Magnetic resonance imaging in locally advanced rectal cancer: quantitative evaluation of the complete response to neoadjuvant therapy

Tarallo, Nicola; Angeretti, Maria Gloria; Bracchi, Elena; Xhepa, Genti; Molinelli, Valeria; Tagliaferri, Chiara; Antognoni, Paolo; Novario, Raffaele; Sessa, Fausto; Fugazzola, Carlo

doi:10.5114/pjr.2018.81156

Cited by 8 publications

(6 citation statements)

References 39 publications

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“…Study characteristics and methodological details are shown in Tables 1 and 2 and Supplemental Tables 4–10 (Supplemental material available online). Combined, 19 studies investigated T2-mrTRG (25–43), 39 studies investigated DW-MRI (25,32,37,44–79), 13 studies investigated PW-MRI (80…”

Section: Resultsmentioning

confidence: 99%

“…In total, 26 studies reported data on the diagnostic performance of DW-MRI (Supplemental Table 5) (25,37,(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)64,(73)(74)(75)(76)(77)(78)(79). The studies were divided into three groups of distinctly separate imaging analysis: a qualitative diffusion group comprising data from seven studies (25,44,45,(47)(48)(49)74), a quantitative ADC post group In the qualitative diffusion group, the studies performed a visual assessment of the diffusion restriction in the tumor region after nCRT.…”

Section: Adc After Chemoradiotherapymentioning

confidence: 99%

“…Six studies reported data on the diagnostic performance of DW-MRI with ΔADC (Supplemental Table 6) (46,57,(60)(61)(62)75). The PPV and NPV of ΔADC to detect ypCR were in the range of 35%-77% and 79%-96%, Predicting combined stages of moderate to marked tumor regression.…”

Section: Delta Apparent Diffusion Coefficientmentioning

confidence: 99%

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Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature

2021

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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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Section: Resultsmentioning

confidence: 99%

Section: Adc After Chemoradiotherapymentioning

confidence: 99%

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Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature

2021

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“…The possibility that ADC may be associated with the nCRT response has been amply investigated in LARC[ 8 - 12 ]; however, significant correlations have not been found in any studies to date[ 10 ]. Inconsistencies in previous findings may be due to a lack of standardized imaging and acquisition techniques[ 5 , 11 ], but they may also be due to the fact that the ADC measurements were performed using a manually drawn region of interest (ROI) from a single slice of the ADC map, which holds limited ability to reflect the actual whole-tumor characteristics[ 13 - 15 ].…”

Section: Introductionmentioning

confidence: 99%

Whole lesion histogram analysis of apparent diffusion coefficient predicts therapy response in locally advanced rectal cancer

Santos¹,

Reyes-Pérez²,

Osorio³

et al. 2022

WJG

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BACKGROUND Whole-tumor apparent diffusion coefficient (ADC) histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy (nCRT) response in patients with locally advanced rectal cancer (LARC). AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC. METHODS This is a single-center, retrospective study, which included 48 patients with LARC. All patients underwent a pre-treatment magnetic resonance imaging (MRI) scan for primary tumor staging and a second restaging MRI for response evaluation. The sample was distributed as follows: 18 responder patients (R) and 30 non-responders (non-R). Eight parameters derived from the whole-lesion histogram analysis (ADCmean, skewness, kurtosis, and ADC10 th , 25 th , 50 th , 75 th , 90 th percentiles), as well as the ADCmean from the hot spot region of interest (ROI), were calculated for each patient before and after treatment. Then all data were compared between R and non-R using the Mann-Whitney U test. Two measures of diagnostic accuracy were applied: the receiver operating characteristic curve and the diagnostic odds ratio (DOR). We also reported intra- and interobserver variability by calculating the intraclass correlation coefficient (ICC). RESULTS Post-nCRT kurtosis, as well as post-nCRT skewness, were significantly lower in R than in non-R (both P < 0.001, respectively). We also found that, after treatment, R had a larger loss of both kurtosis and skewness than non-R (∆%kurtosis and ∆skewness, P < 0.001). Other parameters that demonstrated changes between groups were post-nCRT ADC10 th , ∆%ADC10 th , ∆%ADCmean, and ROI ∆%ADCmean. However, the best diagnostic performance was achieved by ∆%kurtosis at a threshold of 11.85% (Area under the receiver operating characteristic curve [AUC] = 0.991, DOR = 376), followed by post-nCRT kurtosis = 0.78 × 10 -3 mm 2 /s (AUC = 0.985, DOR = 375.3), ∆skewness = 0.16 (AUC = 0.885, DOR = 192.2) and post-nCRT skewness = 1.59 × 10 -3 mm 2 /s (AUC = 0.815, DOR = 168.6). Finally, intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement, ensuring the implementation of histogram analysis into routine clinical practice. CONCLUSION Whole-tumor ADC histogram parameters, particularly kurtosis and skewness, are relevant biomarkers for predicting the nCRT response in LARC. Both parameters appear to be more reliable than ADCmean from one-slice ROI.

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“…One of the latest advancements in MRI technology, the apparent diffusion coefficient (ADC), which is obtained from diffusion-weighted imaging (DWI), has been proposed to increase the specificity of MRI in the evaluation of treatment response after nCTR ( 6 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer

Santos

Reyes-Pérez

Sandoval-Nava

et al. 2020

Acta Radiologica Open

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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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Magnetic resonance imaging in locally advanced rectal cancer: quantitative evaluation of the complete response to neoadjuvant therapy

Cited by 8 publications

References 39 publications

Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature

Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature

Whole lesion histogram analysis of apparent diffusion coefficient predicts therapy response in locally advanced rectal cancer

The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer

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