Palmisano A, Esposito A, Di Chiara A, Ambrosi A, Passoni P, Slim N, Fiorino C, Albarello L, Di Muzio N, Calandrino R, Rosati R, Del Maschio A, De Cobelli F
Clinical and Experimental Radiology, Experimental Imaging Centre, San Raffaele Hospital, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy.
Clinical and Experimental Radiology, Experimental Imaging Centre, San Raffaele Hospital, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy.
Clin Radiol. 2018 Jun;73(6):555-563. doi: 10.1016/j.crad.2018.01.007. Epub 2018 Feb 17.
To investigate the potential role of an additional magnetic resonance imaging (MRI) examination performed during neoadjuvant chemoradiation therapy (CRT) in the prediction of pathological response in locally advanced rectal cancer (LARC).
Forty-eight consecutive patients with LARC underwent neoadjuvant CRT. MRI studies at 1.5 T, including high-resolution T2-weighted sequences that were acquired parallel and perpendicular to the main axis of the tumour were performed before (preMRI), during (midMRI), and 6-8 weeks after the end of CRT (postMRI). Cancer volumes (V, V, V) were drawn manually and the reduction rate calculated (ΔV, ΔV). According to Rödel's pathological tumour regression grade (TRG), patients were considered non-responders (NR; TRG0-2), partial responders (PR; TRG3), and complete responders (CR; TRG4). Multivariate regression analysis was performed to identify the best MRI predictors of NR, PR, and CR.
Twenty-five patients were considered PR (52%), 13 CR (27%), and 10 NR (22%). Tumour shrinkage mainly occurred shortly after CRT (ΔV: CR: 80±10% versus PR: 56±19% versus NR: 28±22%, p=2.2×10). V, V, ΔV, and ΔV correlated with TRG (p<0.001). At multivariate analysis, the combined assessment of V and ΔV was selected as the best predictor of response to CRT, in that it distinguishes CR, PR, and NR early and accurately (81.5%).
MidMRI allows final response assessment to neoadjuvant CRT earlier and better than the MRI performed after the end of CRT. MRI findings at midMRI may be useful to tailor patient treatment.
探讨在新辅助放化疗（CRT）期间进行额外的磁共振成像（MRI）检查对局部晚期直肠癌（LARC）病理反应预测的潜在作用。
48例连续的LARC患者接受新辅助CRT。在CRT前（preMRI）、期间（midMRI）以及CRT结束后6 - 8周（postMRI）进行1.5T的MRI研究，包括与肿瘤主轴平行和垂直采集的高分辨率T2加权序列。手动绘制癌体积（Vpre、Vmid、Vpost）并计算缩小率（ΔVpre、ΔVmid）。根据Rödel的病理肿瘤退缩分级（TRG），患者被分为无反应者（NR；TRG0 - 2）、部分反应者（PR；TRG3）和完全反应者（CR；TRG4）。进行多变量回归分析以确定NR、PR和CR的最佳MRI预测指标。
25例患者为PR（52%），13例为CR（27%），10例为NR（22%）。肿瘤缩小主要发生在CRT后不久（ΔV：CR：80±10% 对比 PR：56±19% 对比 NR：28±22%，p = 2.2×10）。Vpre、Vmid、ΔVpre和ΔVmid与TRG相关（p < 0.001）。在多变量分析中，Vmid和ΔVmid的联合评估被选为CRT反应的最佳预测指标，因为它能早期且准确地区分CR、PR和NR（81.5%）。
MidMRI比CRT结束后进行的MRI能更早、更好地对新辅助CRT的最终反应进行评估。MidMRI的MRI表现可能有助于调整患者的治疗方案。
