Department of Diagnostic Imaging, University Hospital Alexandrovska, Medical University of Sofia, 1431 Sofia, Bulgaria.
Department of Surgery, University Hospital Lozenetz, 1407 Sofia, Bulgaria.
Medicina (Kaunas). 2023 Dec 13;59(12):2162. doi: 10.3390/medicina59122162.
Colorectal cancer is the third most common oncological disease worldwide. The standard treatment of locally advanced rectal tumors is neoadjuvant radiochemotherapy in combination with surgical resection. The choice of specific treatment algorithm is highly dependent on MRI findings. The aim of this study is to show the potential role of ADC measurements in rectal cancer and their usage in different clinical scenarios. A total of 135 patients had rectal MRI evaluation. Seventy-five (56%) had histologically proven rectal adenocarcinoma and sixty (44%) were evaluated as rectal disease-free. An ADC measurement in the most prominent region of interest was obtained for all patients. Eighteen patients (24% of the rectal cancer group) had a second MRI after neoadjuvant chemoradiotherapy with comparison of the ADC values at the same region of interest as previously measured. Rectal cancer ADC values were found to be significantly lower than the ones in the control group ( < 0.001). A statistically significant correlation was found when ADC values in rectal tumors of different T stages were compared ( = 0.039)-those with higher T stage as in locally advanced disease showed lower ADC values. Patients with extramural vascular invasion showed significantly lower ADC values ( = 0.01). There was a significant increase in ADC values after treatment ( < 0.001), and a negative correlation was observed (r = -0.6572; = 0.004)-tumors with low initial ADC values showed a higher increase in ADC. ADC measurements have a complementary role in the assessment of rectal cancer and have the potential to predict the response to chemoradiotherapy and improve the planning of proper treatment strategies.
结直肠癌是全球第三大常见的肿瘤疾病。局部晚期直肠肿瘤的标准治疗方法是新辅助放化疗联合手术切除。具体治疗方案的选择高度依赖于 MRI 检查结果。本研究旨在展示 ADC 测量在直肠癌中的潜在作用及其在不同临床情况下的应用。
共有 135 例患者接受了直肠 MRI 评估。75 例（56%）患者经组织学证实为直肠腺癌，60 例（44%）患者被评估为直肠无疾病。所有患者均获得了最显著的感兴趣区域的 ADC 测量值。18 例（24%的直肠癌组）患者在新辅助放化疗后进行了第二次 MRI 检查，并对同一感兴趣区域的 ADC 值进行了比较。
直肠癌的 ADC 值明显低于对照组（<0.001）。当比较不同 T 分期直肠肿瘤的 ADC 值时，发现具有统计学意义的相关性（=0.039）——局部晚期疾病中 T 分期较高的肿瘤显示出较低的 ADC 值。有外膜血管侵犯的患者 ADC 值明显较低（=0.01）。治疗后 ADC 值显著升高（<0.001），并且观察到负相关（r = -0.6572；=0.004）——初始 ADC 值较低的肿瘤显示出更高的 ADC 值升高。
ADC 测量在评估直肠癌方面具有互补作用，有望预测放化疗反应并改善适当治疗策略的规划。
