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DCE-MRI time–intensity curve visual inspection to assess pathological response after neoadjuvant therapy in locally advanced rectal cancer

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Abstract

Purpose

To investigate the potential of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to discriminate responder from non-responder patients after preoperative chemoradiotherapy (pCRT) in locally advanced rectal cancer (LARC).

Materials and methods

One hundred and fifty-eight consecutive patients were enrolled in this prospective study. We compared morphological MRI (mMRI) using T2-weighted images about tumor presence and invasiveness, and functional DCE-MRI using time–intensity curve (TIC) visual inspection (qMRI), classifying TIC shape into three types: type 1, persistent enhancement; type 2, high enhancement with plateau; type 3, high enhancement with wash-out. Clinical TNM was obtained before and after CRT by radiological consensus of two expert radiologists. Pathological tumor–nodes–metastasis classification and tumor regression grade (TRG) were confirmed as the golden standard. Non-parametric test, sensitivity, specificity, and positive and negative predictive values were calculated.

Results

Ninety-eight patients (62%) were classified as responders (TRG ≤ 2), while 60 (38%) were classified as non-responders. Sensitivity, specificity, and accuracy were 52, 78, and 62% for mMRI, and 81, 85, and 82% for qMRI, respectively.

Conclusions

TIC visual inspection may be one of the potential biomarkers over morphological analysis using DCE-MRI data to assess pathological response after pCRT in LARC.

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References

  1. Avallone A, Delrio P, Pecori B, Tatangelo F, Petrillo A, Scott N, Marone P, Aloi L, Sandomenico C, Lastoria S, Iaffaioli VR, Scala D, Iodice G, Budillon A, Comella P. Oxaliplatin plus dual inhibition of thymidylate synthase during preoperative pelvic radiotherapy for locally advanced rectal carcinoma: long-term outcome. Int J Radiat Oncol Biol Phys. 2011;79(3):670–6.

    Article  CAS  PubMed  Google Scholar 

  2. Petrillo M, Fusco R, Catalano O, Sansone M, Avallone A, Delrio P, Pecori B, Tatangelo F, Petrillo A. MRI for assessing response to neoadjuvant therapy in locally advanced rectal cancer using DCE-MR and DW-MR data sets: a preliminary report. Biomed Res Int. 2015;2015:514740.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Avallone A, Pecori B, Bianco F, Aloj L, Tatangelo F, Romano C, Granata V, Marone P, Leone A, Botti G, Petrillo A, Caracò C, Iaffaioli VR, Muto P, Romano G, Comella P, Budillon A, Delrio P. Critical role of bevacizumab scheduling in combination with pre-surgical chemo-radiotherapy in MRI-defined high-risk locally advanced rectal cancer: results of the BRANCH trial. Oncotarget. 2015;6(30):30394–407.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Beets-Tan RG, Beets GL. Rectal cancer: review with emphasis on MR imaging. Radiology. 2004;232(2):335–46.

    Article  PubMed  Google Scholar 

  5. Tirkes T, Hollar MA, Tann M, Kohli MD, Akisik F, Sandrasegaran K. Response criteria in oncologic imaging: review of traditional and new criteria. Radiographics. 2013;33(5):1323–41.

    Article  PubMed  Google Scholar 

  6. Petrillo A, Fusco R, Petrillo M, Granata V, Sansone M, Avallone A, Delrio P, Pecori B, Tatangelo F, Ciliberto G. Standardized index of shape (SIS): a quantitative DCE-MRI parameter to discriminate responders by non-responders after neoadjuvant therapy in LARC. Eur Radiol. 2015;25(7):1935–45.

    Article  Google Scholar 

  7. Salmo E, El-Dhuwaib Y, Haboubi NY. Histological grading of tumour regression and radiation colitis in locally advanced rectal cancer following neo-adjuvant therapy; a critical appraisal. Colorectal Dis. 2011;13(10):1100–6.

    Article  CAS  PubMed  Google Scholar 

  8. Daniel BL, Yen YF, Glover GH, et al. Breast disease: dynamic spiral MR imaging. Radiology. 1998;209(2):499–509.

    Article  CAS  PubMed  Google Scholar 

  9. Chen CC, Lee RC, Lin JK, Wang LW, Yang SH, Chen CC, Lee RC, Lin JK, Wang LW, Yang SH. How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum. 2005;48(4):722–8.

    Article  PubMed  Google Scholar 

  10. Hayes C, Padhani AR, Leach MO. Assessing changes in tumour vascular function using dynamic contrast-enhanced magnetic resonance imaging. NMR Biomed. 2002;15(2):154–63.

    Article  PubMed  Google Scholar 

  11. Bajpai J, Gamanagatti S, Sharma MC, Kumar R, Vishnubhatla S, Khan SA, Rastogi S, Malhotra A, Bakhshi S. Noninvasive imaging surrogate of angiogenesis in osteosarcoma. Pediatr Blood Cancer. 2010;54(4):526–31.

    PubMed  Google Scholar 

  12. Zhang XM, Yu D, Zhang HL, et al. 3D dynamic contrast-enhanced MRI of rectal carcinoma at 3 T: correlation with microvascular density and vascular endothelial growth factor markers of tumor angiogenesis. J Magn Reson Imaging. 2008;27(6):1309–16.

    Article  Google Scholar 

  13. Pham CD, Roberts TP, van Bruggen N, et al. Magnetic resonance imaging detects suppression of tumor vascular permeability after administration of antibody to vascular endothelial growth factor. Cancer Invest. 1998;16(4):225–30.

    Article  CAS  PubMed  Google Scholar 

  14. Tofts PS. Modeling tracer kinetics in dynamic Gd-DTPA MR Imaging. J Magn Reson Imaging. 1997;7(1):91–101.

    Article  CAS  Google Scholar 

  15. Intven M, Reerink O, Philippens ME. Dynamic contrast enhanced MR imaging for rectal cancer response assessment after neo-adjuvant chemoradiation. J Magn Reson Imaging. 2014;41(6):1646–53.

    Article  PubMed  Google Scholar 

  16. Fusco R, Sansone M, Maffei S, Petrillo A. Dynamic contrast-enhanced MRI in breast cancer: a comparison between distributed and compartmental tracer kinetic models. J Biomed Graph Comput. 2012;2(2):23.

    Google Scholar 

  17. Fusco R, Petrillo A, Petrillo M, Sansone M. Use of tracer kinetic models for selection of semi-quantitative features for DCE-MRI data classification. Appl Magn Reson. 2013;44(11):1311–24.

    Article  CAS  Google Scholar 

  18. Avallone A, Aloj L, Caracò C, Delrio P, Pecori B, Tatangelo F, Scott N, Casaretti R, Di Gennaro F, Montano M, Silvestro L, Budillon A, Lastoria S. Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome. Eur J Nucl Med Mol Imaging. 2012;39(12):1848–57.

    Article  CAS  PubMed  Google Scholar 

  19. Avallone A, Aloj L, Delrio P, Pecori B, Leone A, Tatangelo F, Perri F, Petrillo A, Scott N, Budillon A. Multidisciplinary approach to rectal cancer: are we ready for selective treatment strategies? Anticancer Agents Med Chem. 2013;13(6):852–60.

    Article  CAS  PubMed  Google Scholar 

  20. Petrillo A, Catalano O, Delrio P, et al. Post-treatment fistulas in patients with rectal cancer: MRI with rectal superparamagnetic contrast agent. Abdom Imaging. 2007;32(3):328–31.

    Article  PubMed  Google Scholar 

  21. Dresen RC, Beets GL, Rutten HJ, Engelen SM, Lahaye MJ, Vliegen RF, de Bruïne AP, Kessels AG, Lammering G, Beets-Tan RG. Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part I. Are we able to predict tumor confined to the rectal wall? Radiology. 2009;252(1):81–91.

    Article  Google Scholar 

  22. Andreola S, Leo E, Belli F, Bonfanti G, Sirizzotti G, Greco P, Valvo F, Tomasic G, Gallino GF. Adenocarcinoma of the lower third of the rectum surgically treated with a < 10 mm distal clearance: preliminary results in 35 N0 patients. Ann Surg Oncol. 2001;8(7):611–5.

    Article  CAS  PubMed  Google Scholar 

  23. Colon and rectum. In: Edge SB, Byrd DR, Compton CC, et al., editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 143–64.

    Google Scholar 

  24. Marijnen CA, Nagtegaal ID, Kapiteijn E. Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of a multicenter randomized trial. Int J Radiat Oncol Biol Phys. 2003;55(5):1311–20.

    Article  CAS  PubMed  Google Scholar 

  25. Hawass NE. Comparing the sensitivities and specificities of two diagnostic procedures performed on the same group of patients. Br J Radiol. 1997;70(832):360–6.

    Article  CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Division of Radiology, “Istituto Nazionale Tumori Fondazione Giovanni Pascale, IRCCS”, Via Mariano Semmola, 80131, Naples, Italy

    Antonella Petrillo, Roberta Fusco, Mario Petrillo & Vincenza Granata

  2. Division of Colorectal Surgical Oncology, “Istituto Nazionale Tumori Fondazione Giovanni Pascale, IRCCS”, Via Mariano Semmola, 80131, Naples, Italy

    Francesco Bianco, Massimiliano Di Marzo & Paolo Delrio

  3. Division of Diagnostic Pathology, “Istituto Nazionale Tumori Fondazione Giovanni Pascale, IRCCS”, Via Mariano Semmola, 80131, Naples, Italy

    Fabiana Tatangelo & Gerardo Botti

  4. Division of Radiotherapy, “Istituto Nazionale Tumori Fondazione Giovanni Pascale, IRCCS”, Via Mariano Semmola, 80131, Naples, Italy

    Biagio Pecori

  5. Division of Abdominal Oncology, “Istituto Nazionale Tumori Fondazione Giovanni Pascale, IRCCS”, Via Mariano Semmola, 80131, Naples, Italy

    Antonio Avallone

Authors
  1. Antonella Petrillo
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  2. Roberta Fusco
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  3. Mario Petrillo
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  4. Vincenza Granata
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  5. Francesco Bianco
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  6. Massimiliano Di Marzo
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  7. Paolo Delrio
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  8. Fabiana Tatangelo
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  9. Gerardo Botti
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  10. Biagio Pecori
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  11. Antonio Avallone
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Corresponding author

Correspondence to Roberta Fusco.

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Conflict of interest

The authors have no conflict of interest to be disclosed.

Ethical standards

All procedures performed in studies involving human participants were made in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Independent Ethical Committee of our institution.

Informed consent

All gave written informed consent to participate in the trial.

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Cite this article

Petrillo, A., Fusco, R., Petrillo, M. et al. DCE-MRI time–intensity curve visual inspection to assess pathological response after neoadjuvant therapy in locally advanced rectal cancer. Jpn J Radiol 36, 611–621 (2018). https://doi.org/10.1007/s11604-018-0760-1

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  • DOI: https://doi.org/10.1007/s11604-018-0760-1

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