1
|
Xia Y, Zhu L, Cai G, Du L, Wang L, Feng W, Fu C, Ma Q, Dong Y, Pan Z, Yan F, Shen H, Li W, Zhang H. Computed Diffusion-Weighted Images of Rectal Cancer: Image Quality, Restaging, and Treatment Response after Neoadjuvant Therapy. J Magn Reson Imaging 2024; 59:297-308. [PMID: 37165908 DOI: 10.1002/jmri.28766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Computed diffusion-weighted images (cDWI) of random b value could be derived from acquired DWI (aDWI) with at least two different b values. However, its comparison between aDWI and cDWI images in locally advanced rectal cancer (LARC) patients after neoadjuvant therapy (NT) is needed. PURPOSE To compare the cDWI and aDWI in image quality, restaging, and treatment response of LARC after NT. STUDY TYPE Retrospective. POPULATION Eighty-seven consecutive patients. FIELD STRENGTH/SEQUENCE 3.0 T/DWI. ASSESSMENT All patients underwent two DWI sequences, including conventional acquisition with b = 0 and 1000 s/mm2 (aDWIb1000 ) and another with b = 0 and 700 s/mm2 on a 3.0-T MR scanner. The images of the latter were used to compute the diffusion images with b = 1000 s/mm2 (cDWIb1000 ). Four radiologists with 3, 4, 14, and 25 years of experience evaluated the images to compare the image quality, TN restaging performance, and treatment response between aDWIb1000 and cDWIb1000 . STATISTICAL TESTS Interclass correlation coefficients, weighted κ coefficient, paired Wilcoxon, and McNemar or Fisher test were used. A significance level of 0.05 was used. RESULTS The cDWIb1000 images were superior to the aDWIb1000 ones in both subjective and objective image quality. In T restaging, the overall diagnostic accuracy of cDWIb1000 images was higher than that of aDWIb1000 images (57.47% vs. 49.43%, P = 0.289 for the inexperienced radiologist; 77.01% vs. 63.22%, significant for the experienced radiologist), with better sensitivity in determining ypT0-Tis tumors. Additionally, it increased the sensitivity in detecting ypT2 tumors for the inexperienced radiologist and ypT3 tumors for the experienced radiologist. N restaging and treatment response were found to be similar between two sequences for both radiologists. DATA CONCLUSION Compared to aDWIb1000 images, the computed ones might serve as a wise approach, providing comparable or better image quality, restaging performance, and treatment response assessment for LARC after NT. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- Yihan Xia
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Gang Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Lianjun Du
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Lingyun Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Weiming Feng
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Caixia Fu
- Department of MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Qianchen Ma
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Yihan Dong
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Zilai Pan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Hailin Shen
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University of Medicine, Suzhou, China
| | - Weiguang Li
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| |
Collapse
|
2
|
Osman MF, Ibrahim SH, Ghoneim SMM, Ali RMM, Sedqi MEM, Gadalla AAEH. Role of apparent diffusion coefficient in assessment of loco-regional nodal spread in cancer rectum: correlative study with histopathological findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-00995-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Background
Rectal cancer is associated with high morbidity and mortality rates. Preoperative assessment and detection of nodal metastasis are crucial for selecting a proper treatment plan. Diffusion-weighted imaging is considered to be a crucial functional imaging technique that can aid in determining the condition of lymph nodes. This study aimed to assess the diagnostic utility of MRI functional images by use of apparent diffusion coefficient in regional nodal assessment in rectal cancer.
Results
This study included 54 patients including 29 males (53.7%) and 25 females (46.3%) presented with pathologically proven rectal cancer. Regarding rectal adenocarcinoma, functional MRI imaging using ADC values found to have a better sensitivity (86.24%) in detection of regional nodal metastasis than conventional morphological MRI criteria with 1.05 × 10−3 mm2/s was employed as cutoff value to distinguish metastatic from non-metastatic lymph nodes with statistically significant P value (< 0.001); nevertheless, regarding the accuracy there was no difference (68.52%). As regards mucinous and signet ring cell carcinoma, morphological assessment using conventional MRI sequences were found to have a better accuracy (72.96%) and sensitivity (57.69%) than ADC value, with the latter showed low statistically significant results (P- value < 0.201) in distinguishing metastatic and non-metastatic nodes. This could be explained by extremely high ADC values of nodes for these pathological types owing to their high mucin content.
Conclusions
MRI functional imaging using ADC values can be utilized to distinguish metastatic from non-metastatic lymph nodes in rectal adenocarcinoma employing diagnostic accuracy of 86.52%. However, morphological assessment using conventional MRI was found to be better in assessment of regional lymph nodes at mucinous and signet ring rectal carcinoma.
Collapse
|
3
|
Xia Y, Wang L, Wu Z, Tan J, Fu M, Fu C, Pan Z, Zhu L, Yan F, Shen H, Ma Q, Cai G. Comparison of Computed and Acquired DWI in the Assessment of Rectal Cancer: Image Quality and Preoperative Staging. Front Oncol 2022; 12:788731. [PMID: 35371999 PMCID: PMC8971285 DOI: 10.3389/fonc.2022.788731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe aim of the study was to evaluate the computed diffusion-weighted images (DWI) in image quality and diagnostic performance of rectal cancer by comparing with the acquired DWI.MethodsA total of 103 consecutive patients with primary rectal cancer were enrolled in this study. All patients underwent two DWI sequences, namely, conventional acquisition with b = 0 and 1,000 s/mm2 (aDWIb1,000) and another with b = 0 and 700 s/mm2 on a 3.0T MR scanner (MAGNETOM Prisma; Siemens Healthcare, Germany). The images (b = 0 and 700 s/mm2) were used to compute the diffusion images with b value of 1,000 s/mm2 (cDWIb1,000). Qualitative and quantitative analysis of both computed and acquired DWI images was performed, namely, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and signal intensity ratio (SIR), and also diagnostic staging performance. Interclass correlation coefficients, weighted κ coefficient, Friedman test, Wilcoxon paired test, and McNemar or Fisher test were used for repeatability and comparison assessment.ResultsCompared with the aDWIb1,000 images, the cDWIb1,000 ones exhibited significant higher scores of subjective image quality (all P <0.050). SNR, SIR, and CNR of the cDWIb1,000 images were superior to those of the aDWIb1,000 ones (P <0.001). The overall diagnostic accuracy of computed images was higher than that of the aDWIb1,000 images in T stage (P <0.001), with markedly better sensitivity and specificity in distinguishing T1–2 tumors from the T3–4 ones (P <0.050).ConclusioncDWIb1,000 images from lower b values might be a useful alternative option and comparable to the acquired DWI, providing better image quality and diagnostic performance in preoperative rectal cancer staging.
Collapse
Affiliation(s)
- Yihan Xia
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Lan Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Jingwen Tan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Meng Fu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Caixia Fu
- Department of MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Zilai Pan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Hailin Shen
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University of Medicine, Suzhou, China
- *Correspondence: Gang Cai, ; Qianchen Ma, ; Hailin Shen,
| | - Qianchen Ma
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
- *Correspondence: Gang Cai, ; Qianchen Ma, ; Hailin Shen,
| | - Gang Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China
- *Correspondence: Gang Cai, ; Qianchen Ma, ; Hailin Shen,
| |
Collapse
|
4
|
Qureshi PAAA, Aleem J, Mushtaq N, Noor MA, Khalid Niazi I, Altaf MO. Role of Diffusion-Weighted Imaging in the Evaluation of Post-Treatment Tumor Response in Rectal Carcinoma. Cureus 2021; 13:e17471. [PMID: 34589364 PMCID: PMC8464380 DOI: 10.7759/cureus.17471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Rectal cancer has become a major cause of mortality worldwide. Imaging has a primary role in staging and assessing the response to therapy. MRI is superior to all other modalities in local staging of the rectal tumor and in predicting tumor response. Pelvic MRI has an undeniable role in the therapeutic management of rectal cancer, particularly for the determination of the circumferential resection margin (CRM), evaluation of sphincter invasion, and assessment of the extramural vascular invasion. Post-chemoradiotherapy (CRT) staging aims at assessing treatment response and choosing methods for further treatment such as surgical resection or extended CRT. MRI with diffusion restriction is a non-invasive and useful tool for assessing the treatment response of locally advanced lower rectal cancer. It will reduce the burden of extensive abdominoperineal resection (APR) surgery in patients. Objective The purpose of this study was to determine the role of diffusion-weighted imaging (DWI) in the evaluation of post-treatment tumor response in rectal carcinoma. Materials and methods The study was approved by our institutional review board, which waived the requirement for informed consent. The clinical data of all the patients treated for rectal carcinoma at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore between February 1, 2014, and February 28, 2019, were retrospectively evaluated. The inclusion criteria were as follows: (1) patients with histopathologically proven rectal adenocarcinoma, (2) those who underwent APR before February 2019 at our hospital, and (3) those who underwent MRI including DWI/apparent diffusion coefficient (ADC) imaging before and after CRT. Those patients who had upfront surgery without neoadjuvant CRT and those who did not have MRI imaging with DWI/ADC were excluded from the study. Results A total of 200 patients who fulfilled the inclusion criteria were included in this study. Among those, 141 were males and 59 were females. On histology, 110 had moderately differentiated adenocarcinoma, 25 had well-differentiated adenocarcinoma, and 65 had poorly differentiated adenocarcinomas. Overall diagnostic accuracy of DWI MRI sequence was calculated to be 91%, while the sensitivity was 98.09%, specificity was 65.12%, positive predictive value was 91.12%, and negative predictive value was 90.32%. Conclusion DWI was proven to be very useful in the post-treatment evaluation of tumor response with very high diagnostic accuracy.
Collapse
Affiliation(s)
| | - Javaria Aleem
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Nadia Mushtaq
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Asif Noor
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Imran Khalid Niazi
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Omer Altaf
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| |
Collapse
|