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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

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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.

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Authors and Affiliations

  1. Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio”, Chieti, Italy

    Andrea Delli Pizzi, Roberta Cianci, Mauro Timpani, Alessandra Tavoletta, Pierluigi Pulsone, Raffaella Basilico, Daniela Gabrielli, Massimo Caulo & Antonella Filippone

  2. ITAB Institute of Advanced Biomedical Technologies, University “G. d’Annunzio”, Via Luigi Polacchi, 11 66100, Chieti, Italy

    Andrea Delli Pizzi & Massimo Caulo

  3. Radiation Oncology Unit, SS Annunziata Hospital, Chieti, Italy

    Domenico Genovesi, Consuelo Rosa, Luciana Caravatta & Monica Di Tommaso

  4. Ospedale “Pesenti Fenaroli”, Via Mazzini, 88 24022, Alzano Lombardo (BG), Italy

    Gianluigi Esposito

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  1. Andrea Delli Pizzi
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  2. Roberta Cianci
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Contributions

All authors were involved in patient management and wrote the report. Written consent to publication was obtained.

Corresponding author

Correspondence to Andrea Delli Pizzi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local institutional review board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Delli Pizzi, A., Cianci, R., Genovesi, D. et al. 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. Abdom Radiol 43, 2221–2230 (2018). https://doi.org/10.1007/s00261-018-1457-8

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  • DOI: https://doi.org/10.1007/s00261-018-1457-8

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