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Performance of diffusion-weighted imaging, perfusion imaging, and texture analysis in predicting tumoral response to neoadjuvant chemoradiotherapy in rectal cancer patients studied with 3T MR: initial experience

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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the performance of texture analysis (TA), diffusion-weighted imaging, and perfusion MR (pMRI) in predicting tumoral response in patients treated with neoadjuvant chemoradiotherapy (CRT).

Methods

12 consecutive patients (8 females, 4 males, 63.2 ± 13.4 years) with rectal cancer were prospectively enrolled, and underwent pre-treatment 3T MRI. Treatment protocol consisted of neoadjuvant CRT with oxaliplatin and 5-fluorouracile. Unenhanced T2-weighted images TA (kurtosis), apparent diffusion coefficient (ADC), and pMRI parameters (Ktrans, Kep, Ve, IAUGC) were quantified by manually delineating a region of interest around the tumor outline. After CRT, all patients underwent complete surgical resection and the surgical specimen served as the gold standard. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminatory power of each quantitative parameter to predict complete response.

Results

Pathological complete response (pCR) was reported in six patients and partial response (PR) in three patients. Three patients were classified as non-responders (NR). Pre-treatment kurtosis was significantly lower in the pCR sub-group in comparison with PR + NR (p = .01). Among ADC and pMRI parameters, only Ve was significantly lower in the pCR sub-group compared with PR + NR (p = .01). A significant negative correlation between kurtosis and ADC (r = −0.650, p = .022) was observed. Pre-treatment area under the ROC curves (AUC), to discriminate between pCR and PR + NR, was significantly higher for kurtosis (0.861, p = .001) and Ve (0.861, p = .003) compared to all other parameters. The optimal cutoff value for pre-treatment kurtosis and Ve was ≤0.19 (100% sensitivity, 67% specificity) and ≤0.311 (83% sensitivity, 83% specificity), respectively.

Conclusion

Pre-treatment kurtosis derived from T2w images and Ve from pMRI have the potential to act as imaging biomarkers of rectal cancer response to neoadjuvant CRT.

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Acknowledgments

This study was funded by AIRC (Associazione Italiana per la Ricerca sul Cancro), Investigator Grant 2013/14129.

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Authors and Affiliations

  1. Diagnostic Imaging Unit, Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, University of Rome “Sapienza” - Polo Pontino, Latina, Italy

    Carlo N. De Cecco, Maria Ciolina, Damiano Caruso, Marco Rengo & Andrea Laghi

  2. Department of Radiology, Medical University of South Carolina, Charleston, SC, USA

    Carlo N. De Cecco

  3. Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, Sussex, United Kingdom

    Balaji Ganeshan

  4. Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany

    Felix G. Meinel

  5. Department of Radiotherapy, University of Rome “Sapienza”, Rome, Italy

    Daniela Musio, Francesca De Felice & Vincenzo Tombolini

Authors
  1. Carlo N. De Cecco
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  2. Maria Ciolina
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  3. Damiano Caruso
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  4. Marco Rengo
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  5. Balaji Ganeshan
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  6. Felix G. Meinel
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  7. Daniela Musio
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  8. Francesca De Felice
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  9. Vincenzo Tombolini
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  10. Andrea Laghi
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Corresponding author

Correspondence to Andrea Laghi.

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Conflict of interest

B. Ganeshan is a director, part-time employee, and shareholder of Feedback Plc (Cambridge, England, UK), company that develops and markets the TexRAD texture analysis algorithm described in this manuscript. The other authors declare that they have no conflict of interest.

Ethical approval

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.

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De Cecco, C.N., Ciolina, M., Caruso, D. et al. Performance of diffusion-weighted imaging, perfusion imaging, and texture analysis in predicting tumoral response to neoadjuvant chemoradiotherapy in rectal cancer patients studied with 3T MR: initial experience. Abdom Radiol 41, 1728–1735 (2016). https://doi.org/10.1007/s00261-016-0733-8

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  • DOI: https://doi.org/10.1007/s00261-016-0733-8

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