MR Imaging with Apparent Diffusion Coefficient Histogram Analysis: Evaluation of Locally Advanced Rectal Cancer after Chemotherapy and Radiation Therapy
MR Imaging with Apparent Diffusion Coefficient Histogram Analysis: Evaluation of Locally Advanced Rectal Cancer after Chemotherapy and Radiation Therapy
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DOI：
10.1148/radiol.2018171804
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发表时间：
2018-07-01
期刊：
影响因子：
19.7
通讯作者：
Imai, Yutaka
中科院分区：
文献类型：
--
作者：
Enkhbaatar, Nandin-Erdene;Inoue, Shigeaki;Imai, Yutaka
目的：应用磁共振（MR）表观扩散系数（ADC）直方图分析局部晚期直肠癌（LARC）患者对新辅助化疗和放疗的反应。材料与方法：92例LARC患者在化疗和放疗（CRT）前后行直肠钡餐MR成像。直肠钡剂扩张使管腔扩张，CRT前后成像几何形状相似，消除粪便、空气和残余液体。评估t2加权图像、ADC变化百分比、ADC直方图偏度和峰度。组织病理学肿瘤消退等级（TRG）从1a级（66%-99%肿瘤细胞残留）到3级（无残留细胞）不等。采用Wilcoxon符号秩检验、Spearman相关检验、多变量线性回归和单因素方差分析确定肿瘤大小与ADC在预处理后和预处理后的差异和相关性。结果：92例患者中，TRG 3 16例（17.4%），TRG 2b 27例（29.3%），TRG 2a 24例（26.1%），TRG 1b 14例（15.2%），TRG 1a 11例（12%）。crt后偏度（回归系数=10.9，P= 0.06）和ADC变化百分比（回归系数=-0.18，P= 0.03）与肿瘤残留百分比相关。crt后偏度和ADC变化百分比分别与组织病理学TRG呈负相关和正相关（crt后偏度：P= 0.024； ADC变化百分比：P= 0.001）。结论：在LARC患者中，CRT后ADC直方图的偏度和ADC的百分比变化有助于预测新辅助CRT的良好反应。(c) RSNA， 2018年
Purpose: To determine response to neoadjuvant chemotherapy and radiation therapy in patients with locally advanced rectal cancer (LARC) by using magnetic resonance (MR) apparent diffusion coefficient (ADC) histogram analysis.Materials and Methods: Ninety-two patients with LARC underwent MR imaging with rectal barium before and after chemotherapy and radiation therapy (CRT). Rectal expansion with barium expanded the lumen, provided similar imaging geometry before and after CRT, and eliminated fecal matter, air, and residual fluid. T2-weighted images, the percentage change in ADC, and ADC histogram skewness and kurtosis were assessed. The histopathologic tumor regression grade (TRG) ranged from 1a (66%-99% residual tumor cells) to 3 (no residual cells). The Wilcoxon signed-rank test, the Spearman correlation test, multivariable linear regression, and one-way analysis of variance were used to determine post-and pretreatment differences and correlations between tumor size and ADC.Results: Of the 92 patients, 16 (17.4%) had TRG 3, 27 (29.3%) had TRG 2b, 24 (26.1%) had TRG 2a, 14 (15.2%) had TRG 1b, and 11 (12%) had TRG 1a. Post-CRT skewness (regression coefficient=10.9, P=.06) and percentage ADC change (regression coefficient=-0.18, P=.03) were associated with the percentage of residual tumor. Post-CRT skewness and percentage ADC change, respectively, showed negative and positive correlation with histopathologic TRG (post-CRT skewness: P=.024; percentage ADC change: P=.001).Conclusion: In patients with LARC, post-CRT skewness of the ADC histogram and percentage change in ADC were useful for predicting a favorable response to neoadjuvant CRT. (c) RSNA, 2018