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Kou S, Leng X, Luo H, Nie H, Zhu Q. Acoustic resolution photoacoustic Doppler flowmetry for assessment of patient rectal cancer blood perfusion. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:S11517. [PMID: 38223679 PMCID: PMC10787588 DOI: 10.1117/1.jbo.29.s1.s11517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
Significance Photoacoustic Doppler flowmetry offers quantitative blood perfusion information in addition to photoacoustic vascular contrast for rectal cancer assessment. Aim We aim to develop and validate a correlational Doppler flowmetry utilizing an acoustic resolution photoacoustic microscopy (AR-PAM) system for blood perfusion analysis. Approach To extract blood perfusion information, we implemented AR-PAM Doppler flowmetry consisting of signal filtering and conditioning, A-line correlation, and angle compensation. We developed flow phantoms and contrast agent to systemically investigate the flowmetry's efficacy in a series of phantom studies. The developed correlational Doppler flowmetry was applied to images collected during in vivo AR-PAM for post-treatment rectal cancer evaluation. Results The linearity and accuracy of the Doppler flow measurement system were validated in phantom studies. Imaging rectal cancer patients treated with chemoradiation demonstrated the feasibility of using correlational Doppler flowmetry to assess treatment response and distinguish residual cancer from cancer-free tumor bed tissue and normal rectal tissue. Conclusions A new correlational Doppler flowmetry was developed and validated through systematic phantom evaluations. The results of its application to in vivo patients suggest it could be a useful addition to photoacoustic endoscopy for post-treatment rectal cancer assessment.
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Affiliation(s)
- Sitai Kou
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Xiandong Leng
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Hongbo Luo
- Washington University in St. Louis, Department of Electrical and System Engineering, St. Louis, Missouri, United States
| | - Haolin Nie
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
| | - Quing Zhu
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri, United States
- Washington University in St. Louis, Department of Electrical and System Engineering, St. Louis, Missouri, United States
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
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Korngold EK, Moreno C, Kim DH, Fowler KJ, Cash BD, Chang KJ, Gage KL, Gajjar AH, Garcia EM, Kambadakone AR, Liu PS, Macomber M, Marin D, Pietryga JA, Santillan CS, Weinstein S, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Staging of Colorectal Cancer: 2021 Update. J Am Coll Radiol 2022; 19:S208-S222. [PMID: 35550803 DOI: 10.1016/j.jacr.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/19/2022]
Abstract
Preoperative imaging of rectal carcinoma involves accurate assessment of the primary tumor as well as distant metastatic disease. Preoperative imaging of nonrectal colon cancer is most beneficial in identifying distant metastases, regardless of primary T or N stage. Surgical treatment remains the definitive treatment for colon cancer, while organ-sparing approach may be considered in some rectal cancer patients based on imaging obtained before and after neoadjuvant treatment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Elena K Korngold
- Oregon Health and Science University, Portland, Oregon; Section Chief, Body Imaging; Chair, P&T Committee; Modality Chief, CT.
| | - Courtney Moreno
- Emory University, Atlanta, Georgia; Chair America College of Radiology CT Colonography Registry Committee
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; Vice Chair of Education (University of Wisconsin Dept of Radiology)
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; ACR LI-RADS Working Group Chair
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association; Chief of GI, UTHealth
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Director of MRI, Associate Chief of Abdominal Imaging; ACR Chair of Committee on C-RADS
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aakash H Gajjar
- PRiSMA Proctology Surgical Medicine & Associates, Houston, Texas; American College of Surgeons
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital; Medical Director, Martha's Vineyard Hospital Imaging
| | - Peter S Liu
- Cleveland Clinic, Cleveland, Ohio; Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland OH
| | | | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Cynthia S Santillan
- University of California San Diego, San Diego, California; Vice Chair of Clinical Operations for Department of Radiology
| | - Stefanie Weinstein
- University of California San Francisco, San Francisco, California; Associate Chief of Radiology, San Francisco VA Health Systems
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director MR and CT at VCUHS; Section Chief Abdominal Imaging VCUHS
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Liu W, Li Y, Zhang X, Li J, Sun J, Lv H, Wang Z. Preoperative T and N Restaging of Rectal Cancer After Neoadjuvant Chemoradiotherapy: An Accuracy Comparison Between MSCT and MRI. Front Oncol 2022; 11:806749. [PMID: 35127518 PMCID: PMC8813750 DOI: 10.3389/fonc.2021.806749] [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] [Received: 11/01/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is well established that magnetic resonance imaging (MRI) is better than multi-slice computed tomography (MSCT) for the accurate diagnosis of pretreatment tumor (T) and node (N) staging of rectal cancer. However, the diagnostic value of MRI and MSCT in local restaging of rectal cancer after neoadjuvant chemoradiotherapy (NCRT) is controversial. The aim of this study is to investigate the performance of the two imaging exams in restaging of patients with rectal cancer. Methods Patients with rectal cancer from April 2015 to April 2021 were analyzed retrospectively. The inclusion criteria are as follows: 1) diagnosis of rectal cancer through pathology; 2) NCRT had been performed; 3) all patients had undergone both MSCT and MRI examination before the surgery. Exclusion criteria are as follows: 1) incomplete clinical and imaging data; 2) previous history of pelvic surgery. Two radiologists performed T and N staging of patient images. Diagnostic accuracy, consistency analysis, and error restaging distribution of the two imaging exams for T and N restaging of rectal cancer were assessed using postoperative pathological staging as the gold standard. Results A total of 62 patients (49 men; mean age: 59 years; age range 29–83 years) were included in the study. The diagnostic accuracy of MSCT and MRI for T restaging was 51.6% (95% CI 39.3%–63.9%) and 41.9% (95% CI 29.6%–54.2%), respectively, and no statistical difference was found between them (p > 0.05). The diagnostic accuracy of MSCT and MRI for N restaging was 56.5% (95% CI 44.2%–68.8%) and 53.2% (95% CI 40.8%–65.6%), respectively, and no statistical difference was found between them (p > 0.05). The consistency analysis showed that T restaging (κ = 0.583, p < 0.001) and N restaging (κ = 0.644, p < 0.001) were similar between MSCT and MRI. There was no significant difference in the distribution of over, accurate, or low staging in T restaging (p > 0.05) and N restaging (p > 0.05) between MSCT and MRI. Conclusions MSCT and MRI have similarly poor performance in the diagnosis of preoperative T and N restaging of rectal cancer after NCRT. Neither of them cannot effectively stage the ypT0-1 of rectal cancer. These findings may be of clinical relevance for planning less imaging exam.
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Affiliation(s)
- Wenjuan Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuyi Li
- Department of Anorectal Surgery, Jining No. 1 People's Hospital, Jining, China
| | - Xue Zhang
- Department of Radiology, Jining No. 1 People's Hospital, Jining, China
| | - Jia Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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4
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Leng X, Amidi E, Kou S, Cheema H, Otegbeye E, Chapman WJ, Mutch M, Zhu Q. Rectal Cancer Treatment Management: Deep-Learning Neural Network Based on Photoacoustic Microscopy Image Outperforms Histogram-Feature-Based Classification. Front Oncol 2021; 11:715332. [PMID: 34631543 PMCID: PMC8495416 DOI: 10.3389/fonc.2021.715332] [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] [Received: 05/26/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
We have developed a novel photoacoustic microscopy/ultrasound (PAM/US) endoscope to image post-treatment rectal cancer for surgical management of residual tumor after radiation and chemotherapy. Paired with a deep-learning convolutional neural network (CNN), the PAM images accurately differentiated pathological complete responders (pCR) from incomplete responders. However, the role of CNNs compared with traditional histogram-feature based classifiers needs further exploration. In this work, we compare the performance of the CNN models to generalized linear models (GLM) across 24 ex vivo specimens and 10 in vivo patient examinations. First order statistical features were extracted from histograms of PAM and US images to train, validate and test GLM models, while PAM and US images were directly used to train, validate, and test CNN models. The PAM-CNN model performed superiorly with an AUC of 0.96 (95% CI: 0.95-0.98) compared to the best PAM-GLM model using kurtosis with an AUC of 0.82 (95% CI: 0.82-0.83). We also found that both CNN and GLMs derived from photoacoustic data outperformed those utilizing ultrasound alone. We conclude that deep-learning neural networks paired with photoacoustic images is the optimal analysis framework for determining presence of residual cancer in the treated human rectum.
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Affiliation(s)
- Xiandong Leng
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Eghbal Amidi
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Sitai Kou
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Hassam Cheema
- Department of Pathology, Washington University in St. Louis, St. Louis, MO, United States
| | - Ebunoluwa Otegbeye
- Division of Colorectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - William Jr Chapman
- Division of Colorectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew Mutch
- Division of Colorectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States.,Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
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5
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Wang C, Padgett KR, Su MY, Mellon EA, Maziero D, Chang Z. Multi-parametric MRI (mpMRI) for treatment response assessment of radiation therapy. Med Phys 2021; 49:2794-2819. [PMID: 34374098 DOI: 10.1002/mp.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022] Open
Abstract
Magnetic resonance imaging (MRI) plays an important role in the modern radiation therapy (RT) workflow. In comparison with computed tomography (CT) imaging, which is the dominant imaging modality in RT, MRI possesses excellent soft-tissue contrast for radiographic evaluation. Based on quantitative models, MRI can be used to assess tissue functional and physiological information. With the developments of scanner design, acquisition strategy, advanced data analysis, and modeling, multiparametric MRI (mpMRI), a combination of morphologic and functional imaging modalities, has been increasingly adopted for disease detection, localization, and characterization. Integration of mpMRI techniques into RT enriches the opportunities to individualize RT. In particular, RT response assessment using mpMRI allows for accurate characterization of both tissue anatomical and biochemical changes to support decision-making in monotherapy of radiation treatment and/or systematic cancer management. In recent years, accumulating evidence have, indeed, demonstrated the potentials of mpMRI in RT response assessment regarding patient stratification, trial benchmarking, early treatment intervention, and outcome modeling. Clinical application of mpMRI for treatment response assessment in routine radiation oncology workflow, however, is more complex than implementing an additional imaging protocol; mpMRI requires additional focus on optimal study design, practice standardization, and unified statistical reporting strategy to realize its full potential in the context of RT. In this article, the mpMRI theories, including image mechanism, protocol design, and data analysis, will be reviewed with a focus on the radiation oncology field. Representative works will be discussed to demonstrate how mpMRI can be used for RT response assessment. Additionally, issues and limits of current works, as well as challenges and potential future research directions, will also be discussed.
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Affiliation(s)
- Chunhao Wang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Kyle R Padgett
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA.,Department of Radiology, University of Miami, Miami, Florida, USA
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, California, USA.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Eric A Mellon
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Danilo Maziero
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Zheng Chang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
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6
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Leng X, Uddin KMS, Chapman W, Luo H, Kou S, Amidi E, Yang G, Chatterjee D, Shetty A, Hunt S, Mutch M, Zhu Q. Assessing Rectal Cancer Treatment Response Using Coregistered Endorectal Photoacoustic and US Imaging Paired with Deep Learning. Radiology 2021; 299:349-358. [PMID: 33754826 PMCID: PMC8108559 DOI: 10.1148/radiol.2021202208] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/13/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022]
Abstract
Background Conventional radiologic modalities perform poorly in the radiated rectum and are often unable to differentiate residual cancer from treatment scarring. Purpose To report the development and initial patient study of an imaging system comprising an endorectal coregistered photoacoustic (PA) microscopy (PAM) and US system paired with a convolution neural network (CNN) to assess the rectal cancer treatment response. Materials and Methods In this prospective study (ClinicalTrials.gov identifier NCT04339374), participants completed radiation and chemotherapy from September 2019 to September 2020 and images were obtained with the PAM/US system prior to surgery. Another group's colorectal specimens were studied ex vivo. The PAM/US system consisted of an endorectal imaging probe, a 1064-nm laser, and one US ring transducer. The PAM CNN and US CNN models were trained and validated to distinguish normal from malignant colorectal tissue using ex vivo and in vivo patient data. The PAM CNN and US CNN were then tested using additional in vivo patient data that had not been seen by the CNNs during training and validation. Results Twenty-two patients' ex vivo specimens and five patients' in vivo images (a total of 2693 US regions of interest [ROIs] and 2208 PA ROIs) were used for CNN training and validation. Data from five additional patients were used for testing. A total of 32 participants (mean age, 60 years; range, 35-89 years) were evaluated. Unique PAM imaging markers of the complete tumor response were found, specifically including recovery of normal submucosal vascular architecture within the treated tumor bed. The PAM CNN model captured this recovery process and correctly differentiated these changes from the residual tumor. The imaging system remained highly capable of differentiating tumor from normal tissue, achieving an area under the receiver operating characteristic curve of 0.98 (95% CI: 0.98, 0.99) for data from five participants. By comparison, the US CNN had an area under the receiver operating characteristic curve of 0.71 (95% CI: 0.70, 0.73). Conclusion An endorectal coregistered photoacoustic microscopy/US system paired with a convolutional neural network model showed high diagnostic performance in assessing the rectal cancer treatment response and demonstrated potential for optimizing posttreatment management. © RSNA, 2021 Supplemental material is available for this article. See also the editorial by Klibanov in this issue.
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Affiliation(s)
| | | | - William Chapman
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Hongbo Luo
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Sitai Kou
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Eghbal Amidi
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Guang Yang
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Deyali Chatterjee
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Anup Shetty
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Steve Hunt
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Matthew Mutch
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
| | - Quing Zhu
- From the Department of Biomedical Engineering (X.L., K.M.S.U., S.K.,
E.A., G.Y., Q.Z.), Division of Surgery, Barnes-Jewish Hospital (W.C., S.H.,
M.M.), and Department of Electrical and System Engineering (H.L.), Washington
University in St. Louis, 1 Brookings Dr, Mail Box 1097, St Louis, MO 63130;
Department of Pathology (D.C.) and Mallinckrodt Institute of Radiology (A.S.,
Q.Z.), Washington University School of Medicine, St Louis, Mo
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Felder SI, Feuerlein S, Parsee A, Imanirad I, Sanchez J, Dessureault S, Kim R, Hoffe S, Frakes J, Costello J. Endoscopic and MRI response evaluation following neoadjuvant treatment for rectal cancer: a pictorial review with matched MRI, endoscopic, and pathologic examples. Abdom Radiol (NY) 2021; 46:1783-1804. [PMID: 33111189 DOI: 10.1007/s00261-020-02827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/05/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
A nonoperative management strategy, or Watch-and-Wait, following neoadjuvant therapies of locally advanced rectal adenocarcinoma is increasingly considered for select patients. Yet, standardized tumor response assessment to best select and surveil suitable patients remains an unmet clinical challenge. Endoscopic and MRI currently provide the most reliable tumor response estimations. However, resources illustrating variable tumor responses to neoadjuvant therapies remain limited. This pictorial review aims to provide detailed and annotated examples of common endoscopic and MRI findings of rectal cancer treatment response, while also emphasizing their respective diagnostic shortcomings and consequently, the necessity for a multidisciplinary approach to optimally manage these patients.
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Application of Field-of-View Optimized and Constrained Undistorted Single Shot (FOCUS) with Intravoxel Incoherent Motion (IVIM) in 3T in Locally Advanced Rectal Cancer. DISEASE MARKERS 2021; 2021:5565902. [PMID: 33936322 PMCID: PMC8055408 DOI: 10.1155/2021/5565902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/26/2021] [Accepted: 03/11/2021] [Indexed: 01/05/2023]
Abstract
Purpose To evaluate the efficacy of field-of-view (FOV) optimized and constrained undistorted single shot (FOCUS) with IVIM in 3T MRI in the grading of patients with locally advanced rectal cancer. Methods From January 1st to December 31st, 2019, patients with locally advanced rectal cancer were retrieved. FOCUS DWI and FOCUS IVIM were obtained. Apparent diffusion coefficient (ADC) and IVIM parameters including mean true diffusion coefficient (D), pseudodiffusion coefficient associated with blood flow (D∗), and perfusion fraction (f) of the tumor parenchyma and normal rectal wall, as well as the normalized tumor parameters by corresponding normal intestinal wall parameters (ADCNOR, DNOR, D∗NOR, and fNOR), were compared between the well/moderately differentiated and poorly differentiated groups by Student's t-test. The relationship between the above parameters and the histologic grade was analyzed using Spearman's correlation test, with the ROC curve generated. Results Eighty-eight patients (aged 31 to 77 years old, mean = 56) were included for analysis. Dtumor and ftumor were positively correlated with the tumor grade (r = 0.483, p < 0.001 and r = 0.610, p < 0.001, respectively). All the normalized parameters (ADCNOR, DNOR, D∗NOR, and fNOR) were positively correlated with the tumor grade (r = 0.267, p = 0.007; r = 0.564, p = 0.001; r = 0.414, p = 0.005; and r = 0.605, p < 0.001, respectively). The best discriminative parameter was the ftumor value, and the area under the ROC curve was 0.927. With a cut-off value of 22.0%, ftumor had a sensitivity of 88.9% and a specificity of 100%. Conclusion FOCUS IVIM-derived parameters and normalized parameters are useful for predicting the histologic grade in rectal cancer patients.
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Meyer VM, Meuzelaar RR, Schoenaker Y, de Groot JW, de Boer E, Reerink O, de Vos tot Nederveen Cappel W, Beets GL, van Westreenen HL. Delayed Surgery after Neoadjuvant Treatment for Rectal Cancer Does Not Lead to Impaired Quality of Life, Worry for Cancer, or Regret. Cancers (Basel) 2021; 13:cancers13040742. [PMID: 33670120 PMCID: PMC7916848 DOI: 10.3390/cancers13040742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Rectal cancer patients with an initial (near) complete clinical response to neoadjuvant chemoradiotherapy can be repeatedly assessed to see if a complete response endures. Up to 75% of these patients are able to avoid surgery and its related complications. However, the remaining 25% who ‘fail’ will eventually have to undergo surgery. Although recent studies have shown that patients undergoing delayed surgery have promising surgical and oncological outcomes, it is not known how these patients fare in terms of quality of life. The aim of this study was to compare quality of life between these immediate and delayed surgery groups through validated questionnaires. Our study including 51 patients shows no difference in quality of life, worry for cancer, or decision regret. Therefore, from a quality of life perspective, this study supports a repeated response assessment strategy after chemoradiotherapy for rectal carcinoma to identify all complete responders. Abstract Non operative management of complete clinical responders after neoadjuvant treatment for rectal cancer enjoys an increasing popularity because of the increased functional outcome results. Even a near complete response can evolve in a cCR, and therefore further delaying response assessment is accepted. However, up to 40% of patients will develop a regrowth and will eventually require delayed surgery. It is presently unknown if and to what extent quality of life of these patients is affected, compared to patients who undergo immediate surgery. Between January 2015-May 2020, 200 patients were treated with neoadjuvant therapy of whom 94 received TME surgery. Fifty-one (59%) of 87 alive patients returned the questionnaires: 33 patients who underwent immediate and 18 patients who underwent delayed surgery. Quality of life was measured through the QLQ-C30, QLQ-CR29, and Cancer Worry Scale questionnaires. Regret to participate in repeated response assessment protocol was assessed through the Decision Regret Scale. Exploratory factor analysis (EFA) and a ‘known groups comparison’ was performed to assess QLQ questionnaires validity in this sample. Higher mean physical function scores (89.2 vs. 77.6, p = 0.03) were observed in the immediate surgery group, which lost significance after correction for operation type (p = 0.25). Arousal for men was higher in the delayed surgery group (20.0 vs. 57.1, p = 0.02). There were no differences between surgical groups for the other questionnaire items. Worry for cancer was lower in the delayed surgery group (10.8 vs. 14.0, p = 0.21). Regret was very low (12–16%). EFA reproduced most QLQ C-30 and CR29 subscales with good internal consistency. Quality of life is not impaired in patients undergoing delayed TME surgery after neoadjuvant treatment for rectal cancer. Moreover, there is very low regret and no increase in worry for cancer. Therefore, from a quality of life perspective, this study supports a repeated response assessment strategy after CRTx for rectal carcinoma to identify all complete responders.
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Affiliation(s)
- Vincent Maurice Meyer
- Department of Surgery, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; (R.R.M.); (Y.S.); (H.L.v.W.)
- Correspondence:
| | - Richtje R Meuzelaar
- Department of Surgery, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; (R.R.M.); (Y.S.); (H.L.v.W.)
| | - Yvonne Schoenaker
- Department of Surgery, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; (R.R.M.); (Y.S.); (H.L.v.W.)
| | - Jan-Willem de Groot
- Department of Oncology, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands;
| | - Edwin de Boer
- Department of Radiology, Isala Hospitals, 8025 AB Zwolle, The Netherlands;
| | - Onno Reerink
- Department of Radiotherapy, Isala Hospitals, 8025 AB Zwolle, The Netherlands;
| | | | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Henderik L van Westreenen
- Department of Surgery, Isala Hospitals, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; (R.R.M.); (Y.S.); (H.L.v.W.)
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10
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Meng Y, Wan L, Zhang C, Wang C, Ye F, Li S, Zou S, Cheng J, Xu K, Zhou C, Zhang H. The Predictive Value of Pre-/Postneoadjuvant Chemoradiotherapy MRI Characteristics for Patient Outcomes in Locally Advanced Rectal Cancer. Acad Radiol 2020; 27:e233-e243. [PMID: 31780392 DOI: 10.1016/j.acra.2019.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 01/18/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to investigate the predictive value of pre-/postneoadjuvant chemoradiotherapy (nCRT) magnetic resonance imaging (MRI) characteristics for the long-term survival outcomes in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS We retrospectively evaluated pre- and post-nCRT MRI and clinicopathologic characteristics of LARC patients. The 3-year disease-free survival (DFS) was estimated using the Kaplan-Meier product-limit method. Associations between MRI variabilities and survival outcomes were assessed using Cox proportional hazards model. RESULTS In total, 171 LARC patients (112 men and 59 women) with a median age of 55 years (range, 27-82 years) treated with nCRT were evaluated. The median follow-up was 47.6 months, and the 3-, 4-, and 5-year DFS in the overall cohort was 76.6%, 74.5%, and 73.7%, respectively. MRI assessment of extramural venous invasion (mrEMVI) positivity was a significant independent adverse factor of long-term survival (hazard ratio [HR] = 2.589, 95% confidence interval [CI] = 1.398-4.794, p = 0.002) on multivariate analysis. Patients with positive mrEMVI had significantly lower 3-year DFS than those with negative mrEMVI (52.6 months vs 65.1 months; p = 0.003). Moreover, the tumor regression grade on MRI (mrTRG) also significantly correlated with survival outcomes in patients with LARC. Patients with partial response on post-nCRT MRI (mrPR) showed short DFS than those with complete response (mrCR; HR = 4.914, 95% CI = 1.176-20.533, p = 0.029). The 3-year DFS of mrCR and mrPR patients were 74.3 months and 58.9 months, respectively (p = 0.011). CONCLUSION The pre-/post-nCRT MRI characteristics may be used to long-term survival stratification in LARC patients. mrEMVI positivity was an independent adverse prognostic indicator for 3-year DFS. Further, mrTRG may also be a predictive factor for the prognosis of LARC patients. The pre-/post-nCRT MR imaging may offer more information for providing individualized treatment.
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Affiliation(s)
- Yankai Meng
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China; College of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China
| | - Lijuan Wan
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China
| | - Chongda Zhang
- Tandon school of Engineering, New York university, New York, USA
| | - Chen Wang
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China
| | - Feng Ye
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China
| | - Shaodong Li
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China
| | - Shuangmei Zou
- Department of Pathology, National Cancer Center/ National Clinical Research Center for Cancer /Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jyh Cheng
- College of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China.; Department of Biomedical and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Kai Xu
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China; College of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China..
| | - Chunwu Zhou
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China.
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China.
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11
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López-Campos F, Martín-Martín M, Fornell-Pérez R, García-Pérez JC, Die-Trill J, Fuentes-Mateos R, López-Durán S, Domínguez-Rullán J, Ferreiro R, Riquelme-Oliveira A, Hervás-Morón A, Couñago F. Watch and wait approach in rectal cancer: Current controversies and future directions. World J Gastroenterol 2020; 26:4218-4239. [PMID: 32848330 PMCID: PMC7422545 DOI: 10.3748/wjg.v26.i29.4218] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/25/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
According to the main international clinical guidelines, the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. However, doubts have been raised about the appropriate definition of clinical complete response (cCR) after neoadjuvant therapy and the role of surgery in patients who achieve a cCR. Surgical resection is associated with significant morbidity and decreased quality of life (QoL), which is especially relevant given the favourable prognosis in this patient subset. Accordingly, there has been a growing interest in alternative approaches with less morbidity, including the organ-preserving watch and wait strategy, in which surgery is omitted in patients who have achieved a cCR. These patients are managed with a specific follow-up protocol to ensure adequate cancer control, including the early identification of recurrent disease. However, there are several open questions about this strategy, including patient selection, the clinical and radiological criteria to accurately determine cCR, the duration of neoadjuvant treatment, the role of dose intensification (chemotherapy and/or radiotherapy), optimal follow-up protocols, and the future perspectives of this approach. In the present review, we summarize the available evidence on the watch and wait strategy in this clinical scenario, including ongoing clinical trials, QoL in these patients, and the controversies surrounding this treatment approach.
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Affiliation(s)
- Fernando López-Campos
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | | | - Roberto Fornell-Pérez
- Department of Radiology, Hospital Universitario de Basurto, Bilbao 48013, Vizcaya, Spain
| | | | - Javier Die-Trill
- Department of Surgery, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Raquel Fuentes-Mateos
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Sergio López-Durán
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - José Domínguez-Rullán
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Reyes Ferreiro
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | | | - Asunción Hervás-Morón
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28003, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Universidad Europea de Madrid (UEM), Madrid 28223, Spain
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12
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Gürses B, Altınmakas E, Böge M, Aygün MS, Bayram O, Balık E. Multiparametric MRI of rectal cancer-repeatability of quantitative data: a feasibility study. Diagn Interv Radiol 2020; 26:87-94. [PMID: 32071023 DOI: 10.5152/dir.2019.19127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE In this study, we aimed to analyze the repeatability of quantitative multiparametric rectal magnetic resonance imaging (MRI) parameters with different measurement techniques. METHODS All examinations were performed with 3 T MRI system. In addition to routine sequences for rectal cancer imaging protocol, small field-of-view diffusion-weighted imaging and perfusion sequences were acquired in each patient. Apparent diffusion coefficient (ADC) was used for diffusion analysis and ktrans was used for perfusion analysis. Three different methods were used in measurement of these parameters; measurements were performed twice by one radiologist for intraobserver and separately by three radiologists for interobserver variability analysis. ADC was measured by the lowest value, the value at maximum wall thickness, and freehand techniques. Ktrans was measured at the slice with maximum wall thickness, by freehand drawn region of interest (ROI), and at the dark red spot with maximum value. RESULTS A total of 30 patients with biopsy-proven rectal adenocarcinoma were included in the study. The mean values of the parameters measured by the first radiologist on the first and second measurements were as follows: mean lowest ADC, 721.31±147.18 mm2/s and 718.96±135.71 mm2/s; mean ADC value on the slice with maximum wall thickness, 829.90±144.24 mm2/s and 829.48±149.23 mm2/s; mean ADC value measured by freehand ROI on the slice with maximum wall thickness, 846.56±136.31 mm2/s and 848.23±144.15 mm2/s; mean ktrans value on the slice with maximum wall thickness, 0.219±0.080 and 0.214±0.074; mean ktrans by freehand ROI technique (including as much tumoral tissue as possible), 0.208±0.074 and 0.207±0.069; mean ktrans measured from the dark red foci, 0.308±0.109 and 0.311±0.105. Intraobserver agreement was very good among diffusion and perfusion parameters obtained with all three measurement techniques. Interobserver agreement was very good, except for one of the measurement techniques. As far as interobserver variability is considered, only ADC value measured on the slice with maximum wall thickness differed significantly. CONCLUSION Multiparametric MRI of rectum, using ADC as the diffusion and ktrans as the perfusion parameter is a repeatable technique. This technique may potentially be used in prediction and evaluation of neoadjuvant treatment response. New studies with larger patient groups are needed to validate the role of multiparametric MRI.
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Affiliation(s)
- Bengi Gürses
- Department of Radiology, Koç University School of Medicine, İstanbul, Turkey
| | - Emre Altınmakas
- Department of Radiology, Koç University School of Medicine, İstanbul, Turkey
| | - Medine Böge
- Department of Radiology, Koç University School of Medicine, İstanbul, Turkey
| | - M Serhat Aygün
- Department of Radiology, Koç University School of Medicine, İstanbul, Turkey
| | - Onur Bayram
- Department of General Surgery, Koç University School of Medicine, İstanbul, Turkey
| | - Emre Balık
- Department of General Surgery, Koç University School of Medicine, İstanbul, Turkey
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13
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Primary and post-chemoradiotherapy staging using MRI in rectal cancer: the role of diffusion imaging in the assessment of perirectal infiltration. Abdom Radiol (NY) 2019; 44:3674-3682. [PMID: 31332499 DOI: 10.1007/s00261-019-02139-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To analyze changes in MRI diagnostic accuracy in main rectal tumor (T) evaluation resulting from the use of diffusion-weighted imaging (DWI), according to the degree of experience of the radiologist. METHODS This is a cross-sectional study of a database including one hundred 1.5 T MRI records (2011-2016) from patients with biopsy-proven rectal cancer, including primary staging and post-chemoradiotherapy follow-up. All cases were individually blindedly reviewed by ten radiologists: three experienced in rectal cancer, three specialized in other areas, and four residents. Each case was assessed twice to detect perirectal infiltration: first, evaluating just high-resolution T2-weighted sequences (HRT2w); second, evaluation of DWI plus HRT2w sequences. Results were pooled by experience, calculating accuracy (area under ROC curve), sensitivity and specificity, predictive values, likelihood ratios, and overstaging/understaging. Histology of surgical specimens provided the reference standard. RESULTS DWI significantly improved specificity by experienced radiologists in primary staging (63.2% to 75.9%) and, to a lesser extent, positive likelihood ratio (2.06 to 2.87); minimal changes were observed post-chemoradiotherapy, with a slight decrease of accuracy (0.657 to 0.626). Inexperienced radiologists showed a similar pattern, but with slight enhancement post-chemoradiotherapy (accuracy 0.604 to 0.621). Residents experienced small changes, with increased sensitivity/decreased specificity in both primary (69% to 72%/67.2% to 64.7%) and post-chemoradiotherapy (68.1% to 73.6%/47.3% to 44.6%) staging. CONCLUSIONS Adding DWI to HRT2w significantly improved specificity for the detection of perirectal infiltration at primary staging by experienced radiologists and also by inexperienced ones, although to a lesser extent. In the post-neoadjuvant treatment subgroup, only minimal changes were observed.
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14
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Fornell-Perez R, Perez-Alonso E, Aleman-Flores P, Lozano-Rodriguez A, Loro-Ferrer JF. Nodal staging in the rectal cancer follow-up MRI after chemoradiotherapy: use of morphology, size, and diffusion criteria. Clin Radiol 2019; 75:100-107. [PMID: 31515052 DOI: 10.1016/j.crad.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/08/2019] [Indexed: 02/07/2023]
Abstract
AIM To analyse changes in post-neoadjuvant follow-up magnetic resonance imaging (MRI) staging accuracy for malignant adenopathies in rectal cancer, by comparing size criteria with morphological criteria using high-resolution T2-weighted sequences, as well as variations when adding diffusion-weighted imaging. METHODS AND MATERIALS The present study was a cross-sectional study of a database including 46 1.5-T MRI examinations (2011-2016) from patients with biopsy-proven rectal cancer and chemoradiotherapy treatment before surgery. All cases were reviewed by three radiologists individually, who were blinded to any clinical information. The radiologists were experienced in rectal cancer (3-6 years) and evaluated the presence of malignant nodes in each patient. Malignancy was determined using morphological, size (5 mm), and diffusion criteria separately, as well as morphology plus diffusion. Each case was assessed four times: (1) evaluation of morphological criteria; (2) size criteria; (3) evaluation only using diffusion (b-values 50, 400, and 800); and (4) diffusion plus morphological criteria. Histological staging of surgical specimens was the reference standard. Statistical analysis included accuracy (area under the receiver operating characteristic [ROC] curve [AUC]), sensitivity, specificity, and positive/negative predictive values (PPV/NPV) for each radiologist, and group agreement (Fleiss' kappa). RESULTS Mean values using morphological criteria were: AUC 0.78, sensitivity 77.7%, specificity 73.8%, PPV 66.1%, NPV 85.2%. Using size criterion: AUC 0.75, sensitivity 62.9%, specificity 83.2%, PPV 74.1%, NPV 80%. Added diffusion yielded no improvement, and yielded worse results by itself. CONCLUSIONS Although morphological criteria showed better results in accuracy, sensitivity, and NPV, size criterion yielded the best specificity and PPV. Adding diffusion did not demonstrate a clear advantage over the criteria by themselves. Thus, mixed size-morphology criteria could have the greatest diagnostic value for follow-up N-staging.
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Affiliation(s)
- R Fornell-Perez
- Clinical Sciences Department, Faculty of Medicine, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016, Las Palmas de Gran Canaria, Spain.
| | - E Perez-Alonso
- Clinical Sciences Department, Faculty of Medicine, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016, Las Palmas de Gran Canaria, Spain; Department of General Surgery, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Spain
| | - P Aleman-Flores
- Department of Radiology, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Spain
| | - A Lozano-Rodriguez
- Department of Radiology, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n, 35016, Las Palmas de Gran Canaria, Spain
| | - J F Loro-Ferrer
- Clinical Sciences Department, Faculty of Medicine, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016, Las Palmas de Gran Canaria, Spain
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15
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Value of High-Resolution DWI in Combination With Texture Analysis for the Evaluation of Tumor Response After Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer. AJR Am J Roentgenol 2019; 212:1279-1286. [PMID: 30860889 DOI: 10.2214/ajr.18.20689] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE. The purpose of this study is to determine the performance of the apparent diffusion coefficient (ADC) value calculated from high-resolution DWI using readout-segmented echo-planar imaging (rs-EPI) and to assess the texture parameters of T2-weighted MR images in identifying pathologic complete response (pCR) after patients with locally advanced rectal cancer (LARC) undergo preoperative chemoradiotherapy (CRT). MATERIALS AND METHODS. A total of 76 patients with LARC who underwent preoperative CRT and subsequent surgery were enrolled in the study retrospectively. All patients underwent post-CRT MRI, which included acquisition of a DWI sequence with use of the rs-EPI technique. The histopathologic tumor regression grade was the reference standard. Patients were subdivided into pCR and non-pCR groups. Two radiologists independently drew whole-tumor ROIs on DW images and T2-weighted MR images to calculate the mean ADC value and first-order texture parameters. RESULTS. Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC], 0.79-0.993) for imaging analysis. Calculated from high-resolution DWI, the mean post-CRT ADC value was significantly higher in the pCR group (p < 0.001). The pCR group also showed lower uniformity (p < 0.001) of the T2-weighted image. The mean ADC value and uniformity were significantly correlated with the tumor regression grade. The mean ADC value was a good indicator for differentiating pCR from absence of pCR (ROC AUC value, 0.912). Uniformity (ROC AUC value, 0.776) showed a moderate ability to identify pCR. Combining the mean ADC value and uniformity yielded an ROC AUC value comparable to that of the mean ADC value (p = 0.125). CONCLUSION. Mean post-CRT ADC values calculated from high-resolution DWI using rs-EPI could effectively select for patients with LARC who have a pCR after preoperative CRT. First-order texture parameters of T2-weighted MR images could also identify patients with pCR by reflecting tumor heterogeneity, even though they could not significantly improve the diagnostic performance.
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Magnetic resonance imaging in locally advanced rectal cancer: quantitative evaluation of the complete response to neoadjuvant therapy. Pol J Radiol 2018; 83:e600-e609. [PMID: 30800199 PMCID: PMC6384410 DOI: 10.5114/pjr.2018.81156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 09/13/2018] [Indexed: 02/01/2023] Open
Abstract
Purpose To assess the diagnostic performance of diffusion-weighted imaging (DWI) for the discrimination of complete responder (CR) from the non-complete responder (n-CR) in patients with locally advanced rectal cancer (LARC) undergoing chemotherapy and radiation (CRT). Material and methods Between December 2009 and January 2014, 32 patients (33 lesions: one patient had two synchronous lesions) were enrolled in this retrospective study. All patients underwent a pre- and post-CRT conventional MRI study completed with DWI. For both data sets (T2-weighted and DWI), the pre- and post-CRT tumour volume (VT2; VDWI) and the tumour volume reduction ratio (ΔV%) were determined as well as pre- and post-CRT apparent diffusion coefficient (ADC) and ADC change (ΔADC%). Histopathological findings were the standard of reference. Receiver operating characteristic (ROC) curves were generated to compare performance of T2-weighted and DWI volumetry, as well as ADC. Results The area under the ROC curve (AUC) revealed a good accuracy of pre- and post-CRT values of VT2 (0.86; 0.91) and VDWI (0.82; 1.00) as well as those of ΔVT2% (0.84) and ΔVDWI% (1.00) for the CR assessment, with no statistical difference. The AUC of pre- and post-CRT ADC (0.53; 0.54) and that of ΔADC% (0.58) were significantly lower. Conclusions Both post-CRT VDWI and ΔVDWI% (AUC = 1) are very accurate for the assessment of the CR, in spite of no significant differences in comparison to the conventional post-CRT VT2 (AUC = 0.91) and ΔVT2% (AUC = 0.84). On the contrary, both ADC and ΔADC% values are not reliable.
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Gollub MJ, Blazic I, Bates DDB, Campbell N, Knezevic A, Gonen M, Lynn P, Weiser MR, Garcia-Aguilar J, Hötker AM, Cercek A, Saltz L. Pelvic MRI after induction chemotherapy and before long-course chemoradiation therapy for rectal cancer: What are the imaging findings? Eur Radiol 2018; 29:1733-1742. [PMID: 30280248 DOI: 10.1007/s00330-018-5726-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the appearance of rectal cancer on MRI after oxaliplatin-based chemotherapy (ICT) and make a preliminary assessment of MRI's value in predicting response to total neoadjuvant treatment (TNT). METHODS In this IRB-approved, HIPAA-compliant, retrospective study between 1 January 2010-20 October 2014, pre- and post-ICT tumour T2 volume, relative T2 signal intensity (rT2SI), node size, signal intensity and border characteristics were assessed in 63 patients (65 tumours) by three readers. The strength of association between the reference standard of histopathological percent tumour response and tumour volume change, rT2SI and lymph node characteristics was assessed with Spearman's correlation coefficient and Wilcoxon's rank sum test. Cox regression was used to assess association between DFS and radiological measures. RESULTS Change in T2 volume was not associated with TNT response. Change in rT2SI showed correlation with TNT response for one reader only using selective regions of interest (ROIs) and borderline correlation with response using total volume ROI. There was a significant negative correlation between baseline and post-ICT node size and TNT response (r = -0.25, p = 0.05; r = -0.35, p = 0.005, readers 1 and 2, respectively). Both baseline and post-induction median node sizes were significantly smaller in complete responders (p = 0.03, 0.001; readers 1 and 2, respectively). Change in largest baseline node size and decrease in post-ICT node signal heterogeneity were associated with 100% tumour response (p = 0.04). Nodal sizes at baseline and post-ICT MRI correlated with DFS. CONCLUSION In patients undergoing post-ICT MRI, tumour volume did not correlate with TNT response, but decreased lymph node sizes were significantly associated with complete response to TNT as well as DFS. Relative T2SI showed borderline correlation with TNT response. KEY POINTS • MRI-based tumour volume after induction chemotherapy and before chemoradiotherapy did not correlate with overall tumour response at the end of all treatment. • Lymph node size after induction chemotherapy and before chemoradiotherapy was strongly associated with complete pathological response after all treatment. • Lymph node sizes at baseline and post-induction chemotherapy MRI correlated with disease-free survival.
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Affiliation(s)
- Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Ivana Blazic
- Department of Radiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, 11080, Serbia
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Naomi Campbell
- IMED Radiology Network, Level 3, 104 Breakfast Creek Road, Newstead, QLD, 4006, Australia
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricio Lynn
- Department of Surgery, New York University Medical Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas M Hötker
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Andrea Cercek
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leonard Saltz
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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18
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Abstract
BACKGROUND The management of rectal cancer has evolved considerably over the last few decades with increasing use of neoadjuvant chemoradiotherapy (nCRT). Complete clinical response (cCR) and even complete pathological response (pCR) have been noted in a proportion of patients who had surgery after nCRT. This raises the concern that we may have been 'over-treating' some of these patients and lead to an increasing interest in 'watch and wait' (W&W) approach for patients who had cCR to avoid the morbidity associated with rectal surgery. METHODS A review of the literature in English pertaining to rectal cancer in the context of W&W, organ preservation and active surveillance. RESULTS Evidence available to support W&W approach comes from non-randomised controlled trials (RCTs) with no current consensus on patients' selection criteria, lack of viable predictors of both cCR and pCR and lack of universal definitions of cCR and pCR. Also, there is no agreed protocol for disease surveillance. CONCLUSION Even though there has been increasing reports on the outcomes of W&W in rectal cancer, the current evidence cannot support its routine use in clinical practice. This approach should be used in clinical trials settings or after thorough counselling with the patient on the outcomes of various treatment options.
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19
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Jang JK, Lee JL, Park SH, Park HJ, Park IJ, Kim JH, Choi SH, Kim J, Yu CS, Kim JC. Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer. Br J Surg 2018; 105:1671-1679. [PMID: 29893988 DOI: 10.1002/bjs.10898] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/15/2018] [Accepted: 05/03/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence to support the specific use of magnetic resonance tumour regression grade (mrTRG) is inadequate. The aim of this study was to investigate the pathological characteristics of mrTRG after chemoradiotherapy (CRT) for rectal cancer and the implications for surgery. METHODS Patients undergoing long-course CRT (45-50 Gy plus a booster dose of 4-6 Gy) for mid or low rectal cancer (cT3-4 or cN+ without metastasis) between 2011 and 2015 who had post-CRT rectal MRI before surgery were included retrospectively. Three board-certified experienced radiologists assessed mrTRG. mrTRG was correlated with pathological tumour regression grade (pTRG), ypT and ypN. In a subgroup of patients with mrTRG1-2 and no tumour spread (such as nodal metastasis) on MRI, the projected rate of completion total mesorectal excision (TME) if they underwent transanal excision (TAE) and had a ypT status of ypT2 or higher was estimated, and recurrence-free survival was calculated according to the operation (TME or TAE) that patients had actually received. RESULTS Some 439 patients (290 men and 149 women of mean(s.d.) age 62·2(11·4) years) were analysed. The accuracy of mrTRG1 for predicting pTRG1 was 61 per cent (40 of 66), and that for ypT1 or less was 74 per cent (49 of 66). For mrTRG2, these values were 22·3 per cent (25 of 112) and 36·6 per cent (41 of 112) respectively. Patients with mrTRG1 and mrTRG2 without tumour spread were ypN+ in 3 per cent (1 of 29) and 16 per cent (8 of 50) respectively. Assuming mrTRG1 or mrTRG1-2 with no tumour spread on post-CRT MRI as the criteria for TAE, the projected completion TME rate was 26 per cent (11 of 43) and 41·0 per cent (41 of 100) respectively. For the 100 patients with mrTRG1-2 and no tumour spread, recurrence-free survival did not differ significantly between TME (79 patients) and TAE (21) (adjusted hazard ratio 1·86, 95 per cent c.i. 0·42 to 8·18). CONCLUSION Patients with mrTRG1 without tumour spread may be suitable for TAE.
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Affiliation(s)
- J K Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J L Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - S H Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - H J Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - I J Park
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J H Kim
- Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - S H Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - C S Yu
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J C Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
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Could early tumour volume changes assessed on morphological MRI predict the response to chemoradiation therapy in locally-advanced rectal cancer? Clin Radiol 2018; 73:555-563. [DOI: 10.1016/j.crad.2018.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 01/11/2018] [Indexed: 01/14/2023]
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21
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Poulsen LØ, Yilmaz MK, Oddershede L, Bøgsted M, Holt G, Eld M, Ljungmann K, Falkmer UG. Is the accuracy of preoperative MRI stage in rectal adenocarcinoma influenced by tumour height? Acta Oncol 2018; 57:728-734. [PMID: 29383974 DOI: 10.1080/0284186x.2018.1433319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM To our knowledge, no prior studies have addressed the possible effects of tumour height on the accuracy of preoperative magnetic resonance imaging (MRI)-based staging relative to postoperative histopathological assessments in patients with adenocarcinoma of the rectum (RC). This study aimed to investigate whether the accuracy of preoperative MRI stage in RC is influenced by tumour height. METHODS A total of 489 consecutive RC patients scheduled for curative treatment between 2009 and 2013 were included. Of the 489 patients, 133 patients had preoperative chemoradiotherapy (CRT), and 356 patients underwent primary surgery. Low, mid and high RC were defined as a tumour <5 cm, 5-10 cm and >10 cm from the anal verge, respectively. Diagnostic MRI and, for patients with CRT, re-staging MRI features including tumour T-stage (mrT), distance between the tumour border and the distance to the mesorectal fascia (mrMRF), extramural tumour depth (mrEMD), extramural vascular invasion (mrEMVI) and nodal involvement (mrN) were correlated with the corresponding postoperative histopathological findings. RESULTS There were 115, 186 and 188 patients with low RC, mid RC and high RC, respectively. For all patients, the correlations between mrT and pT and between mrMRF and pCRM were not influenced by tumour height. None of the correlations between mrEMD, mrEMVI and mrN and the corresponding postoperative histopathological findings significantly differed for tumours of different heights. For patients with CRT, a remarkable proportion with low RC were overstaged as ymrT3 compared to ypT0-2. CONCLUSIONS The ability to preoperatively use MRI to accurately stage is not influenced by tumour height. For patients with preoperative CRT, low RC may be MRI overstaged due to post-radiation fibrosis. We found that mrEMD predicts pEMD reliably and should therefore be considered in treatment decisions. Although new MRI techniques are emerging, preoperative RC staging remains incompletely definitive in daily clinical practice.
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Affiliation(s)
| | | | | | - Martin Bøgsted
- Department of Clinical Science, Aalborg University, Aalborg, Denmark
| | - Gitte Holt
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mikkel Eld
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Ken Ljungmann
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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22
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Chen Y, Yang X, Wen Z, Lu B, Xiao X, Shen B, Yu S. Fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI for predicting small node metastases in patients with rectal cancer. Cancer Imaging 2018; 18:21. [PMID: 29784058 PMCID: PMC5963161 DOI: 10.1186/s40644-018-0153-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
Abstract
Background To investigate the application value of fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI in regional nodes with different short-axis diameter ranges in rectal cancer, especially in nodes ≤5 mm. Methods Patients with rectal adenocarcinoma confirmed by postoperative histopathology were included, and all the patients underwent preoperative 3.0 T rectal magnetic resonance imaging (MRI) and total mesorectal excision (TME) within 2 weeks after an MR scan. The harvested nodes from specimens were matched with nodes in the field of view (FOV) of images for a node-by-node evaluation. The maximum short-axis diameters of all the visible nodes in the FOV of images were measured by a radiologist; the morphological and enhancement characteristics of these nodes were also independently evaluated by two radiologists. The χ2 test was used to evaluate differences in morphological and enhancement characteristics between benign and malignant nodes. The enhancement characteristics were further compared between benign and malignant nodes with different short-axis diameter ranges using the χ2 test. Kappa statistics were used to describe interobserver agreement. Results A total of 441 nodes from 70 enrolled patients were included in the evaluation, of which 111 nodes were metastatic. Approximately 85.5 and 95.6% of benign nodes were found to have obvious enhancement and homogeneous or mild-heterogeneous enhancement, respectively, whereas approximately 89.2 and 85.1% of malignant nodes showed moderate or mild enhancement and obvious-heterogeneous or rim-like enhancement, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) values of the enhancement degree for identifying the overall nodal status, nodes ≤5 mm and nodes > 5 mm and ≤ 10 mm were 0.887, 0.859 and 0.766 for radiologist 1 and 0.892, 0.823 and 0.774 for radiologist 2, respectively. The AUCs of enhancement homogeneity were 0.940, 0.928 and 0.864 for radiologist 1 and 0.944, 0.938 and 0.842 for radiologist 2, respectively. Nodal border and signal homogeneity were also of certain value in distinguishing metastatic nodes. Conclusions Enhancement characteristics based on fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI were helpful for diagnosing metastatic nodes in rectal cancer and were a reliable indicator for nodes ≤5 mm.
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Affiliation(s)
- Yan Chen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Xinyue Yang
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Ziqiang Wen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Baolan Lu
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Xiaojuan Xiao
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Bingqi Shen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Shenping Yu
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China.
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23
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Rengo M, Picchia S, Marzi S, Bellini D, Caruso D, Caterino M, Ciolina M, De Santis D, Musio D, Tombolini V, Laghi A. Magnetic resonance tumor regression grade (MR-TRG) to assess pathological complete response following neoadjuvant radiochemotherapy in locally advanced rectal cancer. Oncotarget 2017; 8:114746-114755. [PMID: 29383117 PMCID: PMC5777729 DOI: 10.18632/oncotarget.21778] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/21/2017] [Indexed: 01/06/2023] Open
Abstract
This study aims to evaluate the feasibility of a magnetic resonance (MR) automatic method for quantitative assessment of the percentage of fibrosis developed within locally advanced rectal cancers (LARC) after neoadjuvant radiochemotherapy (RCT). A total of 65 patients were enrolled in the study and MR studies were performed on 3.0 Tesla scanner; patients were followed-up for 30 months. The percentage of fibrosis was quantified on T2-weighted images, using automatic K-Means clustering algorithm. According to the percentage of fibrosis, an optimal cut-off point for separating patients into favorable and unfavorable pathologic response groups was identified by ROC analysis and tumor regression grade (MR-TRG) classes were determined and compared to histopathologic TRG. An optimal cut-off point of 81% of fibrosis was identified to differentiate between favorable and unfavorable pathologic response groups resulting in a sensitivity of 78.26% and a specificity of 97.62% for the identification of complete responders (CRs). Interobserver agreement was good (0.85). The agreement between P-TRG and MR-TRG was excellent (0.923). Significant differences in terms of overall survival (OS) and disease free survival (DFS) were found between favorable and unfavorable pathologic response groups. The automatic quantification of fibrosis determined by MR is feasible and reproducible.
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Affiliation(s)
- Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Simona Picchia
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Simona Marzi
- Medical Physics Laboratory, Regina Elena National Cancer Institute, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Mauro Caterino
- Radiology Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Ciolina
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Domenico De Santis
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Daniela Musio
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Radiotherapy Unit, Policlinico Umberto I, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Radiotherapy Unit, Policlinico Umberto I, Rome, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
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24
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Engin G, Sharifov R. Magnetic resonance imaging for diagnosis and neoadjuvant treatment evaluation in locally advanced rectal cancer: A pictorial review. World J Clin Oncol 2017; 8:214-229. [PMID: 28638791 PMCID: PMC5465011 DOI: 10.5306/wjco.v8.i3.214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/14/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
High-resolution pelvic magnetic resonance imaging (MRI) is the primary method for staging rectal cancer. MRI is highly accurate in the primary staging of rectal cancer; however, it has not proven to be effective in re-staging, especially in complete response evaluation after neoadjuvant therapy. Neoadjuvant chemoradiotherapy produces many changes in rectal tumors and on adjacent area, as a result, local tumor extent may not be accurately determined. However, adding diffusion-weighted sequences to the standard approach can improve diagnostic accuracy. In this pictorial review, an overview of the situation of MRI in the staging and re-staging of rectal cancer is exhibited as a pictorial assay. An experience- and literature-based discussion of limitations and difficulties in interpretation are also presented.
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