Yuan Wenjing, Lv Xia, Zhao Jiaxin, Jia Ziqi, Zhou Qianling, Zhang Hanliang, Dai Jianhao, Feng Jieping, Chen Weicui, Jiang Wei, Liu Xian
Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Radiotherapy, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China.
Eur Radiol. 2025 Jun;35(6):3158-3168. doi: 10.1007/s00330-024-11220-6. Epub 2024 Dec 2.
To investigate the potential of histogram analysis applied to pre-treatment amide proton transfer-weighted (APTw) imaging in predicting complete pathological regression (pCR) in patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiotherapy (nCRT).
This retrospective study enrolled LARC patients who underwent preoperative rectal magnetic resonance imaging (MRI). Based on histologic assessment, the patients were divided into a pathological complete response (pCR) group or a non-pCR group. APTw histogram features, apparent diffusion coefficient (ADC), and clinical parameters were analyzed. Mann-Whitney U-test, Spearman rank correlation, and univariate and multivariate logistic regression were used for statistical analysis. The predictive performances of different models were evaluated by the receiver operating characteristic curve (ROC).
One-hundred forty-five patients were included (mean age, 61.6 years ± 11.8 [SD]; 87 men). pCR patients exhibited lower pre-treatment ADC value, higher pre-treatment APTw-10%, APTw-90%, minimum, maximum, median, mean, range, and root mean square (RMS) of the primary tumor compared to non-pCR patients (all p < 0.05). APTw-10%, APTw-90%, maximum, mean, median, minimum, range, and RMS showed negative correlations with the tumor regression grade (TRG) category (r ranged between -0.457 and -0.173; all p < 0.005). Skewness, kurtosis, and entropy exhibited positive correlations with the TRG category (r = 0.278, 0.319, and 0.324, respectively; all p < 0.05). The combined model had a higher AUC of 0.930, with 93.9% sensitivity and 83.9% specificity.
Histogram analysis of pre-treatment APTw may hold promise as a novel approach for predicting the response of LARC patients to nCRT.
Question Predicting response to nCRT is crucial for early stratified management of LARC patients; however, current radiological studies remain inconclusive. Finding LARC patients with pCR is correlated with higher pre-treatment APTw intensity-related and lower shape-related histogram features. Clinical relevance The APTw-histogram model and the APTw-clinical combined model demonstrated strong diagnostic efficacy and clinical practicality in predicting LARC patients' responsiveness to nCRT, offering new insights for early clinical decision-making.
探讨直方图分析应用于治疗前酰胺质子转移加权（APTw）成像预测局部晚期直肠癌（LARC）患者接受新辅助放化疗（nCRT）后病理完全缓解（pCR）的潜力。
本回顾性研究纳入接受术前直肠磁共振成像（MRI）的LARC患者。根据组织学评估，将患者分为病理完全缓解（pCR）组或非pCR组。分析APTw直方图特征、表观扩散系数（ADC）和临床参数。采用曼-惠特尼U检验、斯皮尔曼等级相关以及单因素和多因素逻辑回归进行统计分析。通过受试者操作特征曲线（ROC）评估不同模型的预测性能。
共纳入145例患者（平均年龄61.6岁±11.8[标准差]；87例男性）。与非pCR患者相比，pCR患者治疗前ADC值较低，原发肿瘤的治疗前APTw-10%、APTw-90%、最小值、最大值、中位数、平均值、范围和均方根（RMS）较高（均p<0.05）。APTw-10%、APTw-90%、最大值、平均值、中位数、最小值、范围和RMS与肿瘤退缩分级（TRG）类别呈负相关（r介于-0.457至-0.173之间；均p<0.005）。偏度、峰度和熵与TRG类别呈正相关（r分别为0.278、0.319和0.324；均p<0.05）。联合模型的曲线下面积（AUC）较高，为0.930，灵敏度为93.9%，特异度为83.9%。
治疗前APTw的直方图分析有望成为预测LARC患者对nCRT反应的新方法。
问题预测对nCRT的反应对于LARC患者的早期分层管理至关重要；然而，目前的放射学研究尚无定论。发现pCR的LARC患者与治疗前较高的APTw强度相关和较低的形状相关直方图特征有关。临床意义APTw直方图模型和APTw临床联合模型在预测LARC患者对nCRT的反应性方面显示出强大的诊断效能和临床实用性，为早期临床决策提供了新的见解。
