Skip to main content

Advertisement

SpringerLink
Log in

Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate DW MR tumour volumetry and post-CRT ADC in rectal cancer as predicting factors of CR using high b values to eliminate perfusion effects.

Methods

One hundred rectal cancer patients who underwent 1.5-T rectal MR and DW imaging using three b factors (0, 150, and 1,000 s/mm2) were enrolled. The tumour volumes of T2-weighted MR and DW images and pre- and post-CRT ADC150–1000 were measured. The diagnostic accuracy of post-CRT ADC, T2-weighted MR, and DW tumour volumetry was compared using ROC analysis.

Results

DW MR tumour volumetry was superior to T2-weighted MR volumetry comparing the CR and non-CR groups (P < 0.001). Post-CRT ADC showed a significant difference between the CR and non-CR groups (P = 0.001). The accuracy of DW tumour volumetry (Az = 0.910) was superior to that of T2-weighed MR tumour volumetry (Az = 0.792) and post-CRT ADC (Az = 0.705) in determining CR (P = 0.015). Using a cutoff value for the tumour volume reduction rate of more than 86.8 % on DW MR images, the sensitivity and specificity for predicting CR were 91.4 % and 80 %, respectively.

Conclusion

DW MR tumour volumetry after CRT showed significant superiority in predicting CR compared with T2-weighted MR images and post-CRT ADC.

Key Points

• Diffusion-weighted MR (DWMR) imaging offers new information about rectal cancer.

• DWMR helps to predict complete remission after chemoradiotherapy in patients with advanced rectal cancer.

• DWMR provides more accurate diagnostic information than T2-weighted MRI.

• Apparent diffusion coefficients can predict CR, but they have certain clinical limitations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

ADC:

Apparent diffusion coefficient

AUC (Az):

Area under the ROC curve

CR:

Complete response

CRT:

preoperative chemoradiation therapy

DW:

Diffusion weighted

ROC:

Receiver-operating characteristic

ROI:

Region of interest

SI:

Signal intensity

TV:

Tumour volume

References

  1. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  2. Bonnen M, Crane C, Vauthey JN, Skibber J, Delclos ME, Rodriguez-Bigas M, Hoff PM, Lin E, Eng C, Wong A, Janjan NA, Feig BW (2004) Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biol Phys 60:1098–1105

    Article  PubMed  Google Scholar 

  3. Borschitz T, Wachtlin D, Mohler M, Schmidberger H, Junginger T (2008) Neoadjuvant chemoradiation and local excision for T2–3 rectal cancer. Ann Surg Oncol 15:712–720

    Article  PubMed  Google Scholar 

  4. Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA (2003) A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 46:298–304

    Article  PubMed  Google Scholar 

  5. Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W, Paty PB, Weiser MR, Klimstra D, Saltz L, Minsky BD, Wong WD (2005) Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241:829–836, discussion 836–828

    Article  PubMed  Google Scholar 

  6. Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, Allen PK, Lynch PM, Glober G, Wolff R, Rich TA, Skibber J (1999) Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 44:1027–1038

    Article  PubMed  CAS  Google Scholar 

  7. Hartley A, Ho KF, McConkey C, Geh JI (2005) Pathological complete response following pre-operative chemoradiotherapy in rectal cancer: analysis of phase II/III trials. Br J Radiol 78:934–938

    Article  PubMed  CAS  Google Scholar 

  8. Kim SH, Lee JY, Lee JM, Han JK, Choi BI (2011) Apparent diffusion coefficient for evaluating tumour response to neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Eur Radiol 21:987–995

    Article  PubMed  Google Scholar 

  9. Hiotis SP, Weber SM, Cohen AM, Minsky BD, Paty PB, Guillem JG, Wagman R, Saltz LB, Wong WD (2002) Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients. J Am Coll Surg 194:131–135, discussion 135–136

    Article  PubMed  Google Scholar 

  10. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, Campos FG, Kiss DR, Gama-Rodrigues J (2004) Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240:711–717, discussion 717–718

    PubMed  Google Scholar 

  11. O’Neill BD, Brown G, Heald RJ, Cunningham D, Tait DM (2007) Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol 8:625–633

    Article  PubMed  Google Scholar 

  12. Curvo-Semedo L, Lambregts DM, Maas M, Thywissen T, Mehsen RT, Lammering G, Beets GL, Caseiro-Alves F, Beets-Tan RG (2011) Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy—conventional MR volumetry versus diffusion-weighted MR imaging. Radiology 260:734–743

    Article  PubMed  Google Scholar 

  13. Dzik-Jurasz A, Domenig C, George M, Wolber J, Padhani A, Brown G, Doran S (2002) Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet 360:307–308

    Article  PubMed  Google Scholar 

  14. Hein PA, Kremser C, Judmaier W, Griebel J, Pfeiffer KP, Kreczy A, Hug EB, Lukas P, DeVries AF (2003) Diffusion-weighted magnetic resonance imaging for monitoring diffusion changes in rectal carcinoma during combined, preoperative chemoradiation: preliminary results of a prospective study. Eur J Radiol 45:214–222

    Article  PubMed  Google Scholar 

  15. Kang JH, Kim YC, Kim H, Kim YW, Hur H, Kim JS, Min BS, Kim H, Lim JS, Seong J, Keum KC, Kim NK (2010) Tumor volume changes assessed by three-dimensional magnetic resonance volumetry in rectal cancer patients after preoperative chemoradiation: the impact of the volume reduction ratio on the prediction of pathologic complete response. Int J Radiat Oncol Biol Phys 76:1018–1025

    Article  PubMed  Google Scholar 

  16. Kim NK, Baik SH, Min BS, Pyo HR, Choi YJ, Kim H, Seong J, Keum KC, Rha SY, Chung HC (2007) A comparative study of volumetric analysis, histopathologic downstaging, and tumor regression grade in evaluating tumor response in locally advanced rectal cancer following preoperative chemoradiation. Int J Radiat Oncol Biol Phys 67:204–210

    Article  PubMed  Google Scholar 

  17. Kim YC, Lim JS, Keum KC, Kim KA, Myoung S, Shin SJ, Kim MJ, Kim NK, Suh J, Kim KW (2011) Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging 34:570–576

    Article  PubMed  Google Scholar 

  18. Kim YH, Kim DY, Kim TH, Jung KH, Chang HJ, Jeong SY, Sohn DK, Choi HS, Ahn JB, Kim DH, Lim SB, Lee JS, Park JG (2005) Usefulness of magnetic resonance volumetric evaluation in predicting response to preoperative concurrent chemoradiotherapy in patients with resectable rectal cancer. Int J Radiat Oncol Biol Phys 62:761–768

    Article  PubMed  Google Scholar 

  19. Lambregts DM, Vandecaveye V, Barbaro B, Bakers FC, Lambrecht M, Maas M, Haustermans K, Valentini V, Beets GL, Beets-Tan RG (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18:2224–2231

    Article  PubMed  Google Scholar 

  20. Maretto I, Pomerri F, Pucciarelli S, Mescoli C, Belluco E, Burzi S, Rugge M, Muzzio PC, Nitti D (2007) The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 14:455–461

    Article  PubMed  Google Scholar 

  21. Kim SH, Lee JM, Hong SH, Kim GH, Lee JY, Han JK, Choi BI (2009) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology 253:116–125

    Article  PubMed  Google Scholar 

  22. Lambregts DM, Cappendijk VC, Maas M, Beets GL, Beets-Tan RG (2011) Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer. Eur Radiol 21:1250–1258

    Article  PubMed  Google Scholar 

  23. Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H (2011) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology 260:771–780

    Article  PubMed  Google Scholar 

  24. Rao SX, Zeng MS, Chen CZ, Li RC, Zhang SJ, Xu JM, Hou YY (2008) The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection. Eur J Radiol 65:299–303

    Article  PubMed  Google Scholar 

  25. Padhani AR, Liu G, Koh DM, Chenevert TL, Thoeny HC, Takahara T, Dzik-Jurasz A, Ross BD, Van Cauteren M, Collins D, Hammoud DA, Rustin GJ, Taouli B, Choyke PL (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11:102–125

    PubMed  CAS  Google Scholar 

  26. Sun YS, Cui Y, Tang L, Qi LP, Wang N, Zhang XY, Cao K, Zhang XP (2011) Early evaluation of cancer response by a new functional biomarker: apparent diffusion coefficient. AJR Am J Roentgenol 197:W23–W29

    Article  PubMed  Google Scholar 

  27. Babourina-Brooks B, Cowin GJ, Wang D (2012) Diffusion-weighted imaging in the prostate: an apparent diffusion coefficient comparison of half-Fourier acquisition single-shot turbo spin-echo and echo planar imaging. Magn Reson Imaging 30:189–194

    Article  PubMed  Google Scholar 

  28. Barajas RF Jr, Hodgson JG, Chang JS, Vandenberg SR, Yeh RF, Parsa AT, McDermott MW, Berger MS, Dillon WP, Cha S (2010) Glioblastoma multiforme regional genetic and cellular expression patterns: influence on anatomic and physiologic MR imaging. Radiology 254:564–576

    Article  PubMed  Google Scholar 

  29. Costantini M, Belli P, Rinaldi P, Bufi E, Giardina G, Franceschini G, Petrone G, Bonomo L (2010) Diffusion-weighted imaging in breast cancer: relationship between apparent diffusion coefficient and tumour aggressiveness. Clin Radiol 65:1005–1012

    Article  PubMed  CAS  Google Scholar 

  30. Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 12:19–23

    Article  PubMed  CAS  Google Scholar 

  31. Sun YS, Zhang XP, Tang L, Ji JF, Gu J, Cai Y, Zhang XY (2010) Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted MR imaging for early detection of tumor histopathologic downstaging. Radiology 254:170–178

    Article  PubMed  Google Scholar 

  32. Lambregts DM, Beets GL, Maas M, Curvo-Semedo L, Kessels AG, Thywissen T, Beets-Tan RG (2011) Tumour ADC measurements in rectal cancer: effect of ROI methods on ADC values and interobserver variability. Eur Radiol 21:2567–2574

    Article  PubMed  Google Scholar 

  33. Suppiah A, Hunter IA, Cowley J, Garimella V, Cast J, Hartley JE, Monson JR (2009) Magnetic resonance imaging accuracy in assessing tumour down-staging following chemoradiation in rectal cancer. Colorectal Dis 11:249–253

    Article  PubMed  CAS  Google Scholar 

  34. Koh DM, Collins DJ, Orton MR (2011) Intravoxel incoherent motion in body diffusion-weighted MRI: reality and challenges. AJR Am J Roentgenol 196:1351–1361

    Article  PubMed  Google Scholar 

  35. Kim SY, Lee SS, Byun JH, Park SH, Kim JK, Park B, Kim N, Lee MG (2010) Malignant hepatic tumors: short-term reproducibility of apparent diffusion coefficients with breath-hold and respiratory-triggered diffusion-weighted MR imaging. Radiology 255:815–823

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This article was presented as a scientific paper at the RSNA 97th Scientific Assembly and Annual Meeting (2011 RSNA).

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Hong Il Ha, Ah Young Kim, Seong Ho Park & Hyun Kwon Ha

  2. Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, 896 Pyeonchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Korea

    Hong Il Ha

  3. Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 138-736, Korea

    Chang Sik Yu

Authors
  1. Hong Il Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ah Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chang Sik Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seong Ho Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyun Kwon Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ah Young Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ha, H.I., Kim, A.Y., Yu, C.S. et al. Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy. Eur Radiol 23, 3345–3353 (2013). https://doi.org/10.1007/s00330-013-2936-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-013-2936-5

Keywords

Search

Navigation