European Radiology

, Volume 24, Issue 11, pp 2962–2970 | Cite as

Simple measurements on diffusion-weighted MR imaging for assessment of complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

  • Pei-Qiang Cai
  • Yao-Pan Wu
  • Xin An
  • Xue Qiu
  • Ling-Heng Kong
  • Guo-Chen Liu
  • Chuan-Miao Xie
  • Zhi-Zhong Pan
  • Pei-Hong Wu
  • Pei-Rong Ding
Magnetic Resonance



To determine diagnostic performance of simple measurements on diffusion-weighted MR imaging (DWI) for assessment of complete tumour response (CR) after neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC) by signal intensity (SI) and apparent diffusion coefficient (ADC) measurements.

Materials and methods

Sixty-five patients with LARC who underwent neoadjuvant CRT and subsequent surgery were included. Patients underwent pre-CRT and post-CRT 3.0 T MRI. Regions of interest of the highest brightness SI were included in the tumour volume on post-CRT DWI to calculate the SIlesion, rSI, ADClesion and rADC; diagnostic performance was compared by using the receiver operating characteristic (ROC) curves. In order to validate the accuracy and reproducibility of the current strategy, the same procedure was reproduced in 80 patients with LARC at 1.5 T MRI.


Areas under the ROC curve for identification of a CR, based on SIlesion, rSI, ADClesion, and rADC, respectively, were 0.86, 0.94, 0.66, and 0.71 at 3.0 T MRI, and 0.92, 0.91, 0.64, and 0.61 at 1.5 T MRI.


Post-CRT DWI SIlesion and rSI provided high diagnostic performance in assessing CR and were significantly more accurate than ADClesion, and rADC at 3.0 T MRI and 1.5 T MRI.

Key Points

Signal intensity (SI lesion ) and rSI are accurate for assessment of complete response.

rSI seems to be superior to SI lesion at 3.0 T MRI.

ADC or rADC measurements are not accurate for assessment of complete response.


DWI Signal Intensity Complete Response Chemoradiotherapy Locally Advanced Rectal Cancer 



Diffusion-weighted MR imaging


Signal intensity


Apparent diffusion coefficient


Complete response


Locally advanced rectal cancer



The scientific guarantor of this publication is Pei-Rong Ding. 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. This study has received funding by Nature Science Foundation of China [No. 81101591]; Natural Science Foundation of Guangdong Province, China [No.S2011040005278; No.9151008901000157]; Science and Technology Planning Project of Guangdong Province, China [No.2010B060900043]; and Medical Scientific Research Foundation of Guangdong Province, China (WSTJJ20101107440520197505093916). One (Pei-Rong Ding) of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was not required for this study because it is a retrospective analysis. Approval from the institutional animal care committee was not required because the study is not on animals. The study subjects or cohorts have not been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Pei-Qiang Cai, Yao-Pan Wu and Xin An contributed equally to this work.


  1. 1.
    Maas M et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11(9):835–844PubMedCrossRefGoogle Scholar
  2. 2.
    Tulchinsky H et al (2008) An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 15(10):2661–2667PubMedCrossRefGoogle Scholar
  3. 3.
    de Campos-Lobato LF et al (2011) Neoadjuvant therapy for rectal cancer: the impact of longer interval between chemoradiation and surgery. J Gastrointest Surg 15(3):444–450PubMedCrossRefGoogle Scholar
  4. 4.
    Wolthuis AM et al (2012) Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol 19(9):2833–2841PubMedCrossRefGoogle Scholar
  5. 5.
    Rodel C et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23(34):8688–8696PubMedCrossRefGoogle Scholar
  6. 6.
    Valentini V et al (2002) Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys 53(3):664–674PubMedCrossRefGoogle Scholar
  7. 7.
    Govindarajan A et al (2006) Population-based assessment of the surgical management of locally advanced colorectal cancer. J Natl Cancer Inst 98(20):1474–1481PubMedCrossRefGoogle Scholar
  8. 8.
    Guillem JG et al (2005) Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241(5):829–836, discussion 836-8PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Marijnen CA et al (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20(3):817–825PubMedCrossRefGoogle Scholar
  10. 10.
    Larsen SG et al (2008) Prognostic factors after preoperative irradiation and surgery for locally advanced rectal cancer. Eur J Surg Oncol 34(4):410–417PubMedCrossRefGoogle Scholar
  11. 11.
    Habr-Gama A et al (2006) Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 10(10):1319–1328, discussion 1328-9PubMedCrossRefGoogle Scholar
  12. 12.
    O'Neill BD et al (2007) Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol 8(7):625–633PubMedCrossRefGoogle Scholar
  13. 13.
    Borschitz T et al (2008) Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol 15(3):712–720PubMedCrossRefGoogle Scholar
  14. 14.
    Dalton RS et al (2012) A single-centre experience of chemoradiotherapy for rectal cancer: is there potential for nonoperative management? Color Dis 14(5):567–571CrossRefGoogle Scholar
  15. 15.
    Maas M et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29(35):4633–4640PubMedCrossRefGoogle Scholar
  16. 16.
    Barbaro B et al (2010) Restaging locally advanced rectal cancer with MR imaging after chemoradiation therapy. Radiographics 30(3):699–716PubMedCrossRefGoogle Scholar
  17. 17.
    Chen CC et al (2005) How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum 48(4):722–728PubMedCrossRefGoogle Scholar
  18. 18.
    Maretto I et al (2007) The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 14(2):455–461PubMedCrossRefGoogle Scholar
  19. 19.
    Kim SH et al (2009) Accuracy of MRI for predicting the circumferential resection margin, mesorectal fascia invasion, and tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging 29(5):1093–1101PubMedCrossRefGoogle Scholar
  20. 20.
    Dresen RC et al (2009) Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part I. Are we able to predict tumor confined to the rectal wall? Radiology 252(1):71–80PubMedCrossRefGoogle Scholar
  21. 21.
    Curvo-Semedo L et al (2011) Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy–conventional MR volumetry versus diffusion-weighted MR imaging. Radiology 260(3):734–743PubMedCrossRefGoogle Scholar
  22. 22.
    Kim SH et al (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(1):116–125PubMedCrossRefGoogle Scholar
  23. 23.
    Lambregts DM et al (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18(8):2224–2231PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Vandecaveye V et al (2007) Detection of head and neck squamous cell carcinoma with diffusion weighted MRI after (chemo)radiotherapy: correlation between radiologic and histopathologic findings. Int J Radiat Oncol Biol Phys 67(4):960–971PubMedCrossRefGoogle Scholar
  25. 25.
    Mandard AM et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 73(11):2680–2686PubMedCrossRefGoogle Scholar
  26. 26.
    Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70(4):213–220PubMedCrossRefGoogle Scholar
  27. 27.
    DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3):837–845PubMedCrossRefGoogle Scholar
  28. 28.
    Engin G et al (2012) Can diffusion-weighted MRI determine complete responders after neoadjuvant chemoradiation for locally advanced rectal cancer? Diagn Interv Radiol 18(6):574–581PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Pei-Qiang Cai
    • 1
    • 2
  • Yao-Pan Wu
    • 1
    • 2
  • Xin An
    • 1
    • 3
  • Xue Qiu
    • 1
    • 4
  • Ling-Heng Kong
    • 1
    • 4
  • Guo-Chen Liu
    • 1
    • 4
  • Chuan-Miao Xie
    • 1
    • 2
  • Zhi-Zhong Pan
    • 1
    • 4
  • Pei-Hong Wu
    • 1
    • 2
  • Pei-Rong Ding
    • 1
    • 4
  1. 1.State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer MedicineSun Yat-Sen University Cancer CenterGuangzhouPeoples Republic of China
  2. 2.Department of Medical Imaging & Interventional RadiologyGuangzhouPeoples Republic of China
  3. 3.Department of Medical OncologyGuangzhouPeoples Republic of China
  4. 4.Department of Colorectal SurgerySun Yat-sen University Cancer CenterGuangzhouPeoples Republic of China

Personalised recommendations