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Dynamic contrast enhanced-MRI for the detection of pathological complete response to neoadjuvant chemotherapy for locally advanced rectal cancer

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the ability of dynamic contrast enhanced (DCE-MRI) to predict pathological complete response (pCR) after preoperative chemotherapy for rectal cancer.

Methods

In a prospective clinical trial, 23/34 enrolled patients underwent pre- and post-treatment DCE-MRI performed at 1.5T. Gadolinium 0.1 mmol/kg was injected at a rate of 2 mL/s. Using a two-compartmental model of vascular space and extravascular extracellular space, Ktrans, kep, ve, AUC90, and AUC180 were calculated. Surgical specimens were the gold standard. Baseline, post-treatment and changes in these quantities were compared with clinico-pathological outcomes. For quantitative variable comparison, Spearman’s Rank correlation was used. For categorical variable comparison, the Kruskal–Wallis test was used. P ≤ 0.05 was considered significant.

Results

Percentage of histological tumour response ranged from 10 to 100%. Six patients showed pCR. Post chemotherapy Ktrans (mean 0.5 min−1 vs. 0.2 min−1, P = 0.04) differed significantly between non-pCR and pCR outcomes, respectively and also correlated with percent tumour response and pathological size. Post-treatment residual abnormal soft tissue noted in some cases of pCR prevented an MR impression of complete response based on morphology alone.

Conclusion

After neoadjuvant chemotherapy in rectal cancer, MR perfusional characteristics have been identified that can aid in the distinction between incomplete response and pCR.

Key Points

  • Dynamic contrast enhanced (DCE) MRI provides perfusion characteristics of tumours.

  • These objective quantitative measures may be more helpful than subjective imaging alone

  • Some parameters differed markedly between completely responding and incompletely responding rectal cancers.

  • Thus DCE-MRI can potentially offer treatment-altering imaging biomarkers.

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Acknowledgements

We would like to thank Michael Sohn for his invaluable help with database management.

Author information

Authors and Affiliations

  1. Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    M. J. Gollub, D. H. Gultekin, O. Akin, R. K. Do & J. L. Fuqua III

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    M. Gonen & D. Kuk

  3. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    M. Weiser, P. Paty, J. Guillem, G. M. Nash & L. Temple

  4. Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    L. Saltz

  5. Dana Farber Cancer Institute, 44 Binney Street, Boston, MA, 02115, USA

    D. Schrag

  6. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    K. Goodman

  7. Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    J. Shia

  8. Department of Radiology, Columbia University Medical Center/New York Presbyterian Hospital, 180 Fort Washington Avenue, Harkness Pavilion—HP 3-320, New York, NY, 10032, USA

    L. H. Schwartz

Authors
  1. M. J. Gollub
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  2. D. H. Gultekin
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  3. O. Akin
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  4. R. K. Do
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  5. J. L. Fuqua III
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  6. M. Gonen
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  7. D. Kuk
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  8. M. Weiser
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  9. L. Saltz
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  10. D. Schrag
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  11. K. Goodman
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  12. P. Paty
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  13. J. Guillem
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  14. G. M. Nash
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  15. L. Temple
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  16. J. Shia
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  17. L. H. Schwartz
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Corresponding author

Correspondence to M. J. Gollub.

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Gollub, M.J., Gultekin, D.H., Akin, O. et al. Dynamic contrast enhanced-MRI for the detection of pathological complete response to neoadjuvant chemotherapy for locally advanced rectal cancer. Eur Radiol 22, 821–831 (2012). https://doi.org/10.1007/s00330-011-2321-1

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  • DOI: https://doi.org/10.1007/s00330-011-2321-1

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