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European Radiology

, Volume 28, Issue 12, pp 5231–5240 | Cite as

T2-weighted signal intensity-selected volumetry for prediction of pathological complete response after preoperative chemoradiotherapy in locally advanced rectal cancer

  • Sungwon Kim
  • Kyunghwa Han
  • Nieun Seo
  • Hye Jin Kim
  • Myeong-Jin Kim
  • Woong Sub Koom
  • Joong Bae Ahn
  • Joon Seok LimEmail author
Gastrointestinal

Abstract

Objectives

To evaluate the diagnostic value of signal intensity (SI)-selected volumetry findings in T2-weighted magnetic resonance imaging (MRI) as a potential biomarker for predicting pathological complete response (pCR) to preoperative chemoradiotherapy (CRT) in patients with rectal cancer.

Methods

Forty consecutive patients with pCR after preoperative CRT were compared with 80 age- and sex-matched non-pCR patients in a case-control study. SI-selected tumor volume was measured on post-CRT T2-weighted MRI, which included voxels of the treated tumor exceeding the SI (obturator internus muscle SI + [ischiorectal fossa fat SI – obturator internus muscle SI] × 0.2). Three blinded readers independently rated five-point pCR confidence scores and compared the diagnostic outcome with SI-selected volumetry findings. The SI-selected volumetry protocol was validated in 30 additional rectal cancer patients.

Results

The area under the receiver-operating characteristic curve (AUC) of SI-selected volumetry for pCR prediction was 0.831, with an optimal cutoff value of 649.6 mm3 (sensitivity 0.850, specificity 0.725). The AUC of the SI-selected tumor volume was significantly greater than the pooled AUC of readers (0.707, p < 0.001). At this cutoff, the validation trial yielded an accuracy of 0.87.

Conclusion

SI-selected volumetry in post-CRT T2-weighted MRI can help predict pCR after preoperative CRT in patients with rectal cancer.

Key Points

• Fibrosis and viable tumor MRI signal intensities (SIs) are difficult to distinguish.

• T2 SI-selected volumetry yields high diagnostic performance for assessing pathological complete response.

• T2 SI-selected volumetry is significantly more accurate than readers and non-SI-selected volumetry.

• Post-chemoradiation therapy T2-weighted MRI SI-selected volumetry facilitates prediction of pathological complete response.

Keywords

Drug therapy Magnetic resonance imaging Rectal neoplasms Neoadjuvant therapy Tumor burden 

Abbreviations

AUC

The area under the receiver-operating characteristic curve

CRT

Chemoradiotherapy

CS

Confidence score

DCE

Dynamic contrast-enhanced

DFS

Disease-free survival

DWI

Diffusion-weighted imaging

MRI

Magnetic resonance imaging

mrTRG

Tumor regression grade on MRI

pCR

Pathological complete response

pGR

Pathological good response

ROC

Receiver-operating characteristic

ROI

Region of interest

SI

Signal intensity

SIC

Signal intensity category

TME

Total mesorectal excision

TRG

Tumor regression grade

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Joon Seok Lim, MD, PhD.

Conflict of interest

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.

Statistics and biometry

One of the authors has significant statistical expertise (Kyunghwa Han, PhD).

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

Supplementary material

330_2018_5520_MOESM1_ESM.docx (87 kb)
ESM 1 (DOCX 87 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of Radiological Science, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of RadiologyAjou University HospitalSuwonRepublic of Korea
  3. 3.Department of Radiation Oncology, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
  4. 4.Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea

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