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European Radiology

, Volume 23, Issue 12, pp 3345–3353 | Cite as

Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy

  • Hong Il Ha
  • Ah Young KimEmail author
  • Chang Sik Yu
  • Seong Ho Park
  • Hyun Kwon Ha
Gastrointestinal

Abstract

Objective

To evaluate DW MR tumour volumetry and post-CRT ADC in rectal cancer as predicting factors of CR using high b values to eliminate perfusion effects.

Methods

One hundred rectal cancer patients who underwent 1.5-T rectal MR and DW imaging using three b factors (0, 150, and 1,000 s/mm2) were enrolled. The tumour volumes of T2-weighted MR and DW images and pre- and post-CRT ADC150–1000 were measured. The diagnostic accuracy of post-CRT ADC, T2-weighted MR, and DW tumour volumetry was compared using ROC analysis.

Results

DW MR tumour volumetry was superior to T2-weighted MR volumetry comparing the CR and non-CR groups (P < 0.001). Post-CRT ADC showed a significant difference between the CR and non-CR groups (P = 0.001). The accuracy of DW tumour volumetry (Az = 0.910) was superior to that of T2-weighed MR tumour volumetry (Az = 0.792) and post-CRT ADC (Az = 0.705) in determining CR (P = 0.015). Using a cutoff value for the tumour volume reduction rate of more than 86.8 % on DW MR images, the sensitivity and specificity for predicting CR were 91.4 % and 80 %, respectively.

Conclusion

DW MR tumour volumetry after CRT showed significant superiority in predicting CR compared with T2-weighted MR images and post-CRT ADC.

Key Points

Diffusion-weighted MR (DWMR) imaging offers new information about rectal cancer.

DWMR helps to predict complete remission after chemoradiotherapy in patients with advanced rectal cancer.

DWMR provides more accurate diagnostic information than T2-weighted MRI.

Apparent diffusion coefficients can predict CR, but they have certain clinical limitations.

Keywords

Rectal cancer Staging MRI Diffusion Complete remission 

Abbreviations

ADC

Apparent diffusion coefficient

AUC (Az)

Area under the ROC curve

CR

Complete response

CRT

preoperative chemoradiation therapy

DW

Diffusion weighted

ROC

Receiver-operating characteristic

ROI

Region of interest

SI

Signal intensity

TV

Tumour volume

Notes

Acknowledgments

This article was presented as a scientific paper at the RSNA 97th Scientific Assembly and Annual Meeting (2011 RSNA).

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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Hong Il Ha
    • 1
    • 2
  • Ah Young Kim
    • 1
    Email author
  • Chang Sik Yu
    • 3
  • Seong Ho Park
    • 1
  • Hyun Kwon Ha
    • 1
  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  2. 2.Department of RadiologyHallym University Medical Center, Hallym University Sacred Heart HospitalAnyang-siKorea
  3. 3.Department of Colon and Rectal SurgeryUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea

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