Assessment of esophageal carcinoma undergoing concurrent chemoradiotherapy with quantitative dynamic contrast-enhanced magnetic resonance imaging

Abstract

Abstract. The aim of the present study was to investigate whether quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can predict an early response in primary esophageal carcinoma patients undergoing concurrent chemoradiotherapy. A total of 25 patients with who were pathologically confirmed stage II-III esophageal carcinoma underwent quantitative DCE-MRI prior to chemoradiotherapy, and at 3 weeks post-treatment, the quantitative parameters [K trans (volume transfer constant; the rate at which contrast agent distributes from the plasma to the EES), K ep (rate contrast; the rate at which the contrast agent that has diffused to the EES returns to the plasma) and V e (the contrast agent percentage in the space of the extracellular fluid)] were analyzed respectively. The 25 cases were categorized as a complete response (CR) or a partial response (PR). An independent samples Mann-Whitney U test was used to compare the quantitative parameters between CR and PR. A receiver operating characteristic curve (ROC) was used to determine the best predictor. In total, 17 patients were in the CR group and 8 patients were in the PR group. Pretreatment K trans , K ep and V e values were 0.54±0.17/min, 1.12±0.46/min and 0.37±0.14, respectively, in the CR group, and 0.40±0.21/min, 1.07±0.37/min and 0.40±0.22, respectively, in the PR group. There was a significant difference between the two groups for K trans , but there were no significant differences between the two groups for K ep and V e .The K trans , K ep and V e values at 3 weeks post-treatment were 0.33±0.11/min, 0.86±0.31/min and 0.66±0.05, respectively, in the CR group, and 0.62±0.22/min, 1.19±0.39/min and 0.45±0.19, respectively, in the PR group. The corresponding U values were -3.319, -1.719 and -2.628, respectively, and the P-values were 0.006, 0.119 and 0.021, respectively. The areas under the ROC curve of K trans prior to chemoradiotherapy, and of K trans and K ep at 3 weeks post-treatment were 0.648, 0.741 and 0.796, respectively. In conclusion, DCE-MRI can predict an early response in primary esophageal carcinoma following 3 weeks of concurrent chemoradiotherapy. K trans prior to chemoradiotherapy, and K trans and K ep at 3 weeks post-treatment are sensitive prediction parameters. IntroductionEsophageal carcinoma is a common disease, and >80% of cases occur in developing countries. In 2008, esophageal cancer was the eighth most common cancer worldwide and China was ranked with the fourth highest morbidity rate for esophageal cancer worldwide with a five-year survival rate of <40% (1). The early symptoms of the disease, which include difficulty swallowing and esophageal foreign body sensation, are not obvious, and thus the majority of patients are diagnosed at an advanced stage (2). At present, the most common diagnostic techniques involve the examination of esophageal function, and include imaging analysis and esophagoscopy (3). The current treatment methods for esophageal carcinoma include surgery, radiation therapy, chemotherapy, endoscopic ...

Esophageal carcinoma: Ex vivo evaluation by high‐spatial‐resolution T2‐mapping MRI compared with histopathological findings at 3.0T

“…However, the overall prognosis of esophageal carcinoma remains poor because the initial diagnoses are at later stages . Accurate preoperative staging of esophageal carcinoma has been quite difficult by usual imaging . Computed tomography (CT) has been widely used to identify the location of a cancer, relationship to surrounding organs, and to assess the distant metastasis; however, it cannot depict the specific layer invasion of the esophageal wall due to its poor soft‐tissue resolution .…”

Quantitative Multiparametric MRI May Augment the Response to Radiotherapy in Mid-Treatment Assessment of Patients with Esophageal Carcinoma

“…It may also provide a tool to assess therapeutic response [36]. The study has also confirmed that the quantitative parameters of DCE-MRI (K trans and Kep) can be used to supervise the early clinical effects of EC, which may lead to more objective and timely assessment of treatment [37]. De Cobelli et al [38] used DWI to assess gastroesophageal tumor response to neoadjuvant treatment and found that there was a negative correlation between changes in the apparent diffusion coefficient (ΔADC) and tumor regression grade.…”

Does GRASP affect DCE-MRI quantitative parameters and texture analysis in patients with esophageal cancer receiving preoperative neoadjuvant chemotherapy?

“…VS-GR DCE-MRI with three parameters of K trans , K ep and V e had been used in predicting an early response in primary EC patients undergoing concurrent chemoradiotherapy [2]; however, more texture features have not been used to assess the response to nCT treatment for EC. Although some scholars analyzed texture analysis in EC patients, most studies analyzed CT images, only a few adopted MR images.…”

“…The incidence rate of esophageal cancer (EC) is rising rapidly worldwide, and it has become the eighth most common cancer [1]. In China, squamous cell carcinoma (SCC) is the main pathological type of EC, and it has high-grade malignancy, rapid progression, poor response to treatment and high recurrence rate [2]. Moreover, the disease is associated with poor prognosis, limited quality of life after surgery [3] and a high incidence of postoperative morbidity and mortality [4][5][6].…”

“…FDG-PET seems to be a promising technique for predicting therapeutic response, however, more work is required in standardizing protocols and the time of scanning [10]. Although DCE-MRI had also showed the ability in predicting an early response in EC following 3 weeks of concurrent chemoradiotherapy in limited cases [2,11], it remains challenging for predicting response to nCT to find a noninvasive and more effectively imaging tool. Recently, golden-angle radial sparse parallel (GRASP) MRI has gained popularity, and has been applied to imaging of the liver, rectal cancer and renal cell carcinoma [12][13][14][15].…”