Diffusion and perfusion MR parameters to assess preoperative short-course radiotherapy response in locally advanced rectal cancer: a comparative explorative study among Standardized Index of Shape by DCE-MRI, intravoxel incoherent motion- and diffusion kurtosis imaging-derived parameters
- Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Division of Radiology (Italy)
- Department of Electrical Engineering and Information Technologies (DIETI) (Italy)
- Siemens Healthcare GmbH (Germany)
- Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Division of Gastrointestinal Surgical Oncology (Italy)
- Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Division of Diagnostic Pathology (Italy)
- Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Division of Gastrointestinal Medical Oncology (Italy)
- Division of Radiotherapy, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale (Italy)
Purpose: To assess preoperative short-course radiotherapy (SCR) tumor response in locally advanced rectal cancer (LARC) by means of Standardized Index of Shape (SIS) by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters derived from diffusion-weighted MRI (DW-MRI). Materials and methods: Thirty-four patients with LARC who underwent MRI scans before and after SCR followed by delayed surgery, retrospectively, were enrolled. SIS, ADC, IVIM parameters [tissue diffusion (D{sub t}), pseudo-diffusion (D{sub p}), perfusion fraction (f{sub p})] and DKI parameters [mean diffusivity (MD), mean of diffusional kurtosis (MK)] were calculated for each patient. IVIM parameters were estimated using two methods, namely conventional biexponential fitting (CBFM) and variable projection (VARPRO). After surgery, the pathological TNM and tumor regression grade (TRG) were estimated. For each parameter, percentage changes between before and after SCR were evaluated. Furthermore, an artificial neural network was trained for outcome prediction. Nonparametric sample tests and receiver operating characteristic curve (ROC) analysis were performed. Results: Fifteen patients were classified as responders (TRG ≤ 2) and 19 as not responders (TRG > 3). Seven patients had TRG 1 (pathological complete response, pCR). Mean and standard deviation values of pre-treatment CBFM D{sub p} and mean value of VARPRO D{sub p} pre-treatment showed statistically significant differences to predict pCR. (p value at Mann–Whitney test was 0.05, 0.03 and 0.008, respectively.) Exclusively SIS percentage change showed significant differences between responder and non-responder patients after SCR (p value << 0.001) and to assess pCR after SCR (p value << 0.001). The best results to predict pCR were obtained by VARPRO Fp mean value pre-treatment with area under ROC of 0.84, a sensitivity of 96.4%, a specificity of 71.4%, a positive predictive value (PPV) of 92.9%, a negative predictive value (NPV) of 83.3% and an accuracy of 91.2%. The best results to assess after treatment complete pathological response were obtained by SIS with an area under ROC of 0.89, a sensitivity of 85.7%, a specificity of 92.6%, a PPV of 75.0%, a NPV of 96.1% and an accuracy of 91.2%. Moreover, the best results to differentiate after treatment responders vs. non-responders were obtained by SIS with an area under ROC of 0.94, a sensitivity of 93.3%, a specificity of 84.2%, a PPV of 82.4%, a NPV of 94.1% and an accuracy of 88.2%. Promising initial results were obtained using a decision tree tested with all ADC, IVIM and DKI extracted parameter: we reached high accuracy to assess pathological complete response after SCR in LARC (an accuracy of 85.3% to assess pathological complete response after SCR using VARPRO D{sub p} mean value post-treatment, ADC standard deviation value pre-treatment, MD standard deviation value post-treatment). Conclusion: SIS is a hopeful DCE-MRI angiogenic biomarker to assess preoperative treatment response after SCR with delayed surgery. Furthermore, an important prognostic role was obtained by VARPRO F{sub p} mean value pre-treatment and by a decision tree composed by diffusion parameters derived by DWI and DKI to assess pathological complete response.
- OSTI ID:
- 22925066
- Journal Information:
- Abdominal Radiology (Online), Vol. 44, Issue 11; Other Information: Copyright (c) 2019 Springer Science+Business Media, LLC, part of Springer Nature; Country of input: International Atomic Energy Agency (IAEA); ISSN 2366-0058
- Country of Publication:
- United States
- Language:
- English
Similar Records
SU-F-R-48: Early Prediction of Pathological Response of Locally Advanced Rectal Cancer Using Perfusion CT:A Prospective Clinical Study
TU-CD-BRB-09: Prediction of Chemo-Radiation Outcome for Rectal Cancer Based On Radiomics of Tumor Clinical Characteristics and Multi-Parametric MRI