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Quantitative aspects of diffusion-weighted magnetic resonance imaging in rectal cancer response to neoadjuvant therapy

Thiago Bassaneze

Thiago Bassaneze

Department of Gastrointestinal Surgery, State Public Servant Hospital of São PauloSão Paulo, Brazil
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Bassaneze, Thiago
, 
José Eduardo Gonçalves

José Eduardo Gonçalves

Department of Gastrointestinal Surgery, State Public Servant Hospital of São PauloSão Paulo, Brazil
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Gonçalves, José Eduardo
, 
Juliano Ferreira Faria

Juliano Ferreira Faria

Department of Diagnostic Imaging, Federal University of São PauloSão Paulo, Brazil
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Faria, Juliano Ferreira
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Rogério Tadeu Palma

Rogério Tadeu Palma

  • Department of Gastrointestinal Surgery, State Public Servant Hospital of São PauloSão Paulo, Brazil
  • Department of Gastrointestinal Surgery, ABC Medical SchoolSanto André, Brazil
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Palma, Rogério Tadeu
 y 
Jaques Waisberg

Jaques Waisberg

  • Department of Gastrointestinal Surgery, State Public Servant Hospital of São PauloSão Paulo, Brazil
  • Department of Gastrointestinal Surgery, ABC Medical SchoolSanto André, Brazil
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Waisberg, Jaques
  
25 jun 2017
Quantitative aspects of diffusion-weighted magnetic resonance imaging in rectal cancer response to neoadjuvant therapy's Cover Image
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Categoría del artículo: Research Article
Publicado en línea: 25 jun 2017
Páginas: 270 - 276
Recibido: 06 dic 2016
Aceptado: 01 jun 2017
DOI: https://doi.org/10.1515/raon-2017-0025
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© 2017 Thiago Bassaneze, José Eduardo Gonçalves, Juliano Ferreira Faria, Rogério Tadeu Palma, Jaques Waisberg
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Sample of a T2-weighted MRI, DW-MRI (b-value 1000 s/mm2), and ADC map from a locally advanced rectal tumor. The red arrows point to different aspects of the left lateral pre-CRT tumor area. The yellow arrows point to the cancer shrinkage in the post-CRT. Pre- and post-CRT ADC values were 0.92 × 10−3 mm2/s and 1.50 × 10−3 mm2/s, with pCR in the surgical specimen.
Sample of a T2-weighted MRI, DW-MRI (b-value 1000 s/mm2), and ADC map from a locally advanced rectal tumor. The red arrows point to different aspects of the left lateral pre-CRT tumor area. The yellow arrows point to the cancer shrinkage in the post-CRT. Pre- and post-CRT ADC values were 0.92 × 10−3 mm2/s and 1.50 × 10−3 mm2/s, with pCR in the surgical specimen.

Figure 2

Correlation between ADC values and final T staging. (A) The pre-CRT ADC values were similar in the different groups (blue bars, (p > 0.05), although post-CRT ADC values differed in each group (green bars, p < 0.01); statistical significance (*). (B) Post-CRT ADC values with a moderate negative correlation and slope different from zero degrees (Spearman’s Rho = -0.54; 95% confidence interval -0.75 to -0.24). (C) Box plot analysis between post-CRT ADC values and final T staging. The pCR ADC-median value (1.53 × 10’−3 mm2/s) is far away from the lower and upper boundaries of the non-pCR box (p < 0.01).
Correlation between ADC values and final T staging. (A) The pre-CRT ADC values were similar in the different groups (blue bars, (p > 0.05), although post-CRT ADC values differed in each group (green bars, p < 0.01); statistical significance (*). (B) Post-CRT ADC values with a moderate negative correlation and slope different from zero degrees (Spearman’s Rho = -0.54; 95% confidence interval -0.75 to -0.24). (C) Box plot analysis between post-CRT ADC values and final T staging. The pCR ADC-median value (1.53 × 10’−3 mm2/s) is far away from the lower and upper boundaries of the non-pCR box (p < 0.01).

Figure 3

Receiver operating characteristic (ROC) curve and histogram in patients with rectal carcinoma with a normal distribution. (A) The optimal post-CRT ADC cutoff value 1.49 × 10−3 mm2/s (area under the curve = 0.95). (B) Histogram. The mean post-CRT ADC values of patients with pCR was 1.53 (± 1.96 × 0.15 × 10−3 mm2/s) and of patients with non-pCR 1.16 (± 1.96 × 0.19 × 10−3 mm2/s); the area in gray highlights the possible overlap in these values.
Receiver operating characteristic (ROC) curve and histogram in patients with rectal carcinoma with a normal distribution. (A) The optimal post-CRT ADC cutoff value 1.49 × 10−3 mm2/s (area under the curve = 0.95). (B) Histogram. The mean post-CRT ADC values of patients with pCR was 1.53 (± 1.96 × 0.15 × 10−3 mm2/s) and of patients with non-pCR 1.16 (± 1.96 × 0.19 × 10−3 mm2/s); the area in gray highlights the possible overlap in these values.

Calculation of diagnostic performance of conventional T2W MRI and combined set of conventional T2W MRI in addition to DWI for the diagnosis of complete rectal cancer response to neoadjuvant therapy

T2W 95% CI T2W + DWI 95% CI
Sensitivity% 86.9 (0.65−0.96) 96.1 (0.78−0.99)
Specificity% 50 (0.20−0.79) 71.4 (0.30−0.94)
PPV% 80 (0.58−0.92) 92.6 (0.74−0.98)
NPV% 62.5 (0.25−0.89) 83.3 (0.36−0.99)
Accuracy% 75.7 (0.57−0.88) 81.8 (0.63−0.92)

The patients’ clinical characteristics and patohystologic characteristics of the tumor

All pCR non-pCR
Average age, years 59.6 ±11.5 58.5 ±11.2 59.9 ±11.8
Gender

= number of individuals; CRT = chemoradiotherapy; pCR = pathologic complete response
   Male 18 5 13
   Female 15 2 13
Clinical T stage pre-CRT (MRI classification)

= number of individuals; CRT = chemoradiotherapy; pCR = pathologic complete response
   T2 3 1 2
   T3 23 5 18
   T4 7 1 6
Average tumor distance to the anus (cm)

= number of individuals; CRT = chemoradiotherapy; pCR = pathologic complete response

 5.1 (± 2.2) 6.1 (± 1.3) 4.8 (± 2.3)
Type of resection

= number of individuals; CRT = chemoradiotherapy; pCR = pathologic complete response
   Low anterior resection 15 3 12
   Abdominoperineal resection 15 4 11
   Pelvic exenteration 3 0 3
Histologic grade (biopsy)

= number of individuals; CRT = chemoradiotherapy; pCR = pathologic complete response
   Well differentiated 6 2 4
   Moderately differentiated 23 4 19
   Poorly differentiated 4 1 3
Idioma:
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Calendario de la edición:
4 veces al año
Temas de la revista:
Medicina, Medicina Clínica, Medicina Interna, Hematología, oncología, Radiología
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