Department of Radiology, The Netherlands Cancer Institute, PO Box 90203 1066 CX Amsterdam, The Netherlands.
Department of Surgery, The Netherlands Cancer Institute, PO Box 90203 1066 CX Amsterdam, The Netherlands.
Eur J Radiol. 2017 Oct;95:155-168. doi: 10.1016/j.ejrad.2017.08.009. Epub 2017 Aug 12.
Aim was to perform a systematic review to evaluate the clinical value of dynamic contrast-enhanced (DCE) MRI in rectal cancer.
A systematic search was performed on Pubmed, Embase and the Cochrane library. Studies that evaluated DCE-MRI for tumour aggressiveness, primary staging and restaging after chemoradiation (CRT) were included. Information on population, DCE technique, DCE parameters and outcome (angiogenesis, staging and response) were extracted.
19 studies were identified; 10 evaluated quantitative analyses, 6 semiquantitative analyses and 3 evaluated both. 8 studies evaluated correlation between DCE-parameters and angiogenesis or tumour aggressiveness, 11 studies evaluated response prediction pre- and post-CRT. Semiquantitative washin parameters showed a significantly positive correlation with angiogenesis, while for quantitative analyses conflicting results were found. Conflicting results were also reported for the correlation between DCE parameters and tumour aggressiveness: both higher and lower vascularity in more aggressive tumours are reported, while some studies report no correlation. Six studies showed a predictive value of Ktrans for response. A high Ktrans pre-CRT was significantly correlated with a complete/good response, but the reported pre-CRT Ktrans varied substantially (0.36-1.93). After CRT a reduction in Ktrans of 32%-36% was significantly associated with response. For semiquantitative analyses pre-CRT late slope was reported to be significantly lower in good responders, however only few studies exist on semiquantitative analyses of post-CRT DCE-MRI.
DCE-MRI in rectal cancer is promising mainly for prediction and assessment of response to CRT, where a high pre-CRT Ktrans and a decrease in Ktrans are significantly predictive for response.
旨在进行系统评价，评估动态对比增强（DCE）MRI 在直肠癌中的临床价值。
在 Pubmed、Embase 和 Cochrane 图书馆上进行了系统搜索。纳入评估 DCE-MRI 对肿瘤侵袭性、原发分期和放化疗（CRT）后再分期的研究。提取有关人群、DCE 技术、DCE 参数和结果（血管生成、分期和反应）的信息。
共确定了 19 项研究；其中 10 项评估了定量分析，6 项评估了半定量分析，3 项评估了两者。8 项研究评估了 DCE 参数与血管生成或肿瘤侵袭性之间的相关性，11 项研究评估了 CRT 前后的反应预测。半定量 Washin 参数与血管生成呈显著正相关，而定量分析结果则存在差异。DCE 参数与肿瘤侵袭性之间的相关性也存在争议：报道称侵袭性更高的肿瘤中血管生成更高或更低，而一些研究则报道无相关性。6 项研究显示 Ktrans 对反应有预测价值。较高的 CRT 前 Ktrans 与完全/良好反应显著相关，但报道的 CRT 前 Ktrans 差异很大（0.36-1.93）。CRT 后 Ktrans 减少 32%-36%与反应显著相关。对于半定量分析，报道称良好反应者的 CRT 前晚期斜率显著降低，但关于 CRT 后 DCE-MRI 半定量分析的研究较少。
DCE-MRI 在直肠癌中具有很大的应用潜力，主要用于预测和评估 CRT 反应，其中 CRT 前 Ktrans 较高和 Ktrans 降低与反应显著相关。
