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Three-dimension amide proton transfer MRI of rectal adenocarcinoma: correlation with pathologic prognostic factors and comparison with diffusion kurtosis imaging

  • Gastrointestinal
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Abstract

Objectives

To investigate the utility of 3D amide proton transfer (APT) MRI in predicting pathologic factors for rectal adenocarcinoma, in comparison with diffusion kurtosis imaging.

Methods

Sixty-one patients with rectal adenocarcinoma were enrolled in this prospective study. 3D APT and diffusion kurtosis imaging (DKI) were performed. Mean APT-weighted signal intensity (APTw SI), mean kurtosis (MK), mean diffusivity (MD), and ADC values of tumors were calculated on these maps. Pathological analysis included WHO grades, pT stages, pN stages, and extramural venous invasion (EMVI) status. Student’s t test, Spearman correlation, and receiver operating characteristics (ROC) analysis were used for statistical analysis.

Results

High-grade rectal adenocarcinoma showed significantly higher mean APTw SI and MK values (2.771 ± 0.384 vs 2.108 ± 0.409, 1.167 ± 0.216 vs 1.045 ± 0.175, respectively; p < 0.05). T3 rectal adenocarcinoma demonstrated higher mean APTw SI and MK than T2 tumors (2.433 ± 0.467 vs 1.900 ± 0.302, p < 0.05). No kurtosis, diffusivity, and ADC differences were found between T2 and T3 tumors. Tumors with lymph node metastasis and EMVI involvement showed significantly higher mean APTw SI, MK. No difference was found in diffusivity and ADC between pN0 and pN1-2 groups, and EMVI-negative and EMVI-positive statuses. Mean APTw SI exhibited a significantly high positive correlation with WHO grades, demonstrating 92.31% sensitivity and 79.17% specificity for distinguishing low- from high-grade rectal adenocarcinoma, providing a better diagnostic capacity than MK, MD, and mean ADC values.

Conclusion

3D-APT could serve as a non-invasive biomarker for evaluating prognostic factors of rectal adenocarcinoma.

Key Points

• Mean APTw SI was significantly higher in high-grade compared to low-grade rectal adenocarcinoma.

• Mean APTw SI was significantly higher in T3 stage rectal adenocarcinoma, with lymph node metastasis, or in EMVI-positive status.

• APTw SI exhibited greater diagnostic capability in discriminating low-grade from high-grade rectal adenocarcinoma, compared with kurtosis, diffusivity, and ADC.

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Abbreviations

ADC:

Apparent diffusion coefficient

APT:

Amide proton transfer

APTw:

Amide proton transfer weighted

AUC:

Area under the curve

CEST:

Chemical exchange saturation transfer

DKI:

Diffusion kurtosis imaging

DWI:

Diffusion-weighted imaging

EMVI:

Extramural vascular invasion

ROC:

Receiver operating characteristic

ROI:

Region of interest

SD:

Standard deviation

WHO:

World Health Organization

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Funding

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Author notes

  1. Weicui Chen and Ling Li contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade road, Xuexiu District, Guangzhou, 510120, China

    Weicui Chen, Ling Li, Zhaoxian Yan, Jieping Feng, Guoqing Liu, Bo Liu & Xian Liu

  2. Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade road, Xuexiu District, Guangzhou, 510120, China

    Shaowei Hu

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  1. Weicui Chen
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Correspondence to Xian Liu.

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The scientific guarantor of this publication is Xian Liu Ph.D., M.D.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects in this study.

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• retrospective

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Chen, W., Li, L., Yan, Z. et al. Three-dimension amide proton transfer MRI of rectal adenocarcinoma: correlation with pathologic prognostic factors and comparison with diffusion kurtosis imaging. Eur Radiol 31, 3286–3296 (2021). https://doi.org/10.1007/s00330-020-07397-1

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  • DOI: https://doi.org/10.1007/s00330-020-07397-1

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