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Role of dynamic contrast-enhanced MRI in predicting severe acute radiation-induced rectal injury in patients with rectal cancer

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To explore the potential of dynamic contrast-enhanced MRI (DCE-MRI) quantitative parameters in predicting severe acute radiation-induced rectal injury (RRI) in rectal cancer.

Methods

This retrospective study enrolled 49 patients with rectal cancer who underwent neoadjuvant chemoradiotherapy and rectal MRI including a DCE-MRI sequence from November 2014 to March 2021. Two radiologists independently measured DCE-MRI quantitative parameters, including the forward volume transfer constant (Ktrans), rate constant (kep), fractional extravascular extracellular space volume (ve), and the thickness of the rectal wall farthest away from the tumor. These parameters were compared between mild and severe acute RRI groups based on histopathological assessment. Receiver operating characteristic curve analysis was performed to analyze statistically significant parameters.

Results

Forty-nine patients (mean age, 54 years ± 12 [standard deviation]; 37 men) were enrolled, including 25 patients with severe acute RRI. Ktrans was lower in severe acute RRI group than mild acute RRI group (0.032 min−1 vs 0.054 min−1; p = 0.008), but difference of other parameters (kep, ve and rectal wall thickness) was not significant between these two groups (all p > 0.05). The area under the receiver operating characteristic curve of Ktrans was 0.72 (95% confidence interval: 0.57, 0.84). With a Ktrans cutoff value of 0.047 min−1, the sensitivity and specificity for severe acute RRI prediction were 80% and 54%, respectively.

Conclusion

Ktrans demonstrated moderate diagnostic performance in predicting severe acute RRI.

Clinical relevance statement

Dynamic contrast-enhanced MRI can provide non-invasive and objective evidence for perioperative management and treatment strategies in rectal cancer patients with acute radiation-induced rectal injury.

Key Points

• To our knowledge, this study is the first to evaluate the predictive value of contrast-enhanced MRI (DCE-MRI) quantitative parameters for severe acute radiation-induced rectal injury (RRI) in patients with rectal cancer.

• Forward volume transfer constant (Ktrans), derived from DCE-MRI, exhibited moderate diagnostic performance (AUC = 0.72) in predicting severe acute RRI of rectal cancer, with a sensitivity of 80% and specificity of 54%.

• DCE-MRI is a promising imaging marker for distinguishing the severity of acute RRI in patients with rectal cancer.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

CI:

Confidence interval

DCE-MRI:

Dynamic contrast-enhanced MRI

ICC:

Intraclass correlation coefficient

k ep :

Rate constant

K trans :

Forward volume transfer constant

ROI:

Region of interest

RRI:

Radiation-induced rectal injury

v e :

Fractional extravascular extracellular space volume

VOI:

Volume of interest

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Acknowledgements

We thank very much Yun-zhu Wu and Da Shi for their time and valuable contributions to the study.

Funding

This study has received funding by Guangdong Basic and Applied Basic Research Foundation (2020A1515010796).

Author information

Author notes

  1. Yan Chen and Li Ding contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China

    Yan Chen, Zhi-wen Zhang, Xue-han Wu, Yu-tao Que, Yu-ru Ma, Yi-yan Liu, Zi-qiang Wen, Bao-lan Lu & Shen-ping Yu

  2. Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China

    Li Ding

  3. Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518017, China

    Xue-han Wu & Yu-tao Que

  4. Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China

    Xin-yue Yang

  5. Department of Radiotherapy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China

    Yong Bao & Shao-qing Niu

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  1. Yan Chen
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Corresponding authors

Correspondence to Shao-qing Niu or Shen-ping Yu.

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Guarantor

The scientific guarantor of this publication is Shen-ping Yu.

Conflict of interest

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

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board (The First Affiliated Hospital, Sun Yat-sen University).

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Institutional Review Board (The First Affiliated Hospital, Sun Yat-sen University) approval was obtained.

Study subjects or cohorts overlap

Study subjects or cohorts have not been previously reported.

Methodology

  • Retrospective

  • Diagnostic or prognostic study

  • Performed at one institution

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Chen, Y., Ding, L., Zhang, Zw. et al. Role of dynamic contrast-enhanced MRI in predicting severe acute radiation-induced rectal injury in patients with rectal cancer. Eur Radiol 34, 1471–1480 (2024). https://doi.org/10.1007/s00330-023-10194-1

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