ADC Measurements at Diffusion-weighted MR Imaging. Radiology 2016; 282:418-428. [PMID: 27253423 DOI: 10.1148/radiol.2016151908] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To determine the impact of three different methods of region of interest (ROI) positioning for apparent diffusion coefficient (ADC) measurements on the assessment of complete response (CR) to neoadjuvant combined chemotherapy and radiation therapy (CRT) in patients with rectal cancer. Materials and Methods Institutional review board approval was obtained for this study; all patients gave written informed consent. ADCs were measured by two radiologists using three circular ROIs (three-ROIs), single-section (SS), and whole-tumor volume (WTV) methods in 62 patients with locally advanced rectal cancer on pre- and post-CRT images. Interobserver variability was analyzed by calculating intraclass correlation coefficient (ICC). Descriptive statistics and areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate performance in determining CR from pre- and post-CRT ADCs and ADC change. Histopathologic tumor regression grade was the reference standard. Results SS and WTV methods yielded higher AUCs than did the three-ROIs method when determining CR from post-CRT ADC (0.874 [95% confidence interval {CI}: 0.778, 0.970] and 0.886 [95% CI: 0.781, 0.990] vs 0.731 [95% CI: 0.583, 0.878], respectively; P = .033 and P = .003) and numeric change (0.892 [95% CI: 0.812, 0.972] and 0.897 [95% CI: 0.801, 0.994] vs 0.740 [95% CI: 0.591, 0.890], respectively; P = .048 and P = .0021). Respective accuracies of SS, WTV, and three-ROIs methods were 79% (49 of 62), 77% (48 of 62), and 61% (38 of 62) for post-CRT, 79% (49 of 62), 86% (53 of 62), and 60% (37 of 62) for numeric ADC change, and 77% (48 of 62), 84% (52 of 62), and 57% (35 of 62) for percentage ADC change (ADC cut-offs: 1.21, 1.30, and 1.05 × 10-3 mm2/sec, 0.33, 0.45, and 0.27 × 10-3 mm2/sec increases, and 40%, 54%, and 27% increases, respectively). Post-CRT and ADC change measurements achieved negative predictive values of 96% (44 of 46) to 100% (39 of 39). Intraobserver agreement was highest for WTV-derived ADCs (ICC, 0.742 [95% CI: 0.316, 0.892] to 0.891 [95% CI: 0.615, 0.956]) and higher for all pretreatment than posttreatment measurements (ICC, 0.761 [95% CI: 0.209, 0.930] and 0.648 [95% CI: 0.164, 0.895] for three-ROIs method, 0.608 [95% CI: 0.287, 0.844] and 0.582 [95% CI: 0.176, 0.870] for SS method, 0.891 [95% CI: 0.615, 0.956] and 0.742 for WTV method [95% CI: 0.316, 0.892]). Conclusion Tumor ADCs are highly dependent on the ROI positioning method used. Larger area measurements yield greater accuracy in response assessment. Post-CRT ADCs and values of ADC changes accurately identify noncomplete responders. WTV measurement of percentage ADC change provides the best results. © RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on September 19, 2016.
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Affiliation(s)
- Ivana M Blazic
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065-6007 (I.M.B.); Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia (G.B.L.); and Institute for Medical Statistics and Informatics, Belgrade, Serbia (M.M.G.)
| | - Gordana B Lilic
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065-6007 (I.M.B.); Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia (G.B.L.); and Institute for Medical Statistics and Informatics, Belgrade, Serbia (M.M.G.)
| | - Milan M Gajic
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065-6007 (I.M.B.); Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia (G.B.L.); and Institute for Medical Statistics and Informatics, Belgrade, Serbia (M.M.G.)
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Ippolito D, Drago SG, Franzesi CT, Fior D, Sironi S. Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion. World J Gastroenterol 2016; 22:4891-4900. [PMID: 27239115 PMCID: PMC4873881 DOI: 10.3748/wjg.v22.i20.4891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the diagnostic accuracy of multidetector-row computed tomography (MDCT) as compared with conventional magnetic resonance imaging (MRI), in identifying mesorectal fascia (MRF) invasion in rectal cancer patients. METHODS Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner (ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 mAs. Imaging data were reviewed as axial and as multiplanar reconstructions (MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images (DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed. RESULTS According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91 (41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged (45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant (P = 0.02). CONCLUSION New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.
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Blažić I, Maksimović R, Gajić M, Šaranović Đ. Apparent diffusion coefficient measurement covering complete tumor area better predicts rectal cancer response to neoadjuvant chemoradiotherapy. Croat Med J 2016; 56:460-9. [PMID: 26526883 PMCID: PMC4655931 DOI: 10.3325/cmj.2015.56.460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim To determine the impact of two apparent diffusion coefficient (ADC) measurement techniques on diffusion-weighted magnetic resonance images (DW MRI) on the assessment of rectal cancer response to neoadjuvant chemoradiotherapy (CRT). Methods ADC values were measured prospectively with two different techniques – the first, which measures ADCs in the most cellular tumor parts, and the second, which measures the entire tumor area, in 58 patients with locally advanced rectal cancer on pre-CRT and post-CRT image sets. Areas under the receiver operating characteristic curves (AUCs) and parameters of diagnostic accuracy were calculated for pre- and post-CRT ADC values and numeric and percent ADC change for each technique to determine their performance in tumor response evaluation using histopathological tumor-regression grade as the reference standard. Results The second technique yielded higher AUCs (0.935 vs 0.704, P < 0.001), percent-change (0.828 vs 0.636, P < 0.001), and numeric-change (0.866 vs 0.653, P < 0.001) than the first technique for post-CRT ADC. Accuracies for post-CRT ADC assessment were 62% for the first and 88% for the second technique (cut-off values: 0.98 and 1.29 × 10−3 mm2/s, respectively) and for ADC change assessment, both numeric and percent, 59% and 74%, respectively (cut-off values: increase of 0.18 and 0.28 × 10−3 mm2/s; increase of 24% and 37%, respectively). Conclusions The type of measurement technique significantly affected ADC results. ADC measurements covering a larger area better predicted tumor response to therapy. Post-CRT ADCs, regardless of the measurement technique, and numeric ADC change measured in the whole tumor volume accurately identified non-complete responders. Post-CRT ADCs measured in the entire tumor area yielded the highest accuracy level in tumor response evaluation.
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Affiliation(s)
- Ivana Blažić
- Ivana Blažić, 480 Main Street, New York 10044, NY, USA,
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Fu G, Zhu L, Yang K, Zhuang R, Xie J, Zhang F. Diffusion-Weighted Magnetic Resonance Imaging for Therapy Response Monitoring and Early Treatment Prediction of Photothermal Therapy. ACS APPLIED MATERIALS & INTERFACES 2016; 8:5137-47. [PMID: 26845246 PMCID: PMC6375691 DOI: 10.1021/acsami.5b11936] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Photothermal therapy (PTT) as a relatively new cancer treatment method has attracted worldwide attention. Previous research on PTT has focused on its therapy efficiency and selectivity. The early prognosis of PTT, which is pivotal for the assessment of the treatment and the therapy stratification, however, has been rarely studied. In the present study, we investigated diffusion-weighted magnetic resonance imaging (DW-MRI) as a tool for therapy monitoring and early prognosis of PTT. To this end, we injected PEGylated graphene oxide (GO-PEG) or iron oxide deposited graphene oxide (GO-IONP-PEG) to 4T1 tumor models and irradiated the tumors at different drug-light intervals to induce PTT. For GO-IONP-PEG injected animals, we also included therapy arms where an external magnetic field was applied to the tumors to improve the delivery of the nanoparticle transducers. DW-MRI was performed at different time points after PTT and the tumor apparent diffusion coefficients (ADCs) were analyzed and compared. Our studies show that photothermal agents, magnetic guidance, and drug-light intervals can all affect PTT treatment efficacy. Impressively, ADC value changes at early time points after PTT (less than 48 h) were found to be well-correlated with tumor growth suppression that was apparent days or weeks later. The changes were most sensitive to conditions that can extend the survival for more than 4 weeks, in which cases the 48 h ADC values were increased by more than 80%. These studies demonstrate for the first time that DW-MRI can be an accurate prognosis tool for PTT, suggesting an important role it can play in the future PTT evaluation and clinical translation of the modality.
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Affiliation(s)
- Guifeng Fu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, Fujian 361005, China
| | - Lei Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, Fujian 361005, China
| | - Kai Yang
- Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Institute of Functional Nano and Soft Materials Laboratory (FUNSOM), Soochow University, Suzhou, Jiangsu 215123, China
| | - Rongqiang Zhuang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, Fujian 361005, China
| | - Jin Xie
- Department of Chemistry, University of Georgia, Athens, United States
- Bio-Imaging Research Center, University of Georgia, Athens, United States
| | - Fan Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, Fujian 361005, China
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Meng X, Li H, Kong L, Zhao X, Huang Z, Zhao H, Zhu W, Li X, Yu J, Xing L. MRI In rectal cancer: Correlations between MRI features and molecular markers Ki-67, HIF-1α, and VEGF. J Magn Reson Imaging 2016; 44:594-600. [PMID: 26919464 DOI: 10.1002/jmri.25195] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 01/26/2023] Open
Affiliation(s)
- Xiangjiao Meng
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Huijuan Li
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Lingling Kong
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Xianguang Zhao
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Zhaoqin Huang
- Department of Radiology; Provincial Hospital Affiliated to Shandong University; Jinan Shandong China
| | - Hanxi Zhao
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Wanqi Zhu
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Xiaolin Li
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Jinming Yu
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Ligang Xing
- Department of Radiation Oncology of Shandong Cancer Hospital and Institute; Jinan Shandong China
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Sathyakumar K, Chandramohan A, Masih D, Jesudasan MR, Pulimood A, Eapen A. Best MRI predictors of complete response to neoadjuvant chemoradiation in locally advanced rectal cancer. Br J Radiol 2016; 89:20150328. [PMID: 26828967 DOI: 10.1259/bjr.20150328] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To identify the MRI parameters which best predict complete response (CR) to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC) and to assess their diagnostic performance. METHODS This was a prospective study of pre- and post-CRT MRI and diffusion-weighted imaging (DWI) of 64 patients with LARC who underwent neoadjuvant CRT and subsequent surgery. Histopathological tumour regression grade was the reference standard. Multivariate regression analysis was performed to identify the best MRI predictors of CR to neoadjuvant CRT, and their diagnostic performance was assessed. RESULTS The study cohort comprised 48 males and 16 females (n = 64), with mean age of 49.48 ± 14.3 years, range of 23-74 years. 11 patients had pathological complete response. The following factors predicted CR on univariate analysis: low initial (pre-CRT) tumour volume on T2 weighted high-resolution (HR) images and DWI, tumour volume-reduction rate (TVRR) of >95% on DWI and CR on post-CRT DWI (ydwiT0) as assessed by the radiologist. However, the best MRI predictors of CR on multivariate regression analysis were CR on post-CRT DWI (ydwiT0) as assessed by the radiologist and TVRR of >95% on DWI, and these parameters had an area under the curve (95% confidence interval) of 0.881 (0.74-1.0) and 0.843 (0.7-0.98), respectively. The sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of DWI in predicting CR was 81.8%, 94.3%, 75%, 96.1% and 76%; the sensitivity, specificity and accuracy of TVRR of >95% as a predictor of CR was 80%, 84.1% and 64.1%, respectively; however, this difference was not statistically significant. The interobserver agreement was substantial for ydwiT0. CONCLUSION Visual assessment of CR on post-CRT DWI and TVRR of >95% on DWI were the best predictors of CR after neoadjuvant CRT in patients with LARC, and the former being more practical can be used in daily practice. ADVANCES IN KNOWLEDGE In rectal cancer, ydwiT0 as assessed by the radiologist was the best and most practical imaging predictor of CR and scores over standard T2W HR images.
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Affiliation(s)
- Kirthi Sathyakumar
- 1 Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Dipti Masih
- 2 Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mark Ranjan Jesudasan
- 3 Department of General and Colorectal Surgery, Unit II, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anna Pulimood
- 2 Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu Eapen
- 1 Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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