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Abdom Radiol (NY). 2018 Sep;43(9):2221-2230. doi: 10.1007/s00261-018-1457-8.

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.

Author information

1
Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy. andreadellipizzi@gmail.com.
2
ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy. andreadellipizzi@gmail.com.
3
Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.
4
Radiation Oncology Unit, SS Annunziata Hospital, Chieti, Italy.
5
Ospedale "Pesenti Fenaroli", Via Mazzini, 88 24022, Alzano Lombardo (BG), Italy.
6
ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy.

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.

KEYWORDS:

Chemoradiation treatment response; Complete responders; Diffusion-weighted imaging; Locally advanced rectal cancer; Magnetic resonance

PMID:
29332248
DOI:
10.1007/s00261-018-1457-8
[Indexed for MEDLINE]

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