Department of Radiology, Ordu Fatsa State Hospital, Evkaf, Hastane Yolu No:5, 52400, Fatsa/Ordu, Turkey.
Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey.
Abdom Radiol (NY). 2024 Nov;49(11):3768-3779. doi: 10.1007/s00261-024-04389-3. Epub 2024 Jun 1.
To investigate the effectiveness of multiparametric MRI examination in determining tumor response after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal tumors.
46 patients with locally advanced rectal adenocarcinoma were included and were divided into two groups as complete responders and nonresponders based on Mandard score. On MRI, relative T2w signal intensity and ADC values obtained before and after treatment and tumour volumes in dynamic contrast enhanced images (DCI) were used to determine complete response to treatment.
There were no significant differences between mean ADC values obtained by single slice ADC and three circular ROI methods. There were significant differences between two groups in terms of Post-CRT ADC value, ΔADC and %ΔADC obtained by whole tumour volume ADC method (p < 0.05). There were significant differences between Pre-CRT and Post-CRT volume values. ΔV DCI and %ΔV DCI, ΔV ADC and T2w volume values were significantly lower in complete responders (p < 0.05). In multivariate analysis, sensitivity and specificity were calculated as 88.9% and 91.9% (AUC = 0.943) when Post-CRT mean ADC value and Post-CRT DCI volume values were used together, and sensitivity and specificity were calculated as 88.9% and 94.6% (AUC = 0.949) when ΔADC and Post-CRT DCI volume values were used together.
Whole tumour volume mean ADC value is the most useful method to determine treatment response. Post-CRT DCI volume measurement stands out as the most useful method in assessing complete response alone. The highest diagnostic values are achieved when the post-CRT DCI volume is combined with the ADC change value of the whole tumor volume.
探讨多参数 MRI 检查在确定局部晚期直肠肿瘤新辅助放化疗（CRT）后肿瘤反应中的有效性。
纳入 46 例局部晚期直肠腺癌患者，根据 Mandard 评分分为完全缓解组和非缓解组。在 MRI 上，根据治疗前后获得的相对 T2w 信号强度和 ADC 值以及动态对比增强图像（DCI）中的肿瘤体积来确定对治疗的完全反应。
单层面 ADC 和 3 个圆形 ROI 方法获得的平均 ADC 值之间无显著差异。全肿瘤体积 ADC 法的 CRT 后 ADC 值、ΔADC 和 %ΔADC 在两组间有显著差异（p<0.05）。两组间的 CRT 前后体积值有显著差异。完全缓解者的 ΔV DCI 和 %ΔV DCI、ΔV ADC 和 T2w 体积值显著降低（p<0.05）。在多变量分析中，当联合使用 CRT 后平均 ADC 值和 DCI 体积值时，敏感性和特异性分别为 88.9%和 91.9%（AUC=0.943），当联合使用 ΔADC 和 DCI 体积值时，敏感性和特异性分别为 88.9%和 94.6%（AUC=0.949）。
全肿瘤体积平均 ADC 值是确定治疗反应最有用的方法。单独评估完全缓解时，CRT 后 DCI 体积测量法最有用。当将 CRT 后 DCI 体积与全肿瘤体积的 ADC 值变化值相结合时，可获得最高的诊断值。
