Performance of diffusion-weighted magnetic resonance imaging at 3.0T for early assessment of tumor response in locally advanced rectal cancer treated with preoperative chemoradiation therapy

Pizzi, Andrea Delli; Cianci, Roberta; Genovesi, Domenico; Esposito, Gianluigi; Timpani, Mauro; Tavoletta, Alessandra; Pulsone, Pierluigi; Basilico, Raffaella; Gabrielli, Daniela; Rosa, Consuelo; Caravatta, L.; Tommaso, M. Di; Caulo, Massimo; Filippone, Antonella

doi:10.1007/s00261-018-1457-8

Cited by 30 publications

(24 citation statements)

References 32 publications

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“…The Gynecological GEC-ESTRO Working Group gave recommendations for MRI-based adaptive target volume as well as for OARs (2). In addition, ADC values were considered a quantitative tool not only for diagnosis but also for the evaluation of treatment response in cervical cancer (19), as in other malignancies (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers

Rosa

Pizzi

Augurio

et al. 2020

In Vivo

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Aim: To delineate cervical cancer gross tumor volume (GTV) on T2-magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) maps, assessing volumes and inter-observer agreement between two observers. Patients and Methods: A radiologist and a radiation oncologist delineated GTV on T2 (T2 GTV) and ADC (ADC GTV) sequences. Dice similarity index (DICE) and Bland-Altman analysis were used to estimated concordance. Results: Mean T2 GTV and ADC GTV volumes were 43.84±71.47 cc and 37.28±68.92 cc according to the radiologist, and 43.4±70.44 cc and 36.65±69.21 cc according to the radiation oncologist. ADC led to statistically significantly smaller volumes compared to T2. The mean DICE index was 0.86 for T2 GTV and 0.84 for ADC GTV. The Bland-Altman plots globally showed concordance. Conclusion: GTV delineation was smaller in the ADC maps compared to T2-MRI, reaching an almost perfect agreement between observers. Thanks to this acceptable variability, adding functional imaging might provide more information for tumor delineation, improving reproducibility for image-guided adaptive radiotherapy. Nowadays, the mainstay of treatment for locally advanced cervical cancer (LACC) includes external beam radiotherapy (EBRT), concomitant chemotherapy and brachytherapy. T2weighted magnetic resonance imaging (MRI) is the imaging modality to be preferred for careful and accurate primary staging of the tumor (1, 2). Despite the extensive use of MRI, recent studies reported significant uncertainties in T2-weighted MRI delineation, describing a poor interobserver variability in brachytherapy target volume, represented by conformity indices of 0.58-0.60 for gross tumor volume (GTV) at brachytherapy, and 0.39-0.79 (mostly between 0.70-0.79) for high-risk clinical target volume (3, 4). Considering this aspect and the possible advantages of improved diagnostic techniques in a dose-intensification strategy, in particular in patients with higher risk of local relapse, its integration with diffusion-weighted MRI (DWI) might improve tumor volume definition in addition to patient outcome. In this way, a recent study demonstrated the accuracy of the apparent diffusion coefficient (ADC) map obtained at 2 weeks during radiotherapy in allowing an early prediction of treatment response (5). DWI-MRI is considered an encouraging functional imaging mode in the definition of a biological target volume, thanks to its capability for detecting highly metabolic regions. DWI-MRI evaluates the random motion of water molecules, mostly present in the extracellular space: compared to normal tissue, in cervical cancer, as in other neoplasms, tumor is densely cellular, showing restricted diffusion. This distribution is quantitatively well measured by ADC. In DWI, cancer has an increased signal intensity, which results in a reduction of the corresponding ADC map. It is well established that both DWI techniques as well as ADC measurement improves cervical cancer clinical assessment, regarding both tumor and nodal status, and histology (6). Few studies hav...

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Section: Discussionmentioning

confidence: 99%

Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers

Rosa

Pizzi

Augurio

et al. 2020

In Vivo

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“…The present study demonstrates that mean ADC values acquired from the primary tumours were significantly lower in EMVI (+) patients than in those without EMVI. Lower ADC values are expected in poorly differentiated tumours, and these tumours with low ADC values represent more aggressive behaviour [10,25]. Therewithal, ADC has been shown to be an indirect indicator of microvascular circulation [10,26].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Extramural Venous Invasion by Diffusion-Weighted Magnetic Resonance Imaging and Computed Tomography in Rectal Adenocarcinoma

et al. 2019

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Purpose The aim of this study is to evaluate the diagnostic contribution of diffusion-weighted magnetic resonance imaging (MRI) and computed tomography (CT) to distinguish extramural venous invasion (EMVI) in rectal adenocarcinoma. Materials and Methods Fifty-eight patients who had been diagnosed with rectal adenocarcinoma (30 patients with EMVI and 28 patients without EMVI) were enrolled in the study. Apparent diffusion coefficient (ADC) values of the tumour and the EMVI (+) vein, the lengths of the tumours were measured on MRI. The diameters of the superior rectal vein (SRV)-inferior mesenteric vein (IMV) and distant metastatic spread were evaluated on CT. The ability of these findings to detect EMVI was assessed using receiver operating characteristic (ROC) analysis. Pathology was accepted as the reference test for EMVI. Results Mean diameters of the SRV (4.9 ± 0.9 mm vs 3.7 ± 0.8 mm) and IMV (6.9 ± 0.8 mm vs 5.4 ± 0.9 mm) were significantly larger ( P < .001) and tumour ADC values were significantly lower (0.926 ± 0.281 × 10−3 mm2/s vs 1.026 ± 0.246 × 10−3 mm2/s; P = .032) in EMVI (+) patients. Diameters of 3.95 mm for the SRV (area under the curve [AUC] ± standard error [SE]: 0.851 ± 0.051, P < .001, sensitivity: 93.3%, specificity: 67.9%) and 5.95 mm for the IMV (AUC ± SE: 0.893 ± 0.040, P < .001, sensitivity: 93.3%, specificity: 71.4%) and an ADC value of 0.929 × 10−3 mm2/s (AUC ± SE: 0.664 ± 0.072, P = .032 sensitivity: 76.7%, specificity: 57.1%) were found to be cutoff values, determined by ROC analysis, for detection of EMVI. Distant metastases were significantly more prevalent in EMVI (+) patients ( P < .001). Conclusion The measurement of ADC values and SRV-IMV diameters seems to have contribution for diagnosis of EMVI in rectal adenocarcinoma. EMVI (+) patients appear to have higher risks of distant metastases at diagnosis.

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“…When the measurements were >10% different between the two reviewers, another series of measurements was performed by the same two reviewers to reach a consensus. Differences ≤10% were considered negligible and the average was reported ( 23 ). Moreover, the data obtained by each observer were used to calculate the intraclass correlation coefficient (ICC) and the inter-observer agreement.…”

Section: Methodsmentioning

confidence: 99%

The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer

Santos

Reyes-Pérez

Sandoval-Nava

et al. 2020

Acta Radiologica Open

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Background Apparent diffusion coefficient (ADC) values achieve promising results in treatment response prediction in patients with several types of cancers. Purpose To determine whether ADC values predict neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC). Material and Methods Forty-four patients with LARC who underwent magnetic resonance imaging scans before and after nCRT followed by delayed surgery were enrolled retrospectively. The sample was distributed as follows: responders (R), n = 8; and non-responders (Non-R), n = 36. Three markers of treatment response were considered: post-nCRT measures; ΔADC; and Δ%ADC. Statistical analysis included a Wilcoxon test, a Mann–Whitney U test, and a receiver operating characteristic (ROC) analysis in order to evaluate the diagnostic accuracy for each ADC value marker to differentiate between R and Non-R. Results Both minimum and mean ADC values were significantly higher after nCRT in the R group, while non-significant differences between basal and control ADC values were found in the non-R group. In addition, ΔADC and Δ%ADC exhibited increased values after nCRT in R when compared with non-R. ROC analysis revealed the following diagnostic performance parameters: post-nCRT: ADCmin = 1.05 × 10−3 mm2/s (sensitivity 61.1% and specificity 66.7%), ADCmean = 1.50 × 10−3 mm2/s (sensitivity 72.2% and specificity 83.3%), ΔADC: ADCmin = 0.35 (sensitivity 66.7% and specificity 83.3%), ADCmean = 0.50 (sensitivity 72% and specificity 83%); and Δ%ADC: ADCmin = 44% (sensitivity 66.7% and specificity 83.3%) and ADCmean = 60% (sensitivity 83% and specificity 99%). Conclusion Our findings suggest that post-treatment rectal tumor ADC values, as well changes between pre- and post-treatment values, may be biomarkers for predicting treatment response in patients with LARC who underwent nCRT.

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Performance of diffusion-weighted magnetic resonance imaging at 3.0T for early assessment of tumor response in locally advanced rectal cancer treated with preoperative chemoradiation therapy

Abstract: ΔADC at 2 weeks after the beginning of CRT is a reliable tool to early assess treatment response.

Cited by 30 publications

References 32 publications

Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers

Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers

Evaluation of Extramural Venous Invasion by Diffusion-Weighted Magnetic Resonance Imaging and Computed Tomography in Rectal Adenocarcinoma

The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer

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