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The value of intravoxel incoherent motion diffusion-weighted imaging in predicting the pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma

  • Magnetic Resonance
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Abstract

Objective

To explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the prediction of pathologic response to neoadjuvant chemotherapy (NAC) in locally advanced esophageal squamous cell carcinoma (ESCC).

Material and methods

Forty patients with locally advanced ESCC who were treated with NAC followed by radical resection were prospectively enrolled from September 2015 to May 2018. MRI and IVIM were performed within 1 week before and 2–3 weeks after NAC, prior to surgery. Parameters including apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), and pseudodiffusion fraction (f) before and after NAC were measured. Pathologic response was evaluated according to the AJCC tumor regression grade (TRG) system. The changes in IVIM values before and after therapy in different TRG groups were assessed. Receiver operating characteristic (ROC) curves analysis was used to determine the best cutoff value for predicting the pathologic response to NAC.

Results

Twenty-two patients were identified as TRG 2 (responders), and eighteen as TRG 3 (non-responders) in pathologic evaluation. The ADC, D, and f values increased significantly after NAC. The post-NAC D and ΔD values of responders were significantly higher than those of non-responders. The area under the curve (AUC) was 0.722 for post-NAC D and 0.859 for ΔD in predicting pathologic response. The cutoff values of post-NAC D and ΔD were 1.685 × 10−3 mm2/s and 0.350 × 10−3 mm2/s, respectively.

Conclusion

IVIM-DWI may be used as an effective functional imaging technique to predict pathologic response to NAC in locally advanced ESCC.

Key Points

• The optimal cutoff values of post-NAC D and ΔD for predicting pathologic response to NAC in locally advanced ESCC were 1.685 × 10−3 mm2/s and 0.350 × 10−3 mm2/s, respectively.

• Pathologic response to NAC in locally advanced ESCC was favorable in patients with post-NAC D and ΔD values that were higher than the optimal cutoff values.

• IVIM-DWI can potentially be used to preoperatively predict pathologic response to NAC in esophageal carcinoma. Accurate quantification of the D value derived from IVIM-DWI may eventually translate into an effective and non-invasive marker to predict therapeutic efficacy.

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Abbreviations

18F-FDG PET/CT:

Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography

ADC:

Apparent diffusion coefficient

CI:

Confidence intervals

CT:

Computed tomography

D :

True diffusion coefficient

D * :

Pseudodiffusion coefficient

DCE-MRI:

Dynamic contrast-enhanced magnetic resonance images

DWI:

Diffusion-weighted imaging

ESCC:

Esophageal squamous cell carcinoma

EUS:

Endoscopic ultrasonography

f :

Pseudodiffusion fraction

ICC:

Intraclass correlation coefficient

iShim:

Integrated specific slice dynamic shim

IVIM:

Intravoxel incoherent motion

IVIM-DWI:

Intravoxel incoherent motion diffusion-weighted imaging

MRI:

Magnetic resonance imaging

NAC:

Neoadjuvant chemotherapy

NT:

Neoadjuvant therapy

RECIST:

Response evaluation criteria in solid tumors

ROC:

Receiver operating characteristic

ROI:

Region of interest

SD:

Standard deviation

SNR:

Signal-to-noise ratio

TRG:

Tumor regression grade

VIBE:

Volumetric interpolated breath hold examination

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Acknowledgments

We thank Prof. Ihab R. Kamel for valuable advices on revised manuscript and language editing.

Funding

This study has received funding by the National Natural Science Foundation of China (81972802) and National nature science foundation of Henan Province (182300410355).

Author information

Author notes

  1. Jinrong Qu

    Present address: Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China

Authors and Affiliations

  1. Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming road, Jinshui District, Zhengzhou city, Henan Province, China

    Tao Song, Qi Yao, Hongkai Zhang, Yan Zhao, Shouning Zhang, Xianhua Han & Hailiang Li

  2. Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China

    Jianjun Qin

  3. Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China

    Wen Feng

  4. MR Scientific Marketing, Siemens Healthineers, XI’an, 710065, China

    Shaoyu Wang

  5. MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China

    Xu Yan

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Correspondence to Jinrong Qu.

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The scientific guarantor of this publication is Jinrong QU, MD, PHD.

Conflict of interest

Two of the authors of this manuscript (Shaoyu Wang and Xu Yan) are employees of Siemens. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Yan Zhao, one of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• prospective

• diagnostic or prognostic study

• performed at one institution

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Song, T., Yao, Q., Qu, J. et al. The value of intravoxel incoherent motion diffusion-weighted imaging in predicting the pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma. Eur Radiol 31, 1391–1400 (2021). https://doi.org/10.1007/s00330-020-07248-z

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