VALUE OF DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING FOR PREDICTION AND EARLY ASSESSMENT OF RESPONSE TO NEOADJUVANT RADIOCHEMOTHERAPY IN RECTAL CANCER: PRELIMINARY RESULTS
VALUE OF DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING FOR PREDICTION AND EARLY ASSESSMENT OF RESPONSE TO NEOADJUVANT RADIOCHEMOTHERAPY IN RECTAL CANCER: PRELIMINARY RESULTS
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DOI：
10.1016/j.ijrobp.2010.12.063
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发表时间：
2012-02-01
影响因子：
7
通讯作者：
Haustermans, Karin
中科院分区：
文献类型：
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作者：
Lambrecht, Maarten;Vandecaveye, Vincent;Haustermans, Karin
目的：评估扩散加权磁共振成像（DWI）的反应预测之前和反应评估术前放化疗（RCT）的局部进展期直肠癌（LARC.Methods and Materials）：20例接受RCT的LARC患者进行MRI检查，包括DWI RCT前，10-15分后，1至2周手术前。在所有时间点测定肿瘤体积和表观扩散系数（ADC; b值：0-1000 s/mm（2））。将治疗前肿瘤ADC和体积、治疗前和随访检查之间的肿瘤ADC变化（Δ ADC）和体积变化（Δ V）与全直肠系膜切除术后的组织病理学结果进行比较（病理学完全缓解[pCR] vs.无pCR，ypT 0 -2 vs. ypT 3 -4，T分期下调与否）。将治疗前肿瘤ADC和体积、Δ ADC和Δ V检测pCR的区分能力与受试者工作特征分析进行比较。结果：pCR患者治疗前ADC显著低于无pCR患者（单位mm（2）/s：0.94 +/- 0.12 x 10（-3）vs. 1.19 +/- 0.22 x 10（-3），p = 0.003），检测pCR的灵敏度为100%，特异性为86%。RCT期间和之后，pCR患者的减容率显著高于无pCR患者（以%计：Δ V-期间：-62 +/-16 vs. -33 +/-16，p = 0.015; Δ V-后：-86 +/- 12 vs. -60 +/- 21，p = 0.012），得出Delta V-during的敏感性为83%，特异性为71%，Delta V-post的敏感性为83%，特异性为86%。Delta ADC在（Delta ADC（期间））和RCT后pCR患者的Δ ADC（后）值显著高于无pCR患者（以%计：Δ ADC（期间）：72 +/- 14 vs. 16 +/- 12，p = 0.0006; Δ ADC（后）：88 +/- 35 vs. 26 +/- 19，p = 0.0011），得出Delta ADC（治疗期间）的灵敏度和特异性分别为100%，Delta ADC（治疗后）的灵敏度和特异性分别为100%和93%。这些初步研究结果表明，DWI，使用治疗前ADC，Δ ADC（期间），和Δ ADC（后）可能是有用的预测和早期评估的病理反应，术前RCT的LARC，具有更高的准确性比体积测量。(C)2012 Elsevier Inc.
Purpose: To evaluate diffusion-weighted magnetic resonance imaging (DWI) for response prediction before and response assessment during and early after preoperative radiochemotherapy (RCT) for locally advanced rectal cancer (LARC).Methods and Materials: Twenty patients receiving RCT for LARC underwent MRI including DWI before RCT, after 10-15 fractions and 1 to 2 weeks before surgery. Tumor volume and apparent diffusion coefficient (ADC; b-values: 0-1000 s/mm(2)) were determined at all time points. Pretreatment tumor ADC and volume, tumor ADC change (Delta ADC), and volume change (Delta V) between pretreatment and follow-up examinations were compared with histopathologic findings after total mesorectal excision (pathologic complete response [pCR] vs. no pCR, ypT0-2 vs. ypT3-4, T-downstaging or not). The discriminatory capability of pretreatment tumor ADC and volume, Delta ADC, and Delta V for the detection of pCR was compared with receiver operating characteristics analysis.Results: Pretreatment ADC was significantly lower in patients with pCR compared with patients without (in mm(2)/s: 0.94 +/- 0.12 x 10(-3) vs. 1.19 +/- 0.22 x 10(-3),p = 0.003), yielding a sensitivity of 100% and specificity of 86% for detection of pCR. The volume reduction during and after RCT was significantly higher in patients with pCR compared with patients without (in %: Delta V-during: -62 +/- 16 vs. -33 +/- 16, respectively, p = 0.015; and Delta V-post: -86 +/- 12 vs. -60 +/- 21, p = 0.012), yielding a sensitivity of 83% and specificity of 71% for the Delta V-during and, respectively, 83% and 86% for the Delta V-post. The Delta ADC during (Delta ADC(during)) and after RCT (Delta ADC(post)) showed a significantly higher value in patients with pCR compared with patients without (in %: Delta ADC(during): 72 +/- 14 vs. 16 +/- 12, p = 0.0006; and Delta ADC(post): 88 +/- 35 vs. 26 +/- 19,p = 0.0011), yielding a sensitivity and specificity of 100% for the Delta ADC(during) and, respectively, 100% and 93% for the Delta ADC(post).Conclusions: These initial findings indicate that DWI, using pretreatment ADC, Delta ADC(during), and Delta ADC(post) may be useful for prediction and early assessment of pathologic response to preoperative RCT of LARC, with higher accuracy than volumetric measurements. (C) 2012 Elsevier Inc.