Intven Martijn, Monninkhof Evelyn M, Reerink Onne, Philippens Marielle E P
a Department of Radiotherapy , University Medical Center Utrecht , Utrecht , The Netherlands.
b Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , The Netherlands.
Acta Oncol. 2015 Nov;54(10):1729-36. doi: 10.3109/0284186X.2015.1037010. Epub 2015 Apr 27.
To assess the value of combined T2-weighted magnetic resonance imaging (MRI) (T2w) volumetry, diffusion-weighted (DW)-MRI and dynamic contrast enhanced (DCE)-MRI for pathological response prediction after neo-adjuvant chemoradiation (CRT) in locally advanced rectal cancer (LARC).
MRI with DW-MRI and DCE-MRI sequences was performed before start of CRT and before surgery. After surgery, the tumor regression grade (TRG) was obtained based on the score by Mandard et al. Pathological complete responders (pCR, TRG 1), and pathological good responders (GR, TRG 1 + 2) were compared to non-pCR and non-GR patients, respectively.
In total 55 patients were analyzed, six had a pCR (10.9%) and 10 a GR (18.2%). Favorable responders had a larger decrease in tumor volume and Ktrans and a larger increase in apparent diffusion coefficient (ADC) values compared to non-responders. ADC change showed the best diagnostic accuracy for pCR. For GR, the model including ADC change and volume change showed the best diagnostic performance. However, this performance was not statistically better compared to the model with ADC change alone. Inclusion of Ktrans change did not increase the diagnostic accuracy for pathological favorable response.
This explorative study showed that ADC change is a promising diagnostic tool for pCR and GR. Volume decrease showed potential limited additional diagnostic value for GR while Ktrans change showed no additional diagnostic value for pCR and GR.
评估联合使用T2加权磁共振成像（MRI）（T2w）容积测量、扩散加权（DW）-MRI和动态对比增强（DCE）-MRI预测局部晚期直肠癌（LARC）新辅助放化疗（CRT）后病理反应的价值。
在CRT开始前及手术前进行包含DW-MRI和DCE-MRI序列的MRI检查。术后，根据Mandard等人的评分获得肿瘤退缩分级（TRG）。分别将病理完全缓解者（pCR，TRG 1）和病理良好缓解者（GR，TRG 1 + 2）与非pCR和非GR患者进行比较。
共分析了55例患者，6例达到pCR（10.9%），10例达到GR（18.2%）。与无反应者相比，反应良好者的肿瘤体积和Ktrans下降幅度更大，表观扩散系数（ADC）值增加幅度更大。ADC变化对pCR显示出最佳诊断准确性。对于GR，包含ADC变化和体积变化的模型显示出最佳诊断性能。然而，与仅包含ADC变化的模型相比，该性能在统计学上并无显著更好。纳入Ktrans变化并未提高对病理良好反应的诊断准确性。
这项探索性研究表明，ADC变化是预测pCR和GR的一种有前景的诊断工具。体积减小对GR显示出潜在的有限附加诊断价值，而Ktrans变化对pCR和GR均未显示出附加诊断价值。
