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Yu H, Hai Y, Lu J. Exploratory high b value diffusion-weighted MR for quantitative differentiation of ileocecal inflammatory conditions and tumors. Insights Imaging 2025; 16:41. [PMID: 39962029 PMCID: PMC11833009 DOI: 10.1186/s13244-025-01916-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 01/28/2025] [Indexed: 02/20/2025] Open
Abstract
OBJECTIVES To explore the quantitative analysis of high b value (2000 s/mm2) diffusion-weighted imaging (DWI) for the differentiation of ileocecal inflammatory conditions and tumors, compared with conventional b value (800 s/mm2) DWI. METHODS Sixty-six patients with 30 tumors and 36 inflammatory conditions underwent MR enterography with conventional and high b values DWI. Quantitative apparent diffusion coefficient (ADC) values and signal intensity ratios (SIRs) of lesions of the psoas muscle were measured from the two b value DWIs. The receiver operating characteristic (ROC) curve was applied to determine the diagnostic value of ADC and SIR for differentiating tumors from inflammatory conditions. RESULTS The ADC values of tumors were significantly lower than those of inflammatory conditions in 800 s/mm2 (p = 0.001) and 2000 s/mm2 (p < 0.001) DWI. In addition, tumors exhibited significantly higher SIR values compared to inflammatory conditions (p < 0.001 in 800 s/mm2 and 2000 s/mm2 DWI). Areas under the curve (AUC) of ADC and SIR derived from high b value (0.828 for ADC, 0.947 for SIR) were superior to those from conventional b value DWI (0.731 and 0.849, respectively). Compared to ADC, SIR values achieved better AUCs in both two b values DWI. CONCLUSIONS Quantitative ADC values and SIR could be used as non-invasive tools to distinguish ileocecal tumors from inflammatory conditions. The use of high b value DWI would improve this ability. Furthermore, SIR obtained from high b value DWI was the most promising quantitative parameter. CRITICAL RELEVANCE STATEMENT This study indicated that quantitative DWI parameters might be applied as non-invasive imaging biomarkers for distinguishing bowel tumors from inflammatory conditions. The SIR from high b value DWI could improve the differentiation, providing invaluable information for establishing appropriate therapeutic strategies. KEY POINTS Differentiation between bowel inflammatory conditions and tumors is still a dilemma. Quantitative DWI contributed to distinguishing ileocecal tumors from inflammatory conditions. SIR from DWI is a promising parameter for differentiating these pathologies.
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Affiliation(s)
- Hao Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Yucheng Hai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyu Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chen W, Wei Q, Huang W, Chen J, Hu S, Lv X, Mao L, Liu B, Zhou W, Liu X. Combining diffusion kurtosis imaging and clinical data for predicting the extramural venous invasion of rectal adenocarcinoma. Eur J Radiol 2022; 148:110155. [DOI: 10.1016/j.ejrad.2022.110155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/23/2021] [Accepted: 01/06/2022] [Indexed: 11/28/2022]
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3
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Nougaret S, Rousset P, Gormly K, Lucidarme O, Brunelle S, Milot L, Salut C, Pilleul F, Arrivé L, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Rullier E, Cotte E, Rouanet P, Beets-Tan RGH, Frulio N, Hoeffel C. Structured and shared MRI staging lexicon and report of rectal cancer: A consensus proposal by the French Radiology Group (GRERCAR) and Surgical Group (GRECCAR) for rectal cancer. Diagn Interv Imaging 2022; 103:127-141. [PMID: 34794932 DOI: 10.1016/j.diii.2021.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To develop French guidelines by experts to standardize data acquisition, image interpretation, and reporting in rectal cancer staging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and opinions of experts of GRERCAR (Groupe de REcherche en Radiologie sur le CAncer du Rectum [i.e., Rectal Cancer Imaging Research Group]) and GRECCAR (Groupe de REcherche en Chirurgie sur le CAncer du Rectum [i.e., Rectal Cancer Surgery Research Group]) were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts scoring of reporting template and protocol for data acquisition were collected; responses were analyzed and classified as "Recommended" versus "Not recommended" (when ≥ 80% consensus among experts) or uncertain (when < 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 staging with MRI.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, Lyon 1 Claude-Bernard University, 69495 Pierre-Benite, France
| | - Kirsten Gormly
- Dr Jones & Partners Medical Imaging, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, 69495 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Cécile Salut
- Department of Radiology, CHU de Bordeaux, 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
| | - Lionel Arrivé
- Department of Radiology, Hopital St Antoine, Paris, France
| | - Constance Hordonneau
- Department of Radiology, CHU Estaing, Université Clermont-Auvergne, 63000 Clermont-Ferrand, 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 de Paris, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes Cedex, France
| | - Valérie Laurent
- Department of Radiology, Brabois-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, 06100 Nice, France
| | - Eric Rullier
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33600 Pessac, 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
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX, Amsterdam, the Netherlands
| | - Nora Frulio
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
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4
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Park IJ. Watch and wait strategies for rectal cancer A systematic review. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2021.00177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tibermacine H, Rouanet P, Sbarra M, Forghani R, Reinhold C, Nougaret S. Radiomics modelling in rectal cancer to predict disease-free survival: evaluation of different approaches. Br J Surg 2021; 108:1243-1250. [PMID: 34423347 DOI: 10.1093/bjs/znab191] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/11/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Radiomics may be useful in rectal cancer management. The aim of this study was to assess and compare different radiomics approaches over qualitative evaluation to predict disease-free survival (DFS) in patients with locally advanced rectal cancer treated with neoadjuvant therapy. METHODS Patients from a phase II, multicentre, randomized study (GRECCAR4; NCT01333709) were included retrospectively as a training set. An independent cohort of patients comprised the independent test set. For both time points and both sets, radiomic features were extracted from two-dimensional manual segmentation (MS), three-dimensional (3D) MS, and from bounding boxes. Radiomics predictive models of DFS were built using a hyperparameters-tuned random forests classifier. Additionally, radiomics models were compared with qualitative parameters, including sphincter invasion, extramural vascular invasion as determined by MRI (mrEMVI) at baseline, and tumour regression grade evaluated by MRI (mrTRG) after chemoradiotherapy (CRT). RESULTS In the training cohort of 98 patients, all three models showed good performance with mean(s.d.) area under the curve (AUC) values ranging from 0.77(0.09) to 0.89(0.09) for prediction of DFS. The 3D radiomics model outperformed qualitative analysis based on mrEMVI and sphincter invasion at baseline (P = 0.038 and P = 0.027 respectively), and mrTRG after CRT (P = 0.017). In the independent test cohort of 48 patients, at baseline and after CRT the AUC ranged from 0.67(0.09) to 0.76(0.06). All three models showed no difference compared with qualitative analysis in the independent set. CONCLUSION Radiomics models can predict DFS in patients with locally advanced rectal cancer.
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Affiliation(s)
- H Tibermacine
- Radiology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - P Rouanet
- Surgical Oncology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - M Sbarra
- Departmental Faculty of Medicine and Surgery, Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - R Forghani
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - C Reinhold
- Augmented Intelligence and Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - S Nougaret
- Radiology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
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6
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Zunder SM, Perez-Lopez R, de Kok BM, Raciti MV, van Pelt GW, Dienstmann R, Garcia-Ruiz A, Meijer CA, Gelderblom H, Tollenaar RA, Nuciforo P, Wasser MN, Mesker WE. Correlation of the tumour-stroma ratio with diffusion weighted MRI in rectal cancer. Eur J Radiol 2020; 133:109345. [PMID: 33120239 DOI: 10.1016/j.ejrad.2020.109345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/06/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study evaluated the correlation between intratumoural stroma proportion, expressed as tumour-stroma ratio (TSR), and apparent diffusion coefficient (ADC) values in patients with rectal cancer. METHODS This multicentre retrospective study included all consecutive patients with rectal cancer, diagnostically confirmed by biopsy and MRI. The training cohort (LUMC, Netherlands) included 33 patients and the validation cohort (VHIO, Spain) 69 patients. Two observers measured the mean and minimum ADCs based on single-slice and whole-volume segmentations. The TSR was determined on diagnostic haematoxylin & eosin stained slides of rectal tumour biopsies. The correlation between TSR and ADC was assessed by Spearman correlation (rs). RESULTS The ADC values between stroma-low and stroma-high tumours were not significantly different. Intra-class correlation (ICC) demonstrated a good level of agreement for the ADC measurements, ranging from 0.84-0.86 for single slice and 0.86-0.90 for the whole-volume protocol. No correlation was observed between the TSR and ADC values, with ADCmeanrs= -0.162 (p= 0.38) and ADCminrs= 0.041 (p= 0.82) for the single-slice and rs= -0.108 (p= 0.55) and rs= 0.019 (p= 0.92) for the whole-volume measurements in the training cohort, respectively. Results from the validation cohort were consistent; ADCmeanrs= -0.022 (p= 0.86) and ADCminrs = 0.049 (p= 0.69) for the single-slice and rs= -0.064 (p= 0.59) and rs= -0.063 (p= 0.61) for the whole-volume measurements. CONCLUSIONS Reproducibility of ADC values is good. Despite positive reports on the correlation between TSR and ADC values in other tumours, this could not be confirmed for rectal cancer.
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Affiliation(s)
- Stéphanie M Zunder
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Raquel Perez-Lopez
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - Bente M de Kok
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Maria Vittoria Raciti
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Rodrigo Dienstmann
- Department of Oncology Data Science, Vall d'Hebron Institute of Oncology, Cellex Center, Natzaret 115-117 08035 Barcelona, Spain
| | - Alonso Garcia-Ruiz
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - C Arnoud Meijer
- Department of Radiology, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Paolo Nuciforo
- Department of Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Cellex Center, Natzaret 115-117 08035 Barcelona, Spain
| | - Martin N Wasser
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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7
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López-Campos F, Martín-Martín M, Fornell-Pérez R, García-Pérez JC, Die-Trill J, Fuentes-Mateos R, López-Durán S, Domínguez-Rullán J, Ferreiro R, Riquelme-Oliveira A, Hervás-Morón A, Couñago F. Watch and wait approach in rectal cancer: Current controversies and future directions. World J Gastroenterol 2020; 26:4218-4239. [PMID: 32848330 PMCID: PMC7422545 DOI: 10.3748/wjg.v26.i29.4218] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/25/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
According to the main international clinical guidelines, the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. However, doubts have been raised about the appropriate definition of clinical complete response (cCR) after neoadjuvant therapy and the role of surgery in patients who achieve a cCR. Surgical resection is associated with significant morbidity and decreased quality of life (QoL), which is especially relevant given the favourable prognosis in this patient subset. Accordingly, there has been a growing interest in alternative approaches with less morbidity, including the organ-preserving watch and wait strategy, in which surgery is omitted in patients who have achieved a cCR. These patients are managed with a specific follow-up protocol to ensure adequate cancer control, including the early identification of recurrent disease. However, there are several open questions about this strategy, including patient selection, the clinical and radiological criteria to accurately determine cCR, the duration of neoadjuvant treatment, the role of dose intensification (chemotherapy and/or radiotherapy), optimal follow-up protocols, and the future perspectives of this approach. In the present review, we summarize the available evidence on the watch and wait strategy in this clinical scenario, including ongoing clinical trials, QoL in these patients, and the controversies surrounding this treatment approach.
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Affiliation(s)
- Fernando López-Campos
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | | | - Roberto Fornell-Pérez
- Department of Radiology, Hospital Universitario de Basurto, Bilbao 48013, Vizcaya, Spain
| | | | - Javier Die-Trill
- Department of Surgery, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Raquel Fuentes-Mateos
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Sergio López-Durán
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - José Domínguez-Rullán
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Reyes Ferreiro
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | | | - Asunción Hervás-Morón
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28003, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Universidad Europea de Madrid (UEM), Madrid 28223, Spain
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8
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Diffusion-weighted magnetic resonance imaging of mucin pools in locally advanced rectal mucinous adenocarcinoma predicts tumor response to neoadjuvant therapy. Eur J Radiol 2020; 125:108890. [DOI: 10.1016/j.ejrad.2020.108890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 12/16/2022]
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9
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Nougaret S, Castan F, de Forges H, Vargas HA, Gallix B, Gourgou S, Rouanet P. Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial. Br J Surg 2019; 106:1530-1541. [PMID: 31436325 DOI: 10.1002/bjs.11233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tailored neoadjuvant treatment of locally advanced rectal cancer (LARC) may improve outcomes. The aim of this study was to determine early MRI prognostic parameters with which to stratify neoadjuvant treatment in patients with LARC. METHODS All patients from a prospective, phase II, multicentre randomized study (GRECCAR4; NCT01333709) were included, and underwent rectal MRI before treatment, 4 weeks after induction chemotherapy and after completion of chemoradiotherapy (CRT). Tumour volumetry, MRI tumour regression grade (mrTRG), T and N categories, circumferential resection margin (CRM) status and extramural vascular invasion identified by MRI (mrEMVI) were evaluated. RESULTS A total of 133 randomized patients were analysed. Median follow-up was 41·4 (95 per cent c.i. 36·6 to 45·2) months. Thirty-one patients (23·3 per cent) developed tumour recurrence. In univariable analysis, mrEMVI at baseline was the only prognostic factor associated with poorer outcome (P = 0·015). After induction chemotherapy, a larger tumour volume on MRI (P = 0·019), tumour volume regression of 60 per cent or less (P = 0·002), involvement of the CRM (P = 0·037), mrEMVI (P = 0·026) and a poor mrTRG (P = 0·023) were associated with poor outcome. After completion of CRT, the absence of complete response on MRI (P = 0·004), mrEMVI (P = 0·038) and a poor mrTRG (P = 0·005) were associated with shorter disease-free survival. A final multivariable model including all significant variables (baseline, after induction, after CRT) revealed that Eastern Cooperative Oncology Group performance status (P = 0·011), sphincter involvement (P = 0·009), mrEMVI at baseline (P = 0·002) and early tumour volume regression of 60 per cent or less after induction (P = 0·007) were associated with relapse. CONCLUSION Baseline and early post-treatment MRI parameters are associated with prognosis in LARC. Future preoperative treatment should stratify treatment according to baseline mrEMVI status and early tumour volume regression.
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Affiliation(s)
- S Nougaret
- Department of Radiology, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier, Institut National de la Santé et de la Recherche Médicale, U1194, Montpellier, France
| | - F Castan
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - H de Forges
- Clinical Research Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - H A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - B Gallix
- Department of Radiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Gourgou
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - P Rouanet
- Department of Surgical Oncology, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
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Brown PJ, Hyland R, Quyn AJ, West NP, Sebag-Montefiore D, Jayne D, Sagar P, Tolan DJ. Current concepts in imaging for local staging of advanced rectal cancer. Clin Radiol 2019; 74:623-636. [PMID: 31036310 DOI: 10.1016/j.crad.2019.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/22/2019] [Indexed: 12/20/2022]
Abstract
Imaging of rectal cancer has an increasingly pivotal role in the diagnosis, staging, and treatment stratification of patients with the disease. This is particularly true for advanced rectal cancers where magnetic resonance imaging (MRI) findings provide essential information that can change treatment. In this review we describe the rationale for the current imaging standards in advanced rectal cancer for both morphological and functional imaging on the baseline staging and reassessment studies. In addition the clinical implications and future methods by which radiologists may improve these are outlined relative to TNM8.
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Affiliation(s)
- P J Brown
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - R Hyland
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - A J Quyn
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - N P West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Welcome Trust Brenner Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D Sebag-Montefiore
- Department of Clinical Oncology, Bexley Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - D Jayne
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - P Sagar
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - D J Tolan
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
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11
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Grishko PY, Balyasnikova SS, Samsonov DV, Mishchenko AV, Karachun AM, Pravosudov IV. Contemporary view to the principles of rectal cancer diagnostics and treatment according to MRI (literature review). MEDICAL VISUALIZATION 2019:7-26. [DOI: 10.24835/1607-0763-2019-2-7-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
In this article are reviewed the most recent diagnostic methods for patients with probable and verified rectal cancer, in different stages of treatment. The importance of high quality visualization of rectal cancer, opportunities of magnetic resonance imaging in primary diagnosis and restaging of the disease after neoadjuvant chemotherapy, optimal examination methods and interpretation of images in routine are discussed.
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Affiliation(s)
- P. Yu. Grishko
- National Medical Research Center of Oncology named after N. N. Petrov
| | - S. S. Balyasnikova
- National Medical Research Center of Oncology named after N. N. Petrov; The Royal Marsden Hospital, NHS Foundation Trust, Downs Road; Imperial College London
| | - D. V. Samsonov
- National Medical Research Center of Oncology named after N. N. Petrov
| | - A. V. Mishchenko
- National Medical Research Center of Oncology named after N. N. Petrov
| | - A. M. Karachun
- National Medical Research Center of Oncology named after N. N. Petrov
| | - I. V. Pravosudov
- National Medical Research Center of Oncology named after N. N. Petrov
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Li F, Zhang W, Li J, Zhu X, Chen H, Wu Y, Wang J. The clinical application value of MR diffusion-weighted imaging in the diagnosis of rectal cancer: A retrospective study. Medicine (Baltimore) 2018; 97:e13732. [PMID: 30572512 PMCID: PMC6319922 DOI: 10.1097/md.0000000000013732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The present study evaluated the clinical potential of magnetic resonance (MR) diffusion-weighted imaging (DWI) in the diagnosis of rectal cancer.A total of 84 patients confirmed with rectal cancer were used as study subjects in the present study. All patients received conventional sequence MR T1WI, T2WI, and DWI examination as well as operative pathological examination. The differences between the MRI results and operative pathological results were analyzed.The diagnosis accordance rates of conventional sequence examination in stage T1, T2, T3, and T4 were 60.00%, 82.75%, 62.85%, and 80.00%, respectively. The diagnosis accordance rates of conventional sequence combined with DWI examination in stages T1, T2, T3, and T4 were 100.00%, 100.00%, 82.85%, and 100.00% respectively. The total diagnosis accordance rates in the T staging of rectal cancer with conventional (Routinely or generally applied) sequence examination and conventional sequence combined with DWI examination were 71.42% and 92.85%, respectively.The analysis on consistency of MR conventional sequence examination suggested that the conventional sequence combined with DWI examination is more consistent with pathological staging when compared with the convention sequence examination alone. MR DWI combined with conventional sequences reveals quite good accuracy in the T staging of rectal cancer.
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Guo L, Zhang L, Zhao J. CT scan and magnetic resonance diffusion-weighted imaging in the diagnosis and treatment of esophageal cancer. Oncol Lett 2018; 16:7117-7122. [PMID: 30546446 PMCID: PMC6256330 DOI: 10.3892/ol.2018.9532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/06/2018] [Indexed: 12/11/2022] Open
Abstract
Value of computed tomography (CT) scan and diffusion-weighted imaging (DWI) in the diagnosis and treatment of esophageal cancer was investigated. Seventy-eight patients with esophageal cancer treated in Jinan Central Hospital (Jinan, China) from January 2013 to June 2014 were selected. All patients underwent CT scan and DWI examination, and their clinical history data were analyzed. DWI was conducted. The short-term curative effect and the 3-year survival rate of patients in the high apparent diffusion coefficient (ADC) value group and the low ADC value group were compared; ADC values in the complete remission (CR) group and the partial remission (PR) group were compared. The difference in value between the length of esophageal lesions and the length of pathological specimens measured by CT scan was significantly different from that detected via DWI examination with b=600, 800 and 1,000 sec/mm2, respectively (P<0.05). The diagnostic rate of esophageal cancer via CT scan was significantly lower than that via DWI examination (P<0.05). After radiotherapy, the clinical control rate in the high ADC value group was significantly higher than that in the low ADC value group, and the 3-year survival rate in the former was significantly higher than that in the latter (P<0.05). In the 2nd week during radiotherapy and at the end of radiotherapy, the ADC values in the CR group were significantly higher than those in the PR group (P<0.05). In the 2nd week during radiotherapy and at the end of radiotherapy, ADC values were used to predict the CR rate of radiotherapy for esophageal cancer, and the areas under the receiver operating characteristic (ROC) curve were 0.776 and 0.935, respectively. Compared with CT scan, DWI has higher diagnostic rate and higher sensitivity. The length of esophageal tumor measured by DWI is close to that of pathological entity, which can guide the delineation of the target area of esophageal cancer.
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Affiliation(s)
- Lei Guo
- Department of MRI, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Liulong Zhang
- Department of Radiology, Dongying People's Hospital, Dongying, Shandong 257091, P.R. China
| | - Jianshe Zhao
- Department of Radiology, Jinan Children's Hospital, Jinan, Shandong 250022, P.R. China
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Chen J, Hua H, Pang J, Shi X, Bi W, Li Y, Xu W. The Value of Diffusion-Weighted Magnetic Resonance Imaging in Predicting the Efficacy of Radiation and Chemotherapy in Cervical Cancer. Open Life Sci 2018; 13:305-311. [PMID: 33817097 PMCID: PMC7874687 DOI: 10.1515/biol-2018-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/08/2018] [Indexed: 01/22/2023] Open
Abstract
Background To analyze the application value of apparent diffusion coefficient (ADC) and exponent apparent diffusion coefficient (EADC) in evaluating the efficacy of radiation and chemotherapy in cervical cancer using pre- and posttreatment diffusion-weighted magnetic resonance imaging (DW-MRI) scans. Methods 52 patients with cervical cancer were administered radiation and chemotherapy. Both MRI and DW-MRI were obtained at different stages. The ADC and EADC values, as well as the maximum tumor diameter, were measured and analyzed. Results We found that the ADC value increased after treatment, and the EADC value decreased. Changes in the calculated ADC occurred earlier than the morphologic changes of the tumors. A negative correlation was detected between reduced rates in the maximum tumor diameter two months after treatment and pretreatment ADC value (r = –0.658, P < 0.05). An ROC curve and nonlinear regression analysis showed that the formula, y = (1525500.122x2 – 4689.962x + 3.482) × 100%, can be used to calculate the percentage of complete remission after treatment according to the pretreatment ADC value. Conclusion Our data suggest that pretreatment ADC and EADC values are predictive of the efficacy of radiation and chemotherapy. Both ADC and EADC values during treatment were instrumental in early monitoring and dynamic observation.
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Affiliation(s)
- Jingjing Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Hui Hua
- Department of Thyroid Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jing Pang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xianglong Shi
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Weiqun Bi
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Yingduan Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Wenjian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 266000, Shandong Province, China
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Patel UB, Blomqvist L, Chau I, Nicholls J, Brown G. Session 3: Beyond TME and radiotherapy MRI evaluation of rectal cancer treatment response. Colorectal Dis 2018; 20 Suppl 1:76-81. [PMID: 29878685 DOI: 10.1111/codi.14084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance imaging plays an increasingly important role in evaluating the effect of cancer treatment. Imaging alone cannot predict pathological complete response and imaging interpretation should be combined with clinical information and endoscopy findings to predict complete response. Professor Blomqvist reviews current and future imaging techniques and whether the quantitative can add significant or important prognostic information over the current qualitative techniques.
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Affiliation(s)
- U B Patel
- London North-West HealthCare NHS Trust, London, UK
| | | | - I Chau
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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Prezzi D, Goh V. Rectal Cancer Magnetic Resonance Imaging: Imaging Beyond Morphology. Clin Oncol (R Coll Radiol) 2015; 28:83-92. [PMID: 26586163 DOI: 10.1016/j.clon.2015.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/13/2015] [Indexed: 12/16/2022]
Abstract
Magnetic resonance imaging (MRI) has in recent years progressively established itself as one of the most valuable modalities for the diagnosis, staging and response assessment of rectal cancer and its use has largely focused on accurate morphological assessment. The potential of MRI, however, extends beyond detailed anatomical depiction: aspects of tissue physiology, such as perfusion, oxygenation and water molecule diffusivity, can be assessed indirectly. Functional MRI is rapidly evolving as a promising non-invasive assessment tool for tumour phenotyping and assessment of response to new therapeutic agents. In spite of promising experimental data, the evidence base for the application of functional MRI techniques in rectal cancer remains modest, reflecting the relatively poor agreement on technical protocols, image processing techniques and quantitative methodology to date, hampering routine integration into clinical management. This overview outlines the established strengths and the critical limitations of anatomical MRI in rectal cancer; it then introduces some of the functional MRI techniques and quantitative analysis methods that are currently available, describing their applicability in rectal cancer and reviewing the relevant literature; finally, it introduces the concept of a multi-parametric quantitative approach to rectal cancer.
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Affiliation(s)
- D Prezzi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - V Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Cho SH, Kim GC, Jang YJ, Ryeom H, Kim HJ, Shin KM, Park JS, Choi GS, Kim SH. Locally advanced rectal cancer: post-chemoradiotherapy ADC histogram analysis for predicting a complete response. Acta Radiol 2015; 56:1042-50. [PMID: 25270374 DOI: 10.1177/0284185114550193] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/13/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND The value of diffusion-weighted imaging (DWI) for reliable differentiation between pathologic complete response (pCR) and residual tumor is still unclear. Recently, a few studies reported that histogram analysis can be helpful to monitor the therapeutic response in various cancer research. PURPOSE To investigate whether post-chemoradiotherapy (CRT) apparent diffusion coefficient (ADC) histogram analysis can be helpful to predict a pCR in locally advanced rectal cancer (LARC). MATERIAL AND METHODS Fifty patients who underwent preoperative CRT followed by surgery were enrolled in this retrospective study, non-pCR (n = 41) and pCR (n = 9), respectively. ADC histogram analysis encompassing the whole tumor was performed on two post-CRT ADC600 and ADC1000 (b factors 0, 600 vs. 0, 1000 s/mm(2)) maps. Mean, minimum, maximum, SD, mode, 10th, 25th, 50th, 75th, 90th percentile ADCs, skewness, and kurtosis were derived. Diagnostic performance for predicting pCR was evaluated and compared. RESULTS On both maps, 10th and 25th ADCs showed better diagnostic performance than that using mean ADC. Tenth percentile ADCs revealed the best diagnostic performance on both ADC600 (AZ 0.841, sensitivity 100%, specificity 70.7%) and ADC1000 (AZ 0.821, sensitivity 77.8%, specificity 87.8%) maps. In comparison between 10th percentile and mean ADC, the specificity was significantly improved on both ADC600 (70.7% vs. 53.7%; P = 0.031) and ADC1000 (87.8% vs. 73.2%; P = 0.039) maps. CONCLUSION Post-CRT ADC histogram analysis is helpful for predicting pCR in LARC, especially, in improving the specificity, compared with mean ADC.
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Affiliation(s)
- Seung Hyun Cho
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yun-Jin Jang
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hunkyu Ryeom
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kyung-Min Shin
- Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, Dongsan Hospital, College of Medicine, Keimyung University, Daegu, Republic of Korea
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The value of liver-based standardized uptake value and other quantitative 18F-FDG PET-CT parameters in neoadjuvant therapy response in patients with locally advanced rectal cancer: correlation with histopathology. Nucl Med Commun 2015; 36:898-907. [PMID: 25969176 DOI: 10.1097/mnm.0000000000000342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM We aimed to investigate the value of PET-CT in therapy response and the correlation of quantitative PET parameters with histopathologic results in patients with locally advanced rectal cancer (LARC) before and after neoadjuvant chemoradiotherapy. We also analyzed the correlation of PET-CT parameters between Ki-67 and glucose transporter 1 (GLUT1). PATIENTS AND METHODS A total of 29 patients diagnosed with LARC who had undergone a biopsy between 2009 and 2012 were included in our study. Quantitative PET parameters [standardized uptake value (SUV)max-mean, lean body mass SUV(max-mean), tumor/liver SUV, retention index , and [INCREMENT]SUV(max)] were measured before and after therapy using PET-CT. Tumor regression grade (TRG) was evaluated according to Wheeler's classification. Patients in grade 1 were considered responders, whereas patients at grades 2 and 3 were considered nonresponders. Immunohistochemical staining with Ki-67 and GLUT1 was performed on biopsy and surgical specimens. The correlation between staining ratios and SUV was also investigated. RESULTS SUV parameters were significantly decreased after therapy (P < 0.001). Twelve (41%) patients were at TRG1, 10 (35%) were at TRG2, and seven (24%) were at TRG3. A cutoff SUV(max) of 5.05 to discriminate between responders and nonresponders after treatment revealed a sensitivity of 57%, specificity of 73%, negative predictive value of 65%, positive predictive value of 67%, and accuracy of 66%. Using a cutoff of 3.55 for the SUV(mean) (standardized measurement of SUV with 1.2-cm-diameter region of interest) revealed a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 67, 76, 67, 76, and 72%, respectively. For a cutoff of 1.95 for the tumor SUV(mean)/liver SUV(mean), these diagnostic values after therapy were 73, 78, 82, 67, and 76%, respectively. We found a moderate correlation between liver-based SUV(max) (r = -0.35, P = 0.019) and SUV(mean )(r = -0.31, P = 0.036) with GLUT1 after therapy. Quantitative PET parameters and retention index were moderately correlated with Ki-67. CONCLUSION PET-CT is a useful method for assessing the response to neoadjuvant chemoradiotherapy in patients with LARC. The most significant parameter for assessing treatment response using SUV parameters is the tumor/liver ratio.
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Arya S, Das D, Engineer R, Saklani A. Imaging in rectal cancer with emphasis on local staging with MRI. Indian J Radiol Imaging 2015; 25:148-161. [PMID: 25969638 PMCID: PMC4419424 DOI: 10.4103/0971-3026.155865] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Imaging in rectal cancer has a vital role in staging disease, and in selecting and optimizing treatment planning. High-resolution MRI (HR-MRI) is the recommended method of first choice for local staging of rectal cancer for both primary staging and for restaging after preoperative chemoradiation (CT-RT). HR-MRI helps decide between upfront surgery and preoperative CT-RT. It provides high accuracy for prediction of circumferential resection margin at surgery, T category, and nodal status in that order. MRI also helps assess resectability after preoperative CT-RT and decide between sphincter saving or more radical surgery. Accurate technique is crucial for obtaining high-resolution images in the appropriate planes for correct staging. The phased array external coil has replaced the endorectal coil that is no longer recommended. Non-fat suppressed 2D T2-weighted (T2W) sequences in orthogonal planes to the tumor are sufficient for primary staging. Contrast-enhanced MRI is considered inappropriate for both primary staging and restaging. Diffusion-weighted sequence may be of value in restaging. Multidetector CT cannot replace MRI in local staging, but has an important role for evaluating distant metastases. Positron emission tomography-computed tomography (PET/CT) has a limited role in the initial staging of rectal cancer and is reserved for cases with resectable metastatic disease before contemplating surgery. This article briefly reviews the comprehensive role of imaging in rectal cancer, describes the role of MRI in local staging in detail, discusses the optimal MRI technique, and provides a synoptic report for both primary staging and restaging after CT-RT in routine practice.
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Affiliation(s)
- Supreeta Arya
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Deepak Das
- Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Furey E, Jhaveri KS. Magnetic Resonance Imaging in Rectal Cancer. Magn Reson Imaging Clin N Am 2014; 22:165-90, v-vi. [DOI: 10.1016/j.mric.2014.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Biagioli MC, Herman JM. Preoperative endorectal brachytherapy in the treatment of locally advanced rectal cancer: Rethinking neoadjuvant treatment. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Diffusion-weighted magnetic resonance application in response prediction before, during, and after neoadjuvant radiochemotherapy in primary rectal cancer carcinoma. BIOMED RESEARCH INTERNATIONAL 2013; 2013:740195. [PMID: 23936841 PMCID: PMC3722900 DOI: 10.1155/2013/740195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/24/2013] [Indexed: 01/22/2023]
Abstract
Introduction. Our interest was to monitor treatment response using ADC value to predict response of rectal tumour to preoperative radiochemotherapy. Materials and Methods. Twenty-two patients were treated with long course of radiochemotherapy, followed by surgery. Patients were examined by diffusion-weighted imaging MRI at three-time points (prior, during, and after radiochemotherapy) and were classified as responders and nonresponders. Results. A statistical significant correlation was found between preradiochemotherapy ADC values and during treatment ADC values, in responders (F = 21.50, P value <0.05). An increase in ADC value during treatment was predictive of at least a partial response. Discussion. Response of tumour to neoadjuvant therapy cannot be easily evaluated, and such capability might be of great importance in clinical practice, because the number of irradiated and operated patients may be superior to the number of who will really benefit from this multimodal treatment. A reliable prediction of the final clinical TN stage would allow radiotherapist to adapt multidisciplinary approach to a less invasive management, sparing surgical procedure in responder patients or even allowing an early surgery in nonresponders, which would significantly reduce radiochemotherapy related toxicity. Conclusion. Early evaluation of response during neoadjuvant radiochemotherapy treatment shows great promise to predict tumour response.
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