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

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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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

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Funding

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

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Sungwon Kim, Kyunghwa Han, Nieun Seo, Myeong-Jin Kim & Joon Seok Lim

  2. Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea

    Hye Jin Kim

  3. Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Woong Sub Koom

  4. Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Joong Bae Ahn

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  1. Sungwon Kim
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Correspondence to Joon Seok Lim.

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Guarantor

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

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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).

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Kim, S., Han, K., Seo, N. et al. T2-weighted signal intensity-selected volumetry for prediction of pathological complete response after preoperative chemoradiotherapy in locally advanced rectal cancer. Eur Radiol 28, 5231–5240 (2018). https://doi.org/10.1007/s00330-018-5520-1

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