Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2020; 26(20): 2657-2668
Published online May 28, 2020. doi: 10.3748/wjg.v26.i20.2657
Role of dynamic perfusion magnetic resonance imaging in patients with local advanced rectal cancer
Davide Ippolito, Silvia Girolama Drago, Anna Pecorelli, Cesare Maino, Giulia Querques, Ilaria Mariani, Cammillo Talei Franzesi, Sandro Sironi
Davide Ippolito, Silvia Girolama Drago, Anna Pecorelli, Cesare Maino, Giulia Querques, Ilaria Mariani, Cammillo Talei Franzesi, Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
Sandro Sironi, Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital, University of Milano-Bicocca, Bergamo 20110, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Institutional review board statement: The study was ethically approved by the San Gerardo Hospital Ethics Committee.
Clinical trial registration statement: This study is registered at “San Gerardo Hospital” trial registry. The registration identification number is EP 15673/19.
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.
Data sharing statement: There are no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Davide Ippolito, MD, Adjunct Professor, Staff Physician, Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza 20900, Italy.
Received: January 14, 2020
Peer-review started: January 14, 2020
First decision: February 29, 2020
Revised: April 30, 2020
Accepted: May 13, 2020
Article in press: May 13, 2020
Published online: May 28, 2020
Research background

The management of rectal cancer patients is mainly based on the use of the magnetic resonance imaging (MRI) technique as a diagnostic tool for both staging and restaging. After treatment, to date, the evaluation of complete response is based on the histopathology assessment by using different tumor regression grade features (e.g., Dworak or Mandard classifications). While from the radiological point of view, the main attention for the prediction of a complete response after chemo-radiotherapy (CRT) focuses on MRI and the potential role of diffusion-weighted images and perfusion imaging represented by dynamic-contrast enhanced MRI (DCE-MRI). The main aim is to find a reliable tool to predict tumor response in comparison to histopathologic findings.

Research motivation

DCE-MRI is considered an important tool in the assessment of rectal adenocarcinoma because it permits to obtain important information about tumor vascularization quantitatively.

Research objectives

This study investigated the diagnostic role of DCE-MRI, in patients with rectal carcinoma who underwent chemoradiation therapy, as a complementary functional diagnostic tool in the assessment of the response of patients with rectal cancer after CRT, in comparison with standard histopathological analysis.

Research methods

This is an analysis of the evaluation of the response of patients with biopsy-proven rectal adenocarcinoma after chemoradiation therapy, who underwent DCE-MRI.

Research results

Semiquantitative perfusion parameters demonstrated higher values in the tumor tissue than in the healthy tissue. More important, after chemoradiation therapy, those patients that responded to therapy showed lower perfusion values in residual tumor tissue than those who did not respond.

Research conclusions

Dynamic contrast MRI represents a complementary diagnostic tool in identifying vascularity characteristics of local advanced rectal cancer, before and after chemoradiation treatment.

Research perspectives

To strengthen our results, further studies should include a wider cohort of patients, by using pathological correlation as a gold standard.