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Abdominal Radiology

, Volume 43, Issue 9, pp 2221–2230 | Cite as

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

  • Andrea Delli Pizzi
  • Roberta Cianci
  • Domenico Genovesi
  • Gianluigi Esposito
  • Mauro Timpani
  • Alessandra Tavoletta
  • Pierluigi Pulsone
  • Raffaella Basilico
  • Daniela Gabrielli
  • Consuelo Rosa
  • Luciana Caravatta
  • Monica Di Tommaso
  • Massimo Caulo
  • Antonella Filippone
Article

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

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

Notes

Author contributions

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

Compliance with ethical standards

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Andrea Delli Pizzi
    • 1
    • 2
  • Roberta Cianci
    • 1
  • Domenico Genovesi
    • 3
  • Gianluigi Esposito
    • 4
  • Mauro Timpani
    • 1
  • Alessandra Tavoletta
    • 1
  • Pierluigi Pulsone
    • 1
  • Raffaella Basilico
    • 1
  • Daniela Gabrielli
    • 1
  • Consuelo Rosa
    • 3
  • Luciana Caravatta
    • 3
  • Monica Di Tommaso
    • 3
  • Massimo Caulo
    • 1
    • 2
  • Antonella Filippone
    • 1
  1. 1.Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio”ChietiItaly
  2. 2.ITAB Institute of Advanced Biomedical Technologies, University “G. d’Annunzio”ChietiItaly
  3. 3.Radiation Oncology UnitSS Annunziata HospitalChietiItaly
  4. 4.Ospedale “Pesenti Fenaroli”Alzano Lombardo (BG)Italy

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