The value of diffusion kurtosis magnetic resonance imaging for assessing treatment response of neoadjuvant chemoradiotherapy in locally advanced rectal cancer
To evaluate the feasibility and value of diffusion kurtosis (DK) imaging in assessing treatment response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC).
Forty-one patients were included. All patients underwent pre- and post-CRT DCE-MRI on a 3.0-Tesla MRI scanner. Imaging indices (D app , K app and ADC values) were measured. Change value (∆X) and change ratio (r∆X) were calculated. Pathological tumour regression grade scores (Mandard) were the standard reference (good responders: pTRG 1-2; poor responders: pTRG 3-5). Diagnostic performance was compared using ROC analysis.
For the pre-CRT measurements, pre-D app-10th was significantly lower in the good responder group than that of the poor responder group (p = 0.036). For assessing treatment response to neoadjuvant CRT, pre-D app-10th resulted in AUCs of 0.753 (p = 0.036) with a sensitivity of 66.67 % and a specificity of 77.78 %. The r∆D app had a relatively high AUC (0.859) and high sensitivity (100 %) compared with other image indices.
DKI is feasible for selecting good responders for neoadjuvant CRT for LARC.
• LARC responded well after neoadjuvant chemoradiotherapy with lower pre-D app-10th .
• LARC responded well with greater increases in mean ADC and D app .
• The change ratio of D app (r∆D app ) had a relatively better diagnostic performance.
KeywordsLocally advanced rectal cancer Neoadjuvant chemoradiotherapy Diffusion kurtosis imaging Dapp ADC
Apparent diffusion coefficient
Apparent diffusion for Gaussian distribution
Diffusion kurtosis imaging
Apparent kurtosis coefficient
Locally advanced rectal cancer
MRI tumour regression grade
Pathological tumour regression grade
Receiver operating characteristic
The scientific guarantor of this publication is Hai-Bin Shi. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.
- 1.Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rodel C (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30:1926–1933CrossRefPubMedGoogle Scholar
- 4.Rodel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sulberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Kohler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R (2012) Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 13:679–687CrossRefPubMedGoogle Scholar
- 5.Sun YS, Zhang XP, Tang L, Ji JF, Gu J, Cai Y, Zhang XY (2010) Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted MR imaging for early detection of tumor histopathologic downstaging. Radiology 254:170–178CrossRefPubMedGoogle Scholar
- 7.Battersby NJ, Balyasnikova S, Brown G (2014) Guiding post-treatment decisions in rectal cancer: mrTRG is a practical place to start. Oncology (Williston Park) 28:677–680Google Scholar
- 8.Patel UB, Taylor F, Blomqvist L, George C, Evans H, Tekkis P, Quirke P, Sebag-Montefiore D, Moran B, Heald R, Guthrie A, Bees N, Swift I, Pennert K, Brown G (2011) Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 29:3753–3760CrossRefPubMedGoogle Scholar
- 9.Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF, Roussel A, Jacob JH, Segol P, Samama G, Et A (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 73:2680–2686CrossRefPubMedGoogle Scholar
- 10.Lambregts DM, Lahaye MJ, Heijnen LA, Martens MH, Maas M, Beets GL, Beets-Tan RG (2016) MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy. Eur Radiol 26:2118–2125CrossRefPubMedGoogle Scholar
- 11.Hötker AM, Tarlinton L, Mazaheri Y, Woo KM, Gönen M, Saltz LB, Goodman KA, Garcia-Aguilar J, Gollub MJ (2016) Multiparametric MRI in the assessment of response of rectal cancer to neoadjuvant chemoradiotherapy: a comparison of morphological, volumetric and functional MRI parameters. Eur RadiolGoogle Scholar
- 14.Jacobs L, Intven M, van Lelyveld N, Philippens M, Burbach M, Seldenrijk K, Los M, Reerink O (2015) Diffusion-weighted MRI for early prediction of treatment response on preoperative chemoradiotherapy for patients with locally advanced rectal cancer: a feasibility study. Ann Surg 263:522–528CrossRefGoogle Scholar
- 15.Lambrecht M, Vandecaveye V, De Keyzer F, Roels S, Penninckx F, Van Cutsem E, Filip C, Haustermans K (2012) Value of diffusion-weighted magnetic resonance imaging for prediction and early assessment of response to neoadjuvant radiochemotherapy in rectal cancer: preliminary results. Int J Radiat Oncol Biol Phys 82:863–870CrossRefPubMedGoogle Scholar
- 16.Musio D, De Felice F, Magnante AL, Ciolina M, De Cecco CN, Rengo M, Redler A, Laghi A, Raffetto N, Tombolini V (2013) Diffusion-weighted magnetic resonance application in response prediction before, during, and after neoadjuvant radiochemotherapy in primary rectal cancer carcinoma. Biomed Res Int 2013:740195CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Beets-Tan RG, Lambregts DM, Maas M, Bipat S, Barbaro B, Caseiro-Alves F, Curvo-Semedo L, Fenlon HM, Gollub MJ, Gourtsoyianni S, Halligan S, Hoeffel C, Kim SH, Laghi A, Maier A, Rafaelsen SR, Stoker J, Taylor SA, Torkzad MR, Blomqvist L (2013) Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 23:2522–2531CrossRefPubMedGoogle Scholar
- 21.Quentin M, Pentang G, Schimmoller L, Kott O, Muller-Lutz A, Blondin D, Arsov C, Hiester A, Rabenalt R, Wittsack HJ (2014) Feasibility of diffusional kurtosis tensor imaging in prostate MRI for the assessment of prostate cancer: preliminary results. Magn Reson Imaging 32:880–885CrossRefPubMedGoogle Scholar
- 22.Rosenkrantz AB, Sigmund EE, Johnson G, Babb JS, Mussi TC, Melamed J, Taneja SS, Lee VS, Jensen JH (2012) Prostate cancer: feasibility and preliminary experience of a diffusional kurtosis model for detection and assessment of aggressiveness of peripheral zone cancer. Radiology 264:126–135CrossRefPubMedGoogle Scholar
- 26.Vecchio FM, Valentini V, Minsky BD, Padula GD, Venkatraman ES, Balducci M, Micciche F, Ricci R, Morganti AG, Gambacorta MA, Maurizi F, Coco C (2005) The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys 62:752–760CrossRefPubMedGoogle Scholar
- 29.Barbaro B, Fiorucci C, Tebala C, Valentini V, Gambacorta MA, Vecchio FM, Rizzo G, Coco C, Crucitti A, Ratto C, Bonomo L (2009) Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology 250:730–739CrossRefPubMedGoogle Scholar
- 30.Curvo-Semedo L, Lambregts DM, Maas M, Thywissen T, Mehsen RT, Lammering G, Beets GL, Caseiro-Alves F, Beets-Tan RG (2011) Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy--conventional MR volumetry versus diffusion-weighted MR imaging. Radiology 260:734–743CrossRefPubMedGoogle Scholar
- 31.Nougaret S, Rouanet P, Molinari N, Pierredon MA, Bibeau F, Azria D, Lemanski C, Assenat E, Duffour J, Ychou M, Reinhold C, Gallix B (2012) MR volumetric measurement of low rectal cancer helps predict tumor response and outcome after combined chemotherapy and radiation therapy. Radiology 263:409–418CrossRefPubMedGoogle Scholar
- 34.Lambrecht M, Deroose C, Roels S, Vandecaveye V, Penninckx F, Sagaert X, van Cutsem E, de Keyzer F, Haustermans K (2010) The use of FDG-PET/CT and diffusion-weighted magnetic resonance imaging for response prediction before, during and after preoperative chemoradiotherapy for rectal cancer. Acta Oncol 49:956–963CrossRefPubMedGoogle Scholar
- 36.Woodhams R, Kakita S, Hata H, Iwabuchi K, Umeoka S, Mountford CE, Hatabu H (2009) Diffusion-weighted imaging of mucinous carcinoma of the breast: evaluation of apparent diffusion coefficient and signal intensity in correlation with histologic findings. AJR Am J Roentgenol 193:260–266CrossRefPubMedGoogle Scholar