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European Radiology

, Volume 29, Issue 3, pp 1104–1113 | Cite as

Value of adding dynamic contrast-enhanced MRI visual assessment to conventional MRI and clinical assessment in the diagnosis of complete tumour response to chemoradiotherapy for rectal cancer

  • Marc J. GollubEmail author
  • Ivana Blazic
  • Seth Felder
  • Andrea Knezevic
  • Mithat Gonen
  • Julio Garcia-Aguilar
  • P. Phillip Paty
  • J. Joshua Smith
Gastrointestinal
  • 192 Downloads

Abstract

Purpose

To determine if DCE-MRI adds diagnostic value to the combined use of T2WI and DWI-MRI in the determination of clinical complete response (cCR) after neoadjuvant treatment (NAT) in patients with locally advanced rectal cancer.

Methods and materials

In this IRB-approved, HIPAA-compliant retrospective study, response was assessed using a 5-point confidence score by T2WI and DWI-MRI only (‘standard MRI’), then with addition of DCE-MRI. Review of digital rectal exams and endoscopy notes produced a clinical overall response score. The reference standard was CR by histopathology or cCR determined after a minimum of 18 months’ follow-up. Diagnostic accuracy and ROC curves were calculated for standard MRI and added DCE-MRI (to detect complete or good response), for clinical evaluation (to detect CR) and for MRI and clinical methods combined.

Results

Of 65 patients undergoing NAT, 20 had cCR (31%). Sensitivity, specificity and area under the ROC (AUC) were 0.55, 0.87 and 0.69 for clinical evaluation; 0.42, 0.77 and 0.66 for standard MRI, and 0.53, 0.76 and 0.68 for added DCE-MRI, respectively. Combined clinical evaluation and standard MRI with DCE-MRI resulted in the highest specificity of 0.96 and highest AUC of 0.72.

Conclusion

For the assessment of cCR after neoadjuvant therapy using clinical and multi-sequence MRI reading strategies, the addition of DCE-MRI increased specificity and PPV, but not significantly.

Key Points

• The addition of dynamic contrast-enhanced MRI to standard MRI, including DWI-MRI, may not significantly improve accuracy of response assessment in rectal cancer treatment.

• Clinical assessment consisting of digital rectal examination and endoscopy is the most accurate standalone test to assess response to chemoradiotherapy in rectal cancer.

• Combining MRI using DWI and DCE with the clinical assessment may potentially improve the accuracy for response assessment in rectal cancer.

Keywords

Rectal cancer Chemoradiotherapy Magnetic resonance imaging 

Abbreviations

ADC

Apparent diffusion coefficient

cCR

Clinical complete response

cGy

Centigray

CRT

Chemoradiotherapy

DCE

Dynamic contrast-enhanced

ESGAR

European Society of Gastrointestinal and Abdominal Radiologists

FU

Fluorouracil

NAT

Neoadjuvant treatment

NEX

Number of signal averages

NOM

Non-operative management

pCR

Pathological complete response

Notes

Funding

This study has received funding by NIH.

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R25CA020449. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Marc J. Gollub, MD.

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

Ms. Andrea Knezevic, MS and Dr. Mithat Gonen, PhD, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

Supplementary material

330_2018_5719_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of RadiologyClinical Hospital Center ZemunBelgradeSerbia
  3. 3.Department of Surgery, Colorectal ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of Surgery and Gastrointestinal OncologyMoffitt Cancer CenterTampaUSA
  5. 5.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA

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