Locally advanced rectal cancer: Qualitative and quantitative evaluation of diffusion-weighted MR imaging in the response assessment after neoadjuvant chemo-radiotherapy.
Locally advanced rectal cancer: Qualitative and quantitative evaluation of diffusion-weighted MR imaging in the response assessment after neoadjuvant chemo-radiotherapy.
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DOI：
10.1016/j.ejro.2016.06.003
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发表时间：
2016
影响因子：
2
通讯作者：
Ettorre GC
中科院分区：
文献类型：
--
作者：
Foti PV;Privitera G;Piana S;Palmucci S;Spatola C;Bevilacqua R;Raffaele L;Salamone V;Caltabiano R;Magro G;Li Destri G;Milone P;Ettorre GC
旨在研究弥散加权（DW）磁共振（MR）成像的定性和定量评估在局部晚期直肠癌（LARC）患者新辅助放化疗（CRT）后反应评估中的附加值。 31 名 LARC（阶段≥T3）患者参加了该研究。所有患者在开始治疗前和新辅助 CRT 后均接受了常规 MRI 和 DWI。所有患者均接受手术；病理分期代表了参考标准。为了进行定性分析，两名放射科医生回顾性审查了传统 MR 图像以及传统和 DW MR 图像的组合，并记录了他们关于完全响应 (ypCR) 的置信水平。为了进行定量分析，每次检查时都会测量肿瘤的表观扩散系数（ADC）值。比较三组缓解（ypCR、部分缓解 ypPR、疾病稳定 ypSD）的 CRT 前 ADC、CRT 后 ADC 和 ADC 后-ADC 前 Δ ADC。采用接受者操作特征（ROC）曲线分析来研究每个测量的 ypCR、应答者（ypCR、ypPR）和 ypSD 的区分能力。在传统 T2 加权序列中添加 DWI 可以提高 MRI 在 ypCR 评估中的诊断性能。 CRT 前检查中的低肿瘤 ADC 值、CRT 后检查中的高 ADC 值、高 Δ ADC post−ADC pre [>0.3 (×10−3 mm2/s)] 可以预测 ypCR。 DW 序列提高了 MR 评估肿瘤对 CRT 反应的能力。然而，单靠功能性 MR 技术似乎不足以安全地选择 ypCR 患者。
to investigate the added value of qualitative and quantitative evaluation of diffusion weighted (DW) magnetic resonance (MR) imaging in response assessment after neoadjuvant chemo-radiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). 31 patients with LARC (stage ≥ T3) were enrolled in the study. All patients underwent conventional MRI and DWI before starting therapy and after neoadjuvant CRT. All patients underwent surgery; pathologic staging represented the reference standard. For qualitative analysis, two radiologists retrospectively reviewed conventional MR images and the combined set of conventional and DW MR images and recorded their confidence level with respect to complete response (ypCR). For quantitative analysis, tumor’s apparent diffusion coefficient (ADC) values were measured at each examination. ADC pre-CRT, ADC post-CRT and Δ ADC post−ADC pre of the three groups of response (ypCR, partial response ypPR, stable disease ypSD) were compared. Receiver-operating characteristics (ROC) curve analysis was employed to investigate the discriminatory capability for ypCR, responders (ypCR, ypPR) and ypSD of each measure. addition of DWI to conventional T2-weighted sequences improved diagnostic performance of MRI in the evaluation of ypCR. A low tumor ADC value in the pre-CRT examination, a high ADC value in the post-CRT examination, a high Δ ADC post−ADC pre [>0.3 (×10−3 mm2/s)] were predictive of ypCR. DW sequences improve MR capability to evaluate tumor response to CRT. Nevertheless, no functional MR technique alone seems accurate enough to safely select patients with ypCR.