Diffusion-Weighted Magnetic Resonance Imaging for Predicting and Detecting the Early Response to Chemoradiotherapy of Advanced Esophageal Squamous Cell Carcinoma

Abstract

Background: The aim of this study was to investigate the utility of the apparent diffusion coefficient (ADC) value in diffusion-weighted magnetic resonance imaging (DWMRI) for prediction and early detection of treatment response in advanced esophageal squamous cell carcinoma. Method: DWMRI was performed in 27 patients with primary cT4 esophageal carcinoma that were undergoing chemoradiotherapy before treatment and after 20 and 40 Gy. We calculated tumor ADCs and association of the treatment effect between responders and nonresponders. Results: The ADC at the time of 20 Gy was significantly higher in responders compared to nonresponders (1.13 vs. 0.93; p = 0.005). The ADC cut-off value was set at 1.00 × 10^-3 mm²/s and the ADC predicted the responders with a sensitivity, positive predictive value and accuracy of 79, 73 and 74%, respectively. The increased rate of the ADC at the time of 20 Gy (ΔADC20) was also significantly higher in responders compared to nonresponders (35.4 vs. 1.5%; p = 0.0007). An ADC cut-off value for ΔADC20 of 15% predicted the responders with a sensitivity, positive predictive value and accuracy of 71, 100 and 85%, respectively. Conclusion: The ADC values predicted the prognosis of patients with advanced esophageal squamous cell carcinoma as well as the treatment response.

Prediction of clinical outcome after stereotactic body radiotherapy for non-small cell lung cancer using diffusion-weighted MRI and 18F-FDG PET

“…Liu et al reported the percentage ADC value change after 1 month correlated positively with size reduction after 2 months of chemoradiation in 17 patients with cervical cancer [27]. Another study reported the ADC value at the time of 20 Gy was significantly higher in responders compared to nonresponders in 27 patients with primary clinical T4 oesophageal carcinoma treated with chemoradiation [31]. We are planning a study to evaluate usefulness of DW-MRI in evaluation of the tumour response after SBRT and in distinction of treatment-related change from recurrence.…”

Preoperative apparent diffusion coefficient value of gastric cancer by diffusion‐weighted imaging: Correlations with postoperative TNM staging

“…In recent years, MRI is increasingly used in the diagnosis and staging of gastric cancers . In particular, diffusion weighted imaging (DWI), which reflects the mobility of water molecules in vivo and is noninvasively quantified by apparent diffusion coefficient (ADC) values, has been investigated in various tumors …”

“…[3][4][5][6][7] In particular, diffusion weighted imaging (DWI), which reflects the mobility of water molecules in vivo and is noninvasively quantified by apparent diffusion coefficient (ADC) values, has been investigated in various tumors. 8,9 Several studies have confirmed the value of DWI in detection 10 and characterization 11 of gastric cancers. MR imaging with DWI can increase the sensitivity and accuracy in TNM Classification of Malignant Tumors (TNM) staging of gastric cancers, 12,13 especially in T staging.…”

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

“…Although MRI of the oesophagus is technically more challenging, owing to oesophageal motility and motion of the surrounding heart and diaphragm, advances in technology now enable the acquisition of high‐resolution magnetic resonance (MR) images. Previous studies on response prediction with MRI in oesophageal cancer focused on quantitative diffusion‐weighted (DW) MRI parameters. However, visual response assessment on T2‐weighted (T2W) and functional DW‐MRI in rectal cancer yielded higher sensitivity for detecting residual tumour compared with quantitative assessment.…”