Drago Silvia Girolama, Maino Cesare, Giandola Teresa Paola, Franco Paolo Niccolò, Corso Rocco, Talei Franzesi Cammillo, Pecorelli Anna, Ippolito Davide
Department of Diagnostic Radiology, IRCCS Fondazione San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB, Italy.
Radiologia Addomino Pelvica Diagnostica e Interventistica IRCCS Azienda Ospedaliera Universitaria di Bologna Policlinico di Sant'Orsola, Via Pietro Albertoni 15, 40138 Bolonga, BO, Italy.
Life (Basel). 2024 Oct 10;14(10):1282. doi: 10.3390/life14101282.
the aim of this study is to assess the performance of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values in predicting the response to neoadjuvant chemoradiation therapy (CRT) and outcome in patients with locally advanced rectal cancer (LARC).
ninety-four patients with magnetic resonance imaging (MRI) pre- and post-neoadjuvant treatment were retrospectively enrolled. Three regions of interest (ROIs) were manually drawn on three different slices of the tumor for every DWI sequence. ROIs were positioned to include only high signal areas and avoid artifacts or necrotic areas. ROIs were automatically copied onto the corresponding ADC maps and the system derived three different ADC values, distinguishing between mean, maximum, and minimum values, and the standard deviation (SD). Only mean ADC values were considered. After surgical intervention, pTNM and the Mandard tumor regression grade (TRG) were obtained. Patients with a TRG of 1-2 were classified as responders, while patients with a TRG from 3 to 5 were classified as non-responders.
no correlation was found between pre-ADC values and TRG classes, while post-ADC and ΔADC values showed a significant correlation with TRG classes (r = -0.285, = 0.002 and r = -0.290, = 0.019, respectively). Post-ADC values were statistically different between responders and non-responders ( = 0.019). When considering the relation between overall survival (OS) and ADC values, pre-ADC showed a negative correlation with OS (r = -0.381, = 0.001), while a positive correlation was found between ΔADC values and OS (r = 0.323, = 0.013). According to ΔADC values, the mean OS time between responders and non-responders showed a significant difference ( = 0.030). A statistical difference was found between TRG classes and OS ( = 0.038) and by dividing patients in responders and non-responders ( = 0.019).
the pre-ADC and ΔADC values could be used as useful predictors for patient prognosis, thus helping the treatment planning. On the other hand, the post-ADC values, thanks to their relationship with the TRG classes, could be the ideal tool to predict the histopathological response and plan a conservative approach to the treatment of rectal cancer.
本研究旨在评估弥散加权成像（DWI）及表观扩散系数（ADC）值在预测局部晚期直肠癌（LARC）患者新辅助放化疗（CRT）疗效及预后方面的表现。
回顾性纳入94例接受新辅助治疗前后均行磁共振成像（MRI）检查的患者。对于每个DWI序列，在肿瘤的三个不同层面手动绘制三个感兴趣区（ROI）。ROI的放置仅包括高信号区域，避免伪影或坏死区域。ROI自动复制到相应的ADC图上，系统得出三个不同的ADC值，分别为平均值、最大值、最小值以及标准差（SD）。仅考虑平均ADC值。手术干预后，获取pTNM及曼德尔肿瘤退缩分级（TRG）。TRG为1 - 2级的患者被归类为反应者，而TRG为3至5级的患者被归类为无反应者。
ADC值与TRG分级之间未发现相关性，而ADC值及ΔADC值与TRG分级呈显著相关性（分别为r = -0.285，P = 0.002和r = -0.290，P = 0.019）。反应者与无反应者之间的ADC值存在统计学差异（P = 0.019）。在考虑总生存期（OS）与ADC值的关系时，ADC值与OS呈负相关（r = -0.381，P = 0.001），而ΔADC值与OS呈正相关（r = 0.323，P = 0.013）。根据ΔADC值，反应者与无反应者之间的平均OS时间存在显著差异（P = 0.030）。TRG分级与OS之间存在统计学差异（P = 0.038），将患者分为反应者与无反应者时也存在统计学差异（P = 0.019）。
ADC值及ΔADC值可作为患者预后的有用预测指标，从而有助于治疗方案的制定。另一方面，ADC值因其与TRG分级的关系，可能是预测组织病理学反应及规划直肠癌保守治疗方法的理想工具。
