Skip to main content
SpringerLink
Log in

Reduced field-of-view versus full field-of-view diffusion-weighted imaging for the evaluation of complete response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer

  • Hollow Organ GI
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine whether reduced field-of-view (rFOV) DWI sequences can improve image quality and diagnostic performance compared with conventional full FOV (fFOV) DWI in the prediction of complete response (CR) to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancers.

Methods

Between September 2015 and December 2017, seventy-three patients with locally advanced rectal cancers (≥ T3 or lymph node positive) who underwent CRT and subsequent surgery were included in this retrospective study. All patients had tumor located no more than 10 cm from the anal verge, and underwent rectal MRI including fFOV b-1000 DWI and rFOV b-1000 DWI at 3 T before and after CRT. Image quality and diagnostic performance in predicting CR were compared between rFOV DWI and fFOV DWI sets by two reviewers.

Results

Based on a 12-point scale, rFOV DWI provided better image quality scores than fFOV DWI (9.1 ± 1.7 vs. 8.4 ± 1.0, respectively, P < 0.001). Diagnostic accuracy (Az) in evaluating CR was better with the rFOV DWI set than with the fFOV DWI set for both reviewers: reviewer 1, 0.78 vs. 0.57 (P = .004); reviewer 2, 0.72 vs. 0.61 (P = .031).

Conclusion

rFOV DWI of rectal cancer can provide better overall image quality, and its addition to conventional rectal MRI may provide better diagnostic accuracy than fFOV DWI in the evaluation of CR to neoadjuvant CRT in patients with locally advanced rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

rFOV:

Reduced field-of-view

fFOV:

Full field-of-view

CR:

Complete response

CRT:

Chemoradiotherapy

References

  1. Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114-1123

  2. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731-1740

  3. Li Y, Wang J, Ma X et al (2016) A Review of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer. International journal of biological sciences 12:1022-1031

  4. Maas M, Nelemans PJ, Valentini V et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. The Lancet Oncology 11:835-844

  5. Hartley A, Ho KF, McConkey C, Geh JI (2005) Pathological complete response following pre-operative chemoradiotherapy in rectal cancer: analysis of phase II/III trials. The British Journal of Radiology 78:934-938

  6. De Nardi P, Carvello M (2013) How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy? World J Gastroenterol 19:5964-5972

  7. Kim DJ, Kim JH, Lim JS et al (2010) Restaging of Rectal Cancer with MR Imaging after Concurrent Chemotherapy and Radiation Therapy. RadioGraphics 30:503-516

  8. Kim SH, Lee JM, Hong SH et al (2009) Locally Advanced Rectal Cancer: Added Value of Diffusion-weighted MR Imaging in the Evaluation of Tumor Response to Neoadjuvant Chemo- and Radiation Therapy. Radiology 253:116-125

  9. Beets-Tan RGH, Lambregts DMJ, Maas M et al (2018) Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 28:1465-1475

  10. Barentsz MW, Taviani V, Chang JM et al (2015) Assessment of tumor morphology on diffusion-weighted (DWI) breast MRI: Diagnostic value of reduced field of view DWI. Journal of Magnetic Resonance Imaging 42:1656-1665

  11. Kim H, Lee JM, Yoon JH et al (2015) Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Pancreas: Comparison with Conventional Single-Shot Echo-Planar Imaging. Korean J Radiol 16:1216-1225

  12. Wilm BJ, Svensson J, Henning A, Pruessmann KP, Boesiger P, Kollias SS (2007) Reduced field‐of‐view MRI using outer volume suppression for spinal cord diffusion imaging. Magnetic Resonance in Medicine 57:625-630

  13. Singer L, Wilmes LJ, Saritas EU et al (2012) High-resolution Diffusion-weighted Magnetic Resonance Imaging in Patients with Locally Advanced Breast Cancer. Acad Radiol 19:526-534

  14. Saritas EU, Cunningham CH, Lee JH, Han ET, Nishimura DG (2008) DWI of the spinal cord with reduced FOV single‐shot EPI. Magnetic Resonance in Medicine 60:468-473

  15. Zaharchuk G, Saritas EU, Andre JB et al (2011) Reduced Field-of-View Diffusion Imaging of the Human Spinal Cord: Comparison with Conventional Single-Shot Echo-Planar Imaging. American Journal of Neuroradiology 32:813

  16. Reischauer C, Wilm BJ, Froehlich JM et al (2011) High-resolution diffusion tensor imaging of prostate cancer using a reduced FOV technique. Eur J Radiol 80:e34-e41

  17. Bhosale P, Ma J, Iyer R et al (2016) Feasibility of a reduced field-of-view diffusion-weighted (rFOV) sequence in assessment of myometrial invasion in patients with clinical FIGO stage I endometrial cancer. Journal of Magnetic Resonance Imaging 43:316-324

  18. Yang P, Zhen L, Hao T et al (2018) Comparison of reduced field-of-view diffusion-weighted imaging (DWI) and conventional DWI techniques in the assessment of rectal carcinoma at 3.0T: Image quality and histological T staging. Journal of Magnetic Resonance Imaging 47:967-975

  19. Sun H, Xu Y, Xu Q, Shi K, Wang W (2017) Rectal cancer: Short-term reproducibility of intravoxel incoherent motion parameters in 3.0T magnetic resonance imaging. Medicine (Baltimore) 96:e6866

  20. Sassen S, de Booij M, Sosef M et al (2013) Locally advanced rectal cancer: is diffusion weighted MRI helpful for the identification of complete responders (ypT0N0) after neoadjuvant chemoradiation therapy? Eur Radiol 23:3440-3449

  21. Ichikawa T, Erturk SM, Motosugi U et al (2006) High-B-Value Diffusion-Weighted MRI in Colorectal Cancer. American Journal of Roentgenology 187:181-184

  22. Rao S-X, Zeng M-S, Chen C-Z et al (2008) The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection. Eur J Radiol 65:299-303

  23. Blazic IM, Lilic GB, Gajic MM (2017) Quantitative Assessment of Rectal Cancer Response to Neoadjuvant Combined Chemotherapy and Radiation Therapy: Comparison of Three Methods of Positioning Region of Interest for ADC Measurements at Diffusion-weighted MR Imaging. Radiology 282:418-428

  24. Kim SH, Chang HJ, Kim DY et al (2016) What Is the Ideal Tumor Regression Grading System in Rectal Cancer Patients after Preoperative Chemoradiotherapy? Cancer Res Treat 48:998-1009

  25. Landis JR, Koch GG (1977) An Application of Hierarchical Kappa-type Statistics in the Assessment of Majority Agreement among Multiple Observers. Biometrics 33:363-374

  26. Peng Y, Li Z, Tang H et al (2018) Comparison of reduced field-of-view diffusion-weighted imaging (DWI) and conventional DWI techniques in the assessment of rectal carcinoma at 3.0T: Image quality and histological T staging. J Magn Reson Imaging 47:967-975

  27. Riffel P, Michaely HJ, Morelli JN et al (2014) Zoomed EPI-DWI of the Pancreas Using Two-Dimensional Spatially-Selective Radiofrequency Excitation Pulses. PLOS ONE 9:e89468

  28. Poustchi-Amin M, Mirowitz SA, Brown JJ, McKinstry RC, Li T (2001) Principles and applications of echo-planar imaging: a review for the general radiologist. RadioGraphics 21:767-779

  29. Nahas SC, Rizkallah Nahas CS, Sparapan Marques CF et al (2016) Pathologic Complete Response in Rectal Cancer: Can We Detect It? Lessons Learned From a Proposed Randomized Trial of Watch-and-Wait Treatment of Rectal Cancer. Diseases of the Colon & Rectum 59:255-263

  30. Bernier L, Balyasnikova S, Tait D, Brown G (2018) Watch-and-Wait as a Therapeutic Strategy in Rectal Cancer. Curr Colorectal Cancer Rep 14:37-55

  31. van der Valk MJM, Hilling DE, Bastiaannet E et al (2018) Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet 391:2537-2545

  32. Dossa F, Chesney TR, Acuna SA, Baxter NN (2017) A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology 2:501-513

  33. Martens MH, Maas M, Heijnen LA et al (2016) Long-term Outcome of an Organ Preservation Program After Neoadjuvant Treatment for Rectal Cancer. J Natl Cancer Inst 108

  34. Habr-Gama A, Gama-Rodrigues J, Sao Juliao GP et al (2014) Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 88:822–828

  35. Hupkens BJP, Maas M, Martens MH et al (2018) Organ Preservation in Rectal Cancer After Chemoradiation: Should We Extend the Observation Period in Patients with a Clinical Near-Complete Response? Ann Surg Oncol 25:197-203

  36. Dresen RC, Beets GL, Rutten HJ et al (2009) 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 252:71-80

  37. Nahas SC, Nahas CSR, Cama GM et al (2019) Diagnostic performance of magnetic resonance to assess treatment response after neoadjuvant therapy in patients with locally advanced rectal cancer. Abdom Radiol (NY). 10.1007/s00261-019-01894-8

  38. van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S (2013) Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology 269:101-112

  39. Dowell NG, Jenkins TM, Ciccarelli O, Miller DH, Wheeler-Kingshott CA (2009) Contiguous-slice zonally oblique multislice (CO-ZOOM) diffusion tensor imaging: examples of in vivo spinal cord and optic nerve applications. J Magn Reson Imaging 29:454-460

  40. Jeong EK, Kim SE, Guo J, Kholmovski EG, Parker DL (2005) High‐resolution DTI with 2D interleaved multislice reduced FOV single‐shot diffusion‐weighted EPI (2D ss‐rFOV‐DWEPI). Magnetic Resonance in Medicine 54:1575-1579

  41. Sclafani F, Brown G, Cunningham D et al (2017) Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer. British Journal Of Cancer 117:1478

  42. Kim SH, Lee JM, Park HS, Eun HW, Han JK, Choi BI (2009) Accuracy of MRI for predicting the circumferential resection margin, mesorectal fascia invasion, and tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging 29:1093-1101

Download references

Funding

Not applicable.

Author information

Author notes

  1. Jeong Hee Yoon and Jae Seok Bae have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, SMG - SNU Boramae Medical Center, Seoul, Korea

    Siwon Jang

  2. Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Jeong Min Lee, Jeong Hee Yoon & Jae Seok Bae

Authors
  1. Siwon Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeong Min Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeong Hee Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jae Seok Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Siwon Jang, Jeong Min Lee, Jeong Hee Yoon, and Jae Seok Bae. The first draft of the manuscript was written by Siwon Jang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jeong Min Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This retrospective study was approved by the Institutional Review Board of Seoul National University Hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix 1: Detailed information of neoadjuvant CRT

Preoperative radiation therapy of 45 Gy per 25 fractions (1.8 Gy per day) was delivered to the pelvis over the course of 5.5 or 6 weeks. A 5.4 Gy per three fraction boost was then subsequently delivered to the primary tumor. In addition, concurrent with radiation therapy, all patients received an intravenous injection of two cycles of 5-fluorouracil (500 mg/m2/d) for 3 days during the 1st and 5th weeks of radiation therapy. All patients waited 4–6 weeks after neoadjuvant CRT was completed prior to undergoing surgery [42].

Appendix 2: Patient demographics

Tumor response consisted of CR (pTRG 0, n = 17), moderate response (pTRG 1, n = 23), minimal response (pTRG 2, n = 25), and poor response (pTRG 3, n = 8). Pre-CRT local staging based on MR findings and post-CRT pathologic staging of the study population are summarized in the Table 4.

Appendix 3

See Appendix Table 4.

Table 4 Pretreatment MR-estimated tumor and nodal stages and postoperative histopathologic stages of the study population
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jang, S., Lee, J.M., Yoon, J.H. et al. Reduced field-of-view versus full field-of-view diffusion-weighted imaging for the evaluation of complete response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Abdom Radiol 46, 1468–1477 (2021). https://doi.org/10.1007/s00261-020-02763-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02763-5

Keywords

Search

Navigation