From the Department of Radiology, Cancer Center, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, 200032 Shanghai, China.
Radiology. 2024 Aug;312(2):e232713. doi: 10.1148/radiol.232713.
Background A watch-and-wait regimen for locally advanced rectal cancer after neoadjuvant chemotherapy and radiation therapy (NCRT) relies on identifying complete tumor response. However, the concordance between a complete response at combined T2-weighted and diffusion-weighted MRI (T2DWI) and pathologic complete response (pCR; ie, ypT0N0) in the tumor is unsatisfactory. Purpose To assess whether identification of mucosal linear enhancement (MLE) at arterial-phase contrast-enhanced (CE) T1-weighted MRI is associated with ypT0 status in patients with locally advanced rectal cancer after NCRT and to evaluate whether combining MLE at CE T1-weighted MRI and negative lymph node metastasis (LNM) at T2DWI can improve identification of pCR. Materials and Methods This retrospective study included patients with locally advanced rectal cancer who underwent total mesorectal excision after NCRT between July 2020 and July 2023 at a tertiary referral academic center. Restaging MRI included T2DWI and arterial-phase CE T1-weighted MRI for primary tumor assessment and T2DWI for evaluation of LNM status. Imaging features associated with ypT0 status were identified at multivariable regression analysis. Results In total, 239 patients (mean age, 58 years ± 12 [SD]; 180 male patients) were assessed. MLE was more common in the ypT0 group than in the ypT1-4 group after NCRT (73% vs 4%, respectively; < .001). MLE was associated with higher odds of ypT0 status in an adjusted analysis (odds ratio, 137; 95% CI: 25, 767; < .001). The combination of MLE and negative LNM status achieved an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.79, 0.88) for pCR. Conclusion MLE at CE MRI was associated with higher odds of complete tumor response. Combining MLE and negative LNM status showed good performance for identifying complete tumor response and may exclude residual tumors after NCRT in patients with locally advanced rectal cancer. © RSNA, 2024 See also the editorial by Schoellnast in this issue.
新辅助化疗和放疗（NCRT）后局部进展期直肠癌的观察等待方案依赖于识别完全肿瘤反应。然而，联合 T2 加权和弥散加权 MRI（T2DWI）完全缓解与肿瘤病理完全缓解（ypT0N0）之间的一致性并不令人满意。目的：评估在 NCRT 后局部进展期直肠癌患者中，动脉期对比增强（CE）T1 加权 MRI 上黏膜线性强化（MLE）的识别是否与 ypT0 状态相关，并评估在 CE T1 加权 MRI 上的 MLE 与 T2DWI 上的阴性淋巴结转移（LNM）相结合是否可以提高对 pCR 的识别。材料与方法：本回顾性研究纳入了 2020 年 7 月至 2023 年 7 月期间在一家三级转诊学术中心接受 NCRT 后全直肠系膜切除术的局部进展期直肠癌患者。再分期 MRI 包括 T2DWI、动脉期 CE T1 加权 MRI 用于评估原发肿瘤和 T2DWI 用于评估 LNM 状态。在多变量回归分析中确定与 ypT0 状态相关的影像学特征。结果：共评估了 239 例患者（平均年龄，58 岁±12[标准差]；180 例男性患者）。NCRT 后，ypT0 组的 MLE 比 ypT1-4 组更常见（分别为 73%和 4%；<.001）。在调整后的分析中，MLE 与 ypT0 状态的更高几率相关（优势比，137；95%置信区间：25，767；<.001）。MLE 和阴性 LNM 状态的组合在识别 pCR 时的受试者工作特征曲线下面积为 0.84（95%置信区间：0.79，0.88）。结论：CE MRI 上的 MLE 与更高的完全肿瘤反应几率相关。联合 MLE 和阴性 LNM 状态对识别完全肿瘤反应具有良好的性能，并且可能排除局部进展期直肠癌患者 NCRT 后的残留肿瘤。
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