Abdominal Radiology

, Volume 42, Issue 5, pp 1310–1318 | Cite as

Investigation of volumetric apparent diffusion coefficient histogram analysis for assessing complete response and clinical outcomes following pre-operative chemoradiation treatment for rectal carcinoma

  • Vijay Chidambaram
  • James D. Brierley
  • Bernard Cummings
  • Rajesh Bhayana
  • Ravi J. Menezes
  • Erin D. Kennedy
  • Richard Kirsch
  • Kartik S. JhaveriEmail author



To investigate the relationship of pre-treatment volumetric apparent diffusion coefficient (ADC) histogram parameters with post-operative histopathologic treatment response and clinical outcomes following pre-operative chemoradiation treatment (CRT) in rectal cancer.

Materials and methods

In a Health Insurance Portability and Accountability Act compliant retrospective study, 78 rectal cancer patients treated with pre-operative CRT and rectal MRI were included. MR imaging analysis was performed using OncoTREAT (software tool). Multiple volumetric ADC histogram parameters (voxel distribution across ADC ranges, kurtosis, and skewness) were assessed. Correlation was made to post-operative pathological complete response, clinical, or radiological evidence of disease progression using the Mann–Whitney test.


Post CRT, 8 patients showed pathologic complete response and 13 patients showed distant disease progression. Pre-treatment mean ADC was 1.2 × 10−3 mm2/s (range 0.3–1.99 × 10−3 mm2/s). Mean kurtosis measured was 0.56 (range −1 to 6; SD 1.36). Mean skewness was 0.3 (range −1 to 2; SD 0.69). Skewness had significant correlation (p value = 0.006) with disease progression. The mean rectal tumor volume was 24cc (range 1cc–134cc). Pre-treatment MRI tumor volume showed significant correlation (p value = 0.013) with pathologic complete response. Mean ADC and percentage voxels distribution against ADC ranges had no significant correlation with treatment response or disease outcomes.


Volumetric ADC histogram analysis of pre-CRT rectal cancer MRI appears promising for prediction of post-CRT complete response and disease progression.


Rectal carcinoma Diffusion-weighted MRI Apparent diffusion coefficient (ADC) Chemoradiation treatment (CRT) 



Robert Grimm, Siemens Healthcare GmbH, Application Predevelopment, Erlangen, Germany for providing the MR imaging analysis software, OncoTreat.

Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Vijay Chidambaram
    • 1
  • James D. Brierley
    • 2
  • Bernard Cummings
    • 2
  • Rajesh Bhayana
    • 3
  • Ravi J. Menezes
    • 4
  • Erin D. Kennedy
    • 5
  • Richard Kirsch
    • 6
  • Kartik S. Jhaveri
    • 7
    • 8
    Email author
  1. 1.Royal Liverpool and Broadgreen University Hospitals, NHS TrustLiverpoolUK
  2. 2.Department of Radiation Oncology, Princess Margaret Cancer Centre, Princess Margaret HospitalUniversity of TorontoTorontoCanada
  3. 3.Department of Medical Imaging, JDMI ResearchUniversity of TorontoTorontoCanada
  4. 4.Joint Department of Medical Imaging, JDMI ResearchUniversity Health NetworkTorontoCanada
  5. 5.Division of General Surgery, Mount Sinai HospitalUniversity of TorontoTorontoCanada
  6. 6.Pathology & Lab Medicine Department, Mount Sinai HospitalUniversity of TorontoTorontoCanada
  7. 7.Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College HospitalUniversity of TorontoTorontoCanada
  8. 8.Department of Radiology, Princess Margaret HospitalUniversity of TorontoTorontoCanada

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