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Comparison of percentage changes in quantitative diffusion parameters for assessing pathological complete response to neoadjuvant therapy in locally advanced rectal cancer: a meta-analysis

  • Special Section: Rectal Cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate and compare the diagnostic performance of percentage changes in apparent diffusion coefficient (∆ADC%) and slow diffusion coefficient (∆D%) for assessing pathological complete response (pCR) to neoadjuvant therapy in patients with locally advanced rectal cancer (LARC).

Methods

A systematic search in PubMed, EMBASE, the Web of Science, and the Cochrane Library was performed to retrieve related original studies. For each parameter (∆ADC% and ∆D%), we pooled the sensitivity, specificity and calculated the area under summary receiver operating characteristic curve (AUROC) values. Meta-regression and subgroup analyses were performed to explore heterogeneity among the studies on ∆ADC%.

Results

15 original studies (804 patients with 805 lesions, 15 studies on ∆ADC%, 4 of the studies both on ∆ADC% and ∆D%) were included. pCR was observed in 213 lesions (26.46%). For the assessment of pCR, the pooled sensitivity, specificity and AUROC of ∆ADC% were 0.83 (95% confidence intervals [CI] 0.76, 0.89), 0.74 (95% CI 0.66, 0.81), 0.87 (95% CI 0.83, 0.89), and ∆D% were 0.70 (95% CI 0.52, 0.84), 0.81 (95% CI 0.65, 0.90), 0.81 (95% CI 0.77, 0.84), respectively. In the four studies on the both metrics, ∆ADC% yielded an equivalent diagnostic performance (AUROC 0.80 [95% CI 0.76, 0.83]) to ∆D%, but lower than in the studies (n = 11) only on ∆ADC% (AUROC 0.88 [95% CI 0.85, 0.91]). Meta-regression and subgroup analyses showed no significant factors affecting heterogeneity.

Conclusions

Our meta-analysis confirms that ∆ADC% could reliably evaluate pCR in patients with LARC after neoadjuvant therapy. ∆D% may not be superior to ∆ADC%, which deserves further investigation.

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Data availability

All data generated or analyzed during this study are included in this published article.

Abbreviations

ADC:

Apparent diffusion coefficient

AUROC:

Area under receiver operating characteristic curve

CI:

Confidence intervals

D:

Slow diffusion coefficient

DWI:

Diffusion-weighted imaging

FP:

False positive

FN:

False negative

IVIM:

Intravoxel incoherent motion

LARC:

Locally advanced rectal cancer

MRI:

Magnetic resonance imaging

pCR:

Pathological complete response

PICOS:

Problem/population, intervention, comparison, and outcome

QUADAS:

Quality assessment for studies of diagnostic accuracy

ROI:

Region of interest

SROC:

Summary receiver operating characteristic curve

T:

Tesla

TP:

True positive

TN:

True negative

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Funding

This work was supported by the Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation (Grant No. 201905010003), and Health and Family Planning Commission of Hunan Province (Grant No. 20200068).

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Author notes

  1. Kai Chen and Hua-Long She contributed equally to this work.

Authors and Affiliations

  1. Medical Imaging Center, The First Affiliated Hospital of Jinan University, 613 Huangpu Street, Guangzhou, 510630, China

    Kai Chen, Hua-Long She & Liang-Ping Luo

  2. Department of Radiology, Affiliated Hospital of Xiangnan University (Clinical College), 25 Renmin West Road, Chenzhou, 423000, China

    Kai Chen, Hua-Long She & Tao Wu

  3. College of Medical Imaging and Medical Examination, Xiangnan University, 25 Renmin West Road, Chenzhou, 423000, China

    Fang Hu & Tao Li

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  1. Kai Chen
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Contributions

KC and LPL contributed to the study conception and design. Project development, data collection and analysis were performed by KC, HLS, FH, TW, and TL. The first draft of the manuscript was written by KC and edited by TL and LPL. All authors read and approved the final manuscript.

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Correspondence to Tao Li or Liang-Ping Luo.

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Chen, K., She, HL., Wu, T. et al. Comparison of percentage changes in quantitative diffusion parameters for assessing pathological complete response to neoadjuvant therapy in locally advanced rectal cancer: a meta-analysis. Abdom Radiol 46, 894–908 (2021). https://doi.org/10.1007/s00261-020-02770-6

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