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Diffusion-weighted MRI in locally advanced rectal cancer

Pathological response prediction after neo-adjuvant radiochemotherapy

Diffusionsgewichtete MRT bei lokal fortgeschrittenem Rektumkarzinom

Vorhersage der pathologischen Ansprechrate nach neoadjuvanter Radiochemotherapie

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Abstract

Background and purpose

The aim of this study was to assess the predictive potential of diffusion-weighted magnetic resonance imaging (MRI) for the selection of favorable pathological responders after radiochemotherapy for locally advanced rectal cancer.

Patients and methods

In 59 patients with locally advanced rectal cancer, the apparent diffusion coefficient (ADC) in the tumor was obtained at 3 Tesla before radiochemotherapy and surgery. The predictive potential for pathological complete response (pCR) and good response (GR) was assessed. GR was defined as pCR and near-pCR based on the tumor regression grade.

Results

The GR group consisted of 13 patients (22%) with 9 complete responders. Both the preradiochemotherapy ADC values and relative change in ADC (ΔADC) were predictive for pathological response. Preradiochemotherapy ADC values showed a positive predictive value of 42% for pCR and 67% for GR using a similar cut-off value of 0.97*10−3 mm2/s. For ΔADC, the optimal threshold for predicting GR or pCR was a 41% increase of the ADC. With this threshold, positive predictive values of 64% and 91% were found for pCR and GR, respectively.

Conclusion

Low preradiochemotherapy ADC values and high ΔADC correspond to pathological good response. Diffusion-weighted MRI may be used as an additional tool for selecting good treatment responders after radiochemotherapy.

Zusammenfassung

Hintergrund

Ziel dieser prospektiven Studie war die Evaluierung des prädiktiven Werts der diffusionsgewichteten Magnetresonanztomographie (MRT) für ein pathologisch günstiges Ansprechen nach Radiochemotherapie (RCT) bei lokal fortgeschrittenem Rektumkarzinom.

Patienten und Methoden

Bei 59 Patienten mit lokal fortgeschrittenem Rektumkarzinom wurde vor RCT und vor Operation der scheinbare Diffusionskoeffizient („apparent diffusion coefficient“, ADC) des Tumors ermittelt. Das prädiktive Potenzial des ADC zur Ermittlung einer pathologisch kompletten Remission (pKR) oder einer guten Remission (GR) wurde evaluiert. Die GR wurde als pKR und Beinahe-pKR auf der Basis pathologischer Tumorregressionsgrade definiert.

Ergebnisse

Die GR-Gruppe bestand aus 13 Patienten (22%) mit 9 pKR. Sowohl die ADC-Werte vor RCT als auch die relative ADC-Änderung (ΔADC) waren prädiktiv für die pathologische Remission. Die ADC-Werte vor RCT zeigten einen positiven prädiktiven Wert von 42% für pKR und 67% für GR mit einem Cut-off-Wert von 0,97*10−3 mm2/s. Für ΔADC lag die optimale Schwelle zur Vorhersage von GR oder pKR bei einer 41%igen Erhöhung des ADC. Mit dieser Schwelle wurde ein positiver prädiktiver Wert von 64% für pKR bzw. 91% für GR ermittelt.

Schlussfolgerung

Sowohl niedrige ADC-Werte vor RCT als auch eine hohe relative Änderung gehen einher mit einem guten pathologischen Ansprechen. Die diffusionsgewichtete MRT könnte in einem Protokoll zur Verwendung gelangen, mit dem Patienten mit gutem Ansprechen nach RCT ausgewählt werden.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiotherapy, University Medical Center Utrecht, 3508, Utrecht, The Netherlands

    M. Intven MD, O. Reerink MD, PhD & M.E.P. Philippens MD, PhD

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  1. M. Intven MD
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  2. O. Reerink MD, PhD
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  3. M.E.P. Philippens MD, PhD
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Correspondence to M. Intven MD.

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Intven, M., Reerink, O. & Philippens, M. Diffusion-weighted MRI in locally advanced rectal cancer. Strahlenther Onkol 189, 117–122 (2013). https://doi.org/10.1007/s00066-012-0270-5

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