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Fidan M, Nural MS, Çamlıdağ İ, Yürüker SS, Meydan BC. Evaluation of treatment response by multiparametric MR imaging in locally advanced rectal tumors following neoadjuvant chemotherapy. Abdom Radiol (NY) 2024:10.1007/s00261-024-04389-3. [PMID: 38822855 DOI: 10.1007/s00261-024-04389-3] [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: 04/13/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE To investigate the effectiveness of multiparametric MRI examination in determining tumor response after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal tumors. METHODS 46 patients with locally advanced rectal adenocarcinoma were included and were divided into two groups as complete responders and nonresponders based on Mandard score. On MRI, relative T2w signal intensity and ADC values obtained before and after treatment and tumour volumes in dynamic contrast enhanced images (DCI) were used to determine complete response to treatment. RESULTS There were no significant differences between mean ADC values obtained by single slice ADC and three circular ROI methods. There were significant differences between two groups in terms of Post-CRT ADC value, ΔADC and %ΔADC obtained by whole tumour volume ADC method (p < 0.05). There were significant differences between Pre-CRT and Post-CRT volume values. ΔV DCI and %ΔV DCI, ΔV ADC and T2w volume values were significantly lower in complete responders (p < 0.05). In multivariate analysis, sensitivity and specificity were calculated as 88.9% and 91.9% (AUC = 0.943) when Post-CRT mean ADC value and Post-CRT DCI volume values were used together, and sensitivity and specificity were calculated as 88.9% and 94.6% (AUC = 0.949) when ΔADC and Post-CRT DCI volume values were used together. CONCLUSION Whole tumour volume mean ADC value is the most useful method to determine treatment response. Post-CRT DCI volume measurement stands out as the most useful method in assessing complete response alone. The highest diagnostic values are achieved when the post-CRT DCI volume is combined with the ADC change value of the whole tumor volume.
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Affiliation(s)
- Murat Fidan
- Department of Radiology, Ordu Fatsa State Hospital, Evkaf, Hastane Yolu No:5, 52400, Fatsa/Ordu, Turkey
| | - Mehmet Selim Nural
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
| | - İlkay Çamlıdağ
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey.
| | - Saim Savaş Yürüker
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
| | - Bilge Can Meydan
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
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Mislati R, Uccello TP, Lin Z, Iliza KT, Toussaint KC, Gerber SA, Doyley MM. Shear wave elastography can stratify rectal cancer response to short-course radiation therapy. Sci Rep 2023; 13:16149. [PMID: 37752156 PMCID: PMC10522682 DOI: 10.1038/s41598-023-43383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023] Open
Abstract
Rectal cancer is a deadly disease typically treated using neoadjuvant chemoradiotherapy followed by total mesorectal excision surgery. To reduce the occurrence of mesorectal excision surgery for patients whose tumors regress from the neoadjuvant therapy alone, conventional imaging, such as computed tomography (CT) or magnetic resonance imaging (MRI), is used to assess tumor response to neoadjuvant therapy before surgery. In this work, we hypothesize that shear wave elastography offers valuable insights into tumor response to short-course radiation therapy (SCRT)-information that could help distinguish radiation-responsive from radiation-non-responsive tumors and shed light on changes in the tumor microenvironment that may affect radiation response. To test this hypothesis, we performed elastographic imaging on murine rectal tumors (n = 32) on days 6, 10, 12, 16, 18, 20, 23, and 25 post-tumor cell injection. The study revealed that radiation-responsive and non-radiation-responsive tumors had different mechanical properties. Specifically, radiation-non-responsive tumors showed significantly higher shear wave speed SWS (p < 0.01) than radiation-responsive tumors 11 days after SCRT. Furthermore, there was a significant difference in shear wave attenuation (SWA) (p < 0.01) in radiation-non-responsive tumors 16 days after SCRT compared to SWA measured just one day after SCRT. These results demonstrate the potential of shear wave elastography to provide valuable insights into tumor response to SCRT and aid in exploring the underlying biology that drives tumors' responses to radiation.
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Affiliation(s)
- Reem Mislati
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Taylor P Uccello
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA
| | - Zixi Lin
- School of Engineering, Brown University, Providence, RI, USA
| | - Katia T Iliza
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | | | - Scott A Gerber
- Department of Surgery, University of Rochester, Rochester, NY, USA
| | - Marvin M Doyley
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA.
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3
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Gao PF, Lu N, Liu W. MRI VS. FDG-PET for diagnosis of response to neoadjuvant therapy in patients with locally advanced rectal cancer. Front Oncol 2023; 13:1031581. [PMID: 36741013 PMCID: PMC9890074 DOI: 10.3389/fonc.2023.1031581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
Aim In this study, we aimed to compare the diagnostic values of MRI and FDG-PET for the prediction of the response to neoadjuvant chemoradiotherapy (NACT) of patients with locally advanced Rectal cancer (RC). Methods Electronic databases, including PubMed, Embase, and the Cochrane library, were systematically searched through December 2021 for studies that investigated the diagnostic value of MRI and FDG-PET in the prediction of the response of patients with locally advanced RC to NACT. The quality of the included studies was assessed using QUADAS. The pooled sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), and the area under the ROC (AUC) of MRI and FDG-PET were calculated using a bivariate generalized linear mixed model, random-effects model, and hierarchical regression. Results A total number of 74 studies with recruited 4,105 locally advanced RC patients were included in this analysis. The pooled sensitivity, specificity, PLR, NLR, and AUC for MRI were 0.83 (95% CI: 0.77-0.88), 0.85 (95% CI: 0.79-0.89), 5.50 (95% CI: 4.11-7.35), 0.20 (95% CI: 0.14-0.27), and 0.91 (95% CI: 0.88-0.93), respectively. The summary sensitivity, specificity, PLR, NLR and AUC for FDG-PET were 0.81 (95% CI: 0.77-0.85), 0.75 (95% CI: 0.70-0.80), 3.29 (95% CI: 2.64-4.10), 0.25 (95% CI: 0.20-0.31), and 0.85 (95% CI: 0.82-0.88), respectively. Moreover, there were no significant differences between MRI and FDG-PET in sensitivity (P = 0.565), and NLR (P = 0.268), while the specificity (P = 0.006), PLR (P = 0.006), and AUC (P = 0.003) of MRI was higher than FDG-PET. Conclusions MRI might superior than FGD-PET for the prediction of the response of patients with locally advanced RC to NACT.
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Affiliation(s)
- Peng Fei Gao
- Department of Traditional Chinese medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Na Lu
- Department of Radiology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Wen Liu
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China,*Correspondence: Wen Liu,
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Tan Z, Cheng L, Xie L, Zhang L, Lin Z, Han P, Li X. Comparison of the diagnostic performance of changes in signal intensity and volume from multiparametric MRI for assessing response of rectal cancer to neoadjuvant chemoradiotherapy. Asia Pac J Clin Oncol 2022; 19:327-336. [PMID: 36271652 DOI: 10.1111/ajco.13878] [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: 03/05/2022] [Revised: 07/05/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the change in signal intensity (SI) and volume (V) from multiparametric magnetic resonance imaging (MRI) for assessing the response of locally advanced rectal cancer (LARC) to chemoradiotherapy (CRT). MATERIALS AND METHODS Eight-two LARC patients who underwent pre- and post-CRT T2-weighted (T2W), apparent diffusion coefficient (ADC), and contrast-enhanced T1-weighted (ceT1W) MRI were retrospectively analyzed. The change of volume (%△V) and relative SI ratio (%△SIR) from each sequence were determined. All LARCs were confirmed pathologically and classified as tumor regression grade (TRG) -0, 1, 2,or 3. Descriptive statistics and receiver operating characteristic (ROC) analysis, with calculation of area under the curve (AUC), were used to compare the diagnostic performances. RESULTS Sixteen patients had TRG-0, 15 had TRG-1, 35 had TRG-2, and 16 had TRG-3. Except for ADC-%△SIR, the remaining %△V and %△SIR values on MR sequences had significant differences among the four groups. The %△V and %△SIR (alone or together) did not distinguish TRG-1 from TRG-2, nor TRG-2 from TRG-3; however, differences between other TRGs were identified by %△V and %△SIR. The combined use of ADC-%△V and T2W-%△SIR provided the best diagnostic performance in distinguishing of TRG-0 from TRG-2 (AUC: 0.954) and from TRG-3 (AUC: 1.000). CONCLUSIONS Preoperative MRI of LARC patients after CRT has high diagnostic value for determination TRG, and may therefore improve the selection of patients most suitable for surgery.
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Affiliation(s)
- Zhengwu Tan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Lan Cheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Lingling Xie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lan Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Zhenyu Lin
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Xin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
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Xia X, Wen L, Zhou F, Li J, Lu Q, Liu J, Yu X. Predictive value of DCE-MRI and IVIM-DWI in osteosarcoma patients with neoadjuvant chemotherapy. Front Oncol 2022; 12:967450. [PMID: 36313686 PMCID: PMC9614152 DOI: 10.3389/fonc.2022.967450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the predictive value of dynamic contrast enhanced MRI (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for clinical outcomes of osteosarcoma patients with neoadjuvant chemotherapy. Methods The present prospective single-arm cohort study enrolled 163 patients of osteosarcoma during July 2017 to July 2022. All patients received the same treatment strategy of neoadjuvant chemotherapy. Both DCE-MRI and IVIM-DWI were conducted for the patients before the chemotherapy, as well as after one or two chemotherapy treatment cycles. The imaging parameters of contrast agent transfer rate between blood and tissue (Ktrans), contrast agent back-flux rate constant (Kep), extravascular extracellular fractional volume (Ve), as well as pure diffusion coefficient (D value), pseudo-diffusion coefficient (D* value), apparent diffusion coefficient (ADC) and the perfusion fraction (f value) were recorded. RECIST standard [complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD)] was used as the main clinical outcome. Results After two treatment cycles, 112 (68.71%) cases were with CR and PR, 31 (19.02%) cases were with SD and 20 cases (12.27%) were with PD. After 1~2 treatment cycles, patients with CR/PR showed significantly markedly lower Ktrans, Kep, Ve values, while higher D, ADC and f values compared with SD or PD patients. Alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were positively correlated with values of Ktrans, Kep, and Ve, while negative correlation was observed between ALP and values of D, ADC and f, as well as between LDH and D and ADC after the whole treatment. D and Kep values after two treatment cycles showed the best predictive value for diagnosis of PD. The values of Ktran, Kep, ADC as well as ALP and LDH were all risk factors for PD after neoadjuvant chemotherapy. Conclusion DCE-MRI and IVIM-DWI have the potential to predict clinical outcomes of osteosarcoma patients with neoadjuvant chemotherapy.
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Affiliation(s)
- Xibin Xia
- Department of Diagnostic Radiology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Lu Wen
- Department of Diagnostic Radiology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Feng Zhou
- Department of Orthopedics and Soft Tissue, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Junjun Li
- Department of Pathology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qiang Lu
- Department of Diagnostic Radiology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jun Liu
- Department of Diagnostic Radiology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- *Correspondence: Xiaoping Yu, ; Jun Liu,
| | - Xiaoping Yu
- Department of Diagnostic Radiology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- *Correspondence: Xiaoping Yu, ; Jun Liu,
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Albano D, Bruno F, Agostini A, Angileri SA, Benenati M, Bicchierai G, Cellina M, Chianca V, Cozzi D, Danti G, De Muzio F, Di Meglio L, Gentili F, Giacobbe G, Grazzini G, Grazzini I, Guerriero P, Messina C, Micci G, Palumbo P, Rocco MP, Grassi R, Miele V, Barile A. Dynamic contrast-enhanced (DCE) imaging: state of the art and applications in whole-body imaging. Jpn J Radiol 2021; 40:341-366. [PMID: 34951000 DOI: 10.1007/s11604-021-01223-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022]
Abstract
Dynamic contrast-enhanced (DCE) imaging is a non-invasive technique used for the evaluation of tissue vascularity features through imaging series acquisition after contrast medium administration. Over the years, the study technique and protocols have evolved, seeing a growing application of this method across different imaging modalities for the study of almost all body districts. The main and most consolidated current applications concern MRI imaging for the study of tumors, but an increasing number of studies are evaluating the use of this technique also for inflammatory pathologies and functional studies. Furthermore, the recent advent of artificial intelligence techniques is opening up a vast scenario for the analysis of quantitative information deriving from DCE. The purpose of this article is to provide a comprehensive update on the techniques, protocols, and clinical applications - both established and emerging - of DCE in whole-body imaging.
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Affiliation(s)
- Domenico Albano
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy.
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Andrea Agostini
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Clinical, Special and Dental Sciences, Department of Radiology, University Politecnica delle Marche, University Hospital "Ospedali Riuniti Umberto I - G.M. Lancisi - G. Salesi", Ancona, Italy
| | - Salvatore Alessio Angileri
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Benenati
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Oncologia ed Ematologia, RadioterapiaRome, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Vito Chianca
- Ospedale Evangelico Betania, Naples, Italy
- Clinica Di Radiologia, Istituto Imaging Della Svizzera Italiana - Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Diletta Cozzi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giuliana Giacobbe
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giulia Grazzini
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Pasquale Guerriero
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | - Giuseppe Micci
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Abruzzo Health Unit 1, Department of diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, L'Aquila, Italy
| | - Maria Paola Rocco
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Validation of the standardized index of shape tool to analyze DCE-MRI data in the assessment of neo-adjuvant therapy in locally advanced rectal cancer. Radiol Med 2021; 126:1044-1054. [PMID: 34041663 DOI: 10.1007/s11547-021-01369-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/05/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Standardized index of shape (SIS) tool validation to examine dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in preoperative chemo-radiation therapy (pCRT) assessment of locally advanced rectal cancer (LARC) in order to guide the surgeon versus more or less conservative treatment. MATERIALS AND METHODS A total of 194 patients (January 2008-November 2020), with III-IV locally advanced rectal cancer and subjected to pCRT were included. Three expert radiologists performed DCE-MRI analysis using SIS tool. Degree of absolute agreement among measurements, degree of consistency among measurements, degree of reliability and level of variability were calculated. Patients with a pathological tumour regression grade (TRG) 1 or 2 were classified as major responders (complete responders have TRG 1). RESULTS Good significant correlation was obtained between SIS measurements (range 0.97-0.99). The degree of absolute agreement ranges from 0.93 to 0.99, the degree of consistency from 0.81 to 0.9 and the reliability from 0.98 to 1.00 (p value < < 0.001). The variability coefficient ranges from 3.5% to 26%. SIS value obtained to discriminate responders by non-responders a sensitivity of 95.9%, a specificity of 84.7% and an accuracy of 91.8% while to detect complete responders, a sensitivity of 99.2%, a specificity of 63.9% and an accuracy of 86.1%. CONCLUSION SIS tool is suitable to assess pCRT response both to identify major responders and complete responders in order to guide the surgeon versus more or less conservative treatment.
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Khwaja SA, Thipphavong S, Kirsch R, Menezes RJ, Kennedy ED, Brierley JD, Jhaveri KS. Evaluation of a multiparametric MRI scoring system for histopathologic treatment response following preoperative chemoradiotherapy for rectal cancer. Eur J Radiol 2021; 138:109628. [PMID: 33721764 DOI: 10.1016/j.ejrad.2021.109628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the performance of a multiparametric (mp) MRI scoring system for assessment of tumour response in patients with locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT). METHOD Fifty-nine consecutive patients with LARC who had rectal MRI before and after CRT followed by surgery were included. Two radiologists retrospectively assessed tumour response using a proposed mpMRI scoring system. Treatment response was classified as complete, near complete, partial or poor. Accuracy, sensitivity, specificity, positive predictive value and negative predictive values were calculated and inter-reader agreements were assessed. Pathologic tumour regression grade (pTRG) was the reference standard. RESULTS Treatment response was correctly predicted by both readers in 32.2%-40.7% of patients. Overestimation was more common than underestimation. Sensitivity, specificity, PPV and NPV for pathologic complete response (pCR) among both readers was 16.7-33.0 %, 88.7-94.2 %, 14.3-40.0 % and 92.5-94.2 % respectively. Sensitivity and PPV for both readers improved to 56.0-60.0 % and 53.6-66.7 % respectively when complete response and near complete response categories (good responders) were combined. Inter-reader agreement using the scoring system was fair (κ = 0.383). Agreement between mpMRI score and pathological tumour response was poor to fair for both readers (κ = 0.050 to 0.258) but improved when complete and near complete response categories (good responders) were combined (κ = 0.214 to 0.362). CONCLUSIONS Despite low agreement between radiological tumour response and pTRG, the proposed mpMRI-based scoring system appears useful in identifying good responders who may benefit from nonoperative management strategies.
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Affiliation(s)
- Samir A Khwaja
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, University of Toronto, Ontario, Canada; Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Seng Thipphavong
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
| | - Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Ravi J Menezes
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Ontario, Canada.
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - James D Brierley
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
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Zhang AD, Su XH, Wang YF, Shi GF, Han C, Zhang N. Predicting the effects of radiotherapy based on diffusion kurtosis imaging in a xenograft mouse model of esophageal carcinoma. Exp Ther Med 2021; 21:327. [PMID: 33732300 PMCID: PMC7903468 DOI: 10.3892/etm.2021.9758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to assess the predictive value of diffusion kurtosis imaging (DKI) on the effects of radiotherapy in a xenograft model of esophageal cancer. A total of 40 tumor-bearing mice, established by injection of Eca-109 cells in nude mice, were used. The experimental group (n=24) received a single dose of 15 Gy (6 MV by X-ray), and the control group (n=16) did not receive any treatment. Tumor volume, apparent diffusion coefficient (ADC), mean kurtosis (MK) and mean diffusivity (MD) of the two groups were compared, and the expression of aquaporin (AQP) 3 and necrosis ratio at matched time points in xenografts were also observed. There was a significant difference between the two groups from the 7th day of radiotherapy onwards; the xenograft volume of the experimental group was significantly smaller compared with the control group (P<0.05). On the 3rd day, the ADC and MD of the experimental group was significantly higher compared with the control group, and MK was significantly lower compared with the control group (P<0.05). On the 3rd day, AQP3 expression in the experimental group was lower compared with the control group, and the proportion of necrotic cells was higher compared with the control group (P<0.05). Single large fraction dose radiotherapy inhibited the growth of a xenografted esophageal tumor. Changes in ADC, MK and MD were observed prior to morphological changes in the tumor. The change in AQP3 expression and necrosis ratio was in also agreement with the DKI parameters assessed. DKI may thus provide early predictive ability on the effect of radiotherapy in esophageal carcinoma.
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Affiliation(s)
- An-Du Zhang
- Department of Radiotherapy, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Xiao-Hua Su
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Yan-Fei Wang
- Department of CT and MRI, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Gao-Feng Shi
- Department of CT and MRI, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Chun Han
- Department of Radiotherapy, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Nan Zhang
- Department of Radiotherapy, Hebei Medical University Fourth Affiliated Hospital/Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei 050011, P.R. China
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Ippolito D, Drago SG, Pecorelli A, Maino C, Querques G, Mariani I, Franzesi CT, Sironi S. Role of dynamic perfusion magnetic resonance imaging in patients with local advanced rectal cancer. World J Gastroenterol 2020; 26:2657-2668. [PMID: 32523318 PMCID: PMC7265146 DOI: 10.3748/wjg.v26.i20.2657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of rectal cancer patients is mainly based on the use of the magnetic resonance imaging (MRI) technique as a diagnostic tool for both staging and restaging. After treatment, to date, the evaluation of complete response is based on the histopathology assessment by using different tumor regression grade (TRG) features (e.g., Dworak or Mandard classifications). While from the radiological point of view, the main attention for the prediction of a complete response after chemotherapy treatment focuses on MRI and the potential role of diffusion-weighted images and perfusion imaging represented by dynamic-contrast enhanced MRI. The main aim is to find a reliable tool to predict tumor response in comparison to histopathologic findings.
AIM To investigate the value of dynamic contrast-enhanced perfusion-MRI parameters in the evaluation of the healthy rectal wall and tumor response to chemo-radiation therapy in patients with local advanced rectal cancer with histopathologic correlation.
METHODS Twenty-eight patients with biopsy-proven rectal adenocarcinoma who underwent a dynamic contrast-enhanced MR study performed on a 1.5T MRI system (Achieva, Philips), before (MR1) and after chemoradiation therapy (MR2), were enrolled in this study. The protocol included T1 gadolinium enhanced THRIVE sequences acquired on axial planes. A dedicated workstation was used to generate color permeability maps. Region of interest was manually drawn on tumor tissue and normal rectal wall, hence the following parameters were calculated and statistically analyzed: Relative arterial enhancement (RAE), relative venous enhancement (RVE), relative late enhancement (RLE), maximum enhancement (ME), time to peak and area under the curve (AUC). Perfusion parameters were related to pathologic TRG (Mandard's criteria; TRG1 = complete regression, TRG5 = no regression).
RESULTS Ten tumors (36%) showed complete or subtotal regression (TRG1-2) at histology and classified as responders; 18 tumors (64%) were classified as non-responders (TRG3-5). Perfusion MRI parameters were significantly higher in the tumor tissue than in the healthy tissue in MR1 (P < 0.05). At baseline (MR1), no significant difference in perfusion parameters was found between responders and non-responders. After chemo-radiation therapy, at MR2, responders showed significantly (P < 0.05) lower perfusion values [RAE (%) 54 ± 20; RVE (%) 73 ± 24; RLE (%): 82 ± 29; ME (%): 904 ± 429] compared to non-responders [RAE (%): 129 ± 45; RVE (%): 154 ± 39; RLE (%): 164 ± 35; ME (%): 1714 ± 427]. Moreover, in responders group perfusion values decreased significantly at MR2 [RAE (%): 54 ± 20; RVE (%): 73 ± 24; RLE (%): 82 ± 29; ME (%): 904 ± 429] compared to the corresponding perfusion values at MR1 [RAE (%): 115 ± 21; RVE (%): 119 ± 21; RLE (%): 111 ± 74; ME (%): 1060 ± 325]; (P < 0.05). Concerning the time-intensity curves, the AUC at MR2 showed significant difference (P = 0.03) between responders and non-responders [AUC (mm2 × 10-3) 121 ± 50 vs 258 ± 86], with lower AUC values of the tumor tissue in responders compared to non-responders. In non-responders, there were no significant differences between perfusion values at MR1 and MR2.
CONCLUSION Dynamic contrast perfusion-MRI analysis represents a complementary diagnostic tool for identifying vascularity characteristics of tumor tissue in local advanced rectal cancer, useful in the assessment of treatment response.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Silvia Girolama Drago
- Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Anna Pecorelli
- Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Giulia Querques
- Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Ilaria Mariani
- Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, H. S. Gerardo Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital, University of Milano-Bicocca, Bergamo 20110, Italy
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Lambregts DMJ, Min LA, Schurink N, Beets-Tan RGH. Multiparametric Imaging for the Locoregional Follow-up of Rectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2020. [DOI: 10.1007/s11888-020-00450-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Li Y, Xia C, Peng W, Gao Y, Hu S, Zhang K, Zhao F, Benkert T, Zhou X, Zhang H, Li Z. Dynamic contrast-enhanced MR imaging of rectal cancer using a golden-angle radial stack-of-stars VIBE sequence: comparison with conventional contrast-enhanced 3D VIBE sequence. Abdom Radiol (NY) 2020; 45:322-331. [PMID: 31552465 DOI: 10.1007/s00261-019-02225-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare conventional 3D volumetric-interpolated breath-hold examination (C-VIBE) sequence image quality to that of golden-angle radial stack-of stars acquisition scheme (R-VIBE) in rectal cancer patients. METHODS Seventy-eight patients had undergone pre-contrast C-VIBE, followed by DCE-MRI with R-VIBE and post-contrast C-VIBE in the visualization of rectal cancer. The first phase and the last phase of R-VIBE sequence were compared with pre-contrast and post-contrast C-VIBE sequences, respectively. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of rectal neoplasms, gluteus maximus, and subcutaneous fat were compared between the two different sequences. A further qualitative score system (graded 1-5) was used to evaluate the overall image. Quantitative and qualitative parameters from the two sequences were compared. RESULTS In all patients, R-VIBE achieved the same SNR and CNR ratings in pre- and post-contrast (all P > 0.05), with the exception of a higher SNR of fat in pre-contrast images (P = 0.037). In addition, there were no significant differences in scores of overall image quality, lesion conspicuity, and rectal wall boundary (all P > 0.05). There was an improved score in artifacts of post-contrast R-VIBE sequence (P = 0.005). CONCLUSION R-VIBE sequence can provide comparable image quality and less motion artifacts to that of C-VIBE sequence and is feasible for imaging of rectal cancer.
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Affiliation(s)
- Yuming Li
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wanlin Peng
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yue Gao
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Sixian Hu
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Kai Zhang
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Fei Zhao
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Thomas Benkert
- MR Applications Development, Siemens Healthcare, 91052, Erlangen, Germany
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Huapeng Zhang
- Xi'an Branch of Siemens Healthcare Ltd., Xi'an, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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13
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Fusco R, Sansone M, Granata V, Grimm R, Pace U, Delrio P, Tatangelo F, Botti G, Avallone A, Pecori B, Petrillo A. Diffusion and perfusion MR parameters to assess preoperative short-course radiotherapy response in locally advanced rectal cancer: a comparative explorative study among Standardized Index of Shape by DCE-MRI, intravoxel incoherent motion- and diffusion kurtosis imaging-derived parameters. Abdom Radiol (NY) 2019; 44:3683-3700. [PMID: 30361867 DOI: 10.1007/s00261-018-1801-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To assess preoperative short-course radiotherapy (SCR) tumor response in locally advanced rectal cancer (LARC) by means of Standardized Index of Shape (SIS) by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), apparent diffusion coefficient (ADC), intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters derived from diffusion-weighted MRI (DW-MRI). MATERIALS AND METHODS Thirty-four patients with LARC who underwent MRI scans before and after SCR followed by delayed surgery, retrospectively, were enrolled. SIS, ADC, IVIM parameters [tissue diffusion (Dt), pseudo-diffusion (Dp), perfusion fraction (fp)] and DKI parameters [mean diffusivity (MD), mean of diffusional kurtosis (MK)] were calculated for each patient. IVIM parameters were estimated using two methods, namely conventional biexponential fitting (CBFM) and variable projection (VARPRO). After surgery, the pathological TNM and tumor regression grade (TRG) were estimated. For each parameter, percentage changes between before and after SCR were evaluated. Furthermore, an artificial neural network was trained for outcome prediction. Nonparametric sample tests and receiver operating characteristic curve (ROC) analysis were performed. RESULTS Fifteen patients were classified as responders (TRG ≤ 2) and 19 as not responders (TRG > 3). Seven patients had TRG 1 (pathological complete response, pCR). Mean and standard deviation values of pre-treatment CBFM Dp and mean value of VARPRO Dp pre-treatment showed statistically significant differences to predict pCR. (p value at Mann-Whitney test was 0.05, 0.03 and 0.008, respectively.) Exclusively SIS percentage change showed significant differences between responder and non-responder patients after SCR (p value << 0.001) and to assess pCR after SCR (p value << 0.001). The best results to predict pCR were obtained by VARPRO Fp mean value pre-treatment with area under ROC of 0.84, a sensitivity of 96.4%, a specificity of 71.4%, a positive predictive value (PPV) of 92.9%, a negative predictive value (NPV) of 83.3% and an accuracy of 91.2%. The best results to assess after treatment complete pathological response were obtained by SIS with an area under ROC of 0.89, a sensitivity of 85.7%, a specificity of 92.6%, a PPV of 75.0%, a NPV of 96.1% and an accuracy of 91.2%. Moreover, the best results to differentiate after treatment responders vs. non-responders were obtained by SIS with an area under ROC of 0.94, a sensitivity of 93.3%, a specificity of 84.2%, a PPV of 82.4%, a NPV of 94.1% and an accuracy of 88.2%. Promising initial results were obtained using a decision tree tested with all ADC, IVIM and DKI extracted parameter: we reached high accuracy to assess pathological complete response after SCR in LARC (an accuracy of 85.3% to assess pathological complete response after SCR using VARPRO Dp mean value post-treatment, ADC standard deviation value pre-treatment, MD standard deviation value post-treatment). CONCLUSION SIS is a hopeful DCE-MRI angiogenic biomarker to assess preoperative treatment response after SCR with delayed surgery. Furthermore, an important prognostic role was obtained by VARPRO Fp mean value pre-treatment and by a decision tree composed by diffusion parameters derived by DWI and DKI to assess pathological complete response.
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Affiliation(s)
- Roberta Fusco
- Division of Radiology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy.
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies (DIETI), Via Claudio 21, 80125, Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy
| | | | - Ugo Pace
- Division of Gastrointestinal Surgical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy
| | - Paolo Delrio
- Division of Gastrointestinal Surgical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy
| | - Fabiana Tatangelo
- Division of Diagnostic Pathology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy
| | - Gerardo Botti
- Division of Diagnostic Pathology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy
| | - Antonio Avallone
- Division of Gastrointestinal Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy
| | - Biagio Pecori
- Division of Radiotherapy, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy
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14
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Granata V, Fusco R, Reginelli A, Delrio P, Selvaggi F, Grassi R, Izzo F, Petrillo A. Diffusion kurtosis imaging in patients with locally advanced rectal cancer: current status and future perspectives. J Int Med Res 2019; 47:2351-2360. [PMID: 31032670 PMCID: PMC6567719 DOI: 10.1177/0300060519827168] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Morphological magnetic resonance imaging is currently the best imaging technique for local staging in patients with rectal cancer. However, morphological sequences have some limitations, especially after preoperative chemoradiotherapy (pCRT). Diffusion-weighted imaging has been applied to rectal cancer for detection of lesions, characterization of tissue, and evaluation of the response to therapy. In 2005, a non-Gaussian diffusion model called diffusion kurtosis imaging (DKI) was suggested. Several electronic databases were evaluated in the present review. The search included articles published from January 2000 to May 2018. The references of all articles were also evaluated. All titles and abstracts were assessed, and only the studies of DKI in patients with rectal cancer were retained. We identified 35 potentially relevant references through the electronic search. According to the inclusion and exclusion criteria, we retained five clinical studies that met the inclusion criteria. DKI is a useful tool for assessment of tumor aggressiveness, the nodal status, and the risk of early metastases as well as prediction of the response to pCRT. The results of DKI should be considered in treatment decision-making during the work-up of patients with rectal cancer.
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Affiliation(s)
- Vincenza Granata
- 1 Division of Radiology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale," Napoli, Italy
| | - Roberta Fusco
- 1 Division of Radiology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale," Napoli, Italy
| | - Alfonso Reginelli
- 2 Division of Radiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Delrio
- 3 Division of Gastrointestinal Surgical Oncology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale," Napoli, Italy
| | - Francesco Selvaggi
- 4 Division of Colorectal Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Grassi
- 2 Division of Radiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Izzo
- 5 Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale," Napoli, Italy
| | - Antonella Petrillo
- 1 Division of Radiology, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale," Napoli, Italy
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Lambregts DMJ, Boellaard TN, Beets-Tan RGH. Response evaluation after neoadjuvant treatment for rectal cancer using modern MR imaging: a pictorial review. Insights Imaging 2019; 10:15. [PMID: 30758688 PMCID: PMC6375095 DOI: 10.1186/s13244-019-0706-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation. MRI is one of the main tools used to assess response, but has difficulties in assessing response within areas of post-radiation fibrosis. Hence, MR sequences such as diffusion-weighted imaging are increasingly adopted in clinical MR protocols to improve the differentiation between tumor and fibrosis. In this pictorial review, we discuss the strengths and weaknesses of modern MR imaging, including functional imaging sequences such as diffusion-weighted MRI, for response evaluation after chemoradiation treatment and provide the main pearls and pitfalls for image interpretation.
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Affiliation(s)
- Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Thierry N Boellaard
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, The Netherlands
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16
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Granata V, Fusco R, Setola SV, Palaia R, Albino V, Piccirillo M, Grimm R, Petrillo A, Izzo F. Diffusion kurtosis imaging and conventional diffusion weighted imaging to assess electrochemotherapy response in locally advanced pancreatic cancer. Radiol Oncol 2019; 53:15-24. [PMID: 30681974 PMCID: PMC6411027 DOI: 10.2478/raon-2019-0004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/18/2018] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to evaluate diagnostic performance of functional parameters derived by conventional mono-exponential approach of diffusion weighted imaging (DWI) and by diffusion kurtosis imaging (DKI) in the assessment of pancreatic tumours treated with electrochemotherapy (ECT). Patients and methods Twenty-one consecutive patients with locally advanced pancreatic adenocarcinoma subjected to ECT were enrolled in a clinical approved trial. Among twenty-one enrolled patients, 13/21 (61.9%) patients were subjected to MRI before and after ECT. DWI was performed with a 1.5 T scanner; a free breathing axial single shot echo planar DWI pulse sequence parameters were acquired using seven b value = 0, 50, 100, 150, 400, 800, 1000 s/mm2. Apparent diffusion coefficient by conventional mono-exponential approach and mean of diffusion coefficient (MD) and mean of diffusional kurtosis (MK) by DKI approach were derived from DWI. Receiver operating characteristic (ROC) analysis was performed and sensitivity, specificity, positive and negative predictive value were calculated. Results Among investigated diffusion parameters, only the MD derived by DKI showed a significant variation of values between pre and post treatment (p = 0.02 at Wilcoxon test) and a significant statistically difference for percentage change between responders and not responders (p = 0.01 at Kruskal Wallis test). MD had a good diagnostic performance with a sensitivity of 80%, a specificity of 100% and area under ROC of 0.933. Conclusions MD derived by DKI allows identifying responders and not responders patients subject to ECT treatment. MD had higher diagnostic performance to assess ECT response compared to conventional DWI derived parameters.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Instituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Napoli, Italia
- Vincenza Granata, Division of Radiology, Instituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Napoli, Italia. Phone: +39 081 5903 714; Fax:+39 0815903825;
| | | | - Sergio Venanzio Setola
- Division of Radiology, Instituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Napoli, Italia
| | - Raffaele Palaia
- Division of Hepatobiliary Surgical Oncology, Unit, Instituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Vittorio Albino
- Division of Hepatobiliary Surgical Oncology, Unit, Instituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Mauro Piccirillo
- Division of Hepatobiliary Surgical Oncology, Unit, Instituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | | | - Antonella Petrillo
- Division of Radiology, Instituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Napoli, Italia
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, Unit, Instituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
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17
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Petrillo A, Fusco R, Granata V, Filice S, Sansone M, Rega D, Delrio P, Bianco F, Romano GM, Tatangelo F, Avallone A, Pecori B. Assessing response to neo-adjuvant therapy in locally advanced rectal cancer using Intra-voxel Incoherent Motion modelling by DWI data and Standardized Index of Shape from DCE-MRI. Ther Adv Med Oncol 2018; 10:1758835918809875. [PMID: 30479672 PMCID: PMC6243411 DOI: 10.1177/1758835918809875] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Our aim was to investigate preoperative chemoradiation therapy (pCRT) response in locally advanced rectal cancer (LARC) comparing standardized index of shape (SIS) obtained from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with intravoxel-incoherent-motion-modelling-derived parameters by diffusion-weighted imaging (DWI). Materials and methods: Eighty-eight patients with LARC were subjected to MRI before and after pCRT. Apparent diffusion coefficient (ADC), tissue diffusion (Dt), pseudodiffusion (Dp) and perfusion fraction (f) were calculated and percentage changes ∆ADC, ∆Dt, ∆Dp, ∆f were computed. SIS was derived comparing DCE-MRI pre- and post-pCRT. Nonparametric tests and receiver operating characteristic (ROC) curves were performed. Results: A total of 52 patients were classified as responders (tumour regression grade; TRG ⩽ 2) and 36 as not-responders (TRG > 3). Mann–Whitney U test showed statistically significant differences in SIS, ∆ADC and ∆Dt between responders and not-responders and between complete responders (19 patients with TRG = 1) versus incomplete responders. The best parameters to discriminate responders by nonresponders were SIS and ∆ADC, with an accuracy of 91% and 82% (cutoffs of −5.2% and 18.7%, respectively); the best parameters to detect pathological complete responders were SIS, ∆f and ∆Dp with an accuracy of 78% (cutoffs of 38.5%, 60.0% and 83.0%, respectively). No increase of performance was observed by combining linearly each possible couple of parameters or combining all parameters. Conclusion: SIS allows assessment of preoperative treatment response with high accuracy guiding the surgeon versus more or less conservative treatment. DWI-derived parameters reached less accuracy compared with SIS and combining linearly DCE- and DWI-derived parameters; no increase of accuracy was obtained.
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Affiliation(s)
- Antonella Petrillo
- Radiology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | | | - Vincenza Granata
- Radiology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | - Salvatore Filice
- Radiology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies, University ‘Federico II’ of Naples, Naples, Italy
| | - Daniela Rega
- Gastrointestinal Surgical Oncology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | - Paolo Delrio
- Gastrointestinal Surgical Oncology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | - Francesco Bianco
- Gastrointestinal Surgical Oncology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | - Giovanni Maria Romano
- Gastrointestinal Surgical Oncology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | - Fabiana Tatangelo
- Diagnostic Pathology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | - Antonio Avallone
- Gastrointestinal Medical Oncology Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
| | - Biagio Pecori
- Radiotherapy Unit, ‘Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale’, Naples, Italy
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18
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DCE-MRI time-intensity curve visual inspection to assess pathological response after neoadjuvant therapy in locally advanced rectal cancer. Jpn J Radiol 2018; 36:611-621. [PMID: 30039258 DOI: 10.1007/s11604-018-0760-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/17/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the potential of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to discriminate responder from non-responder patients after preoperative chemoradiotherapy (pCRT) in locally advanced rectal cancer (LARC). MATERIALS AND METHODS One hundred and fifty-eight consecutive patients were enrolled in this prospective study. We compared morphological MRI (mMRI) using T2-weighted images about tumor presence and invasiveness, and functional DCE-MRI using time-intensity curve (TIC) visual inspection (qMRI), classifying TIC shape into three types: type 1, persistent enhancement; type 2, high enhancement with plateau; type 3, high enhancement with wash-out. Clinical TNM was obtained before and after CRT by radiological consensus of two expert radiologists. Pathological tumor-nodes-metastasis classification and tumor regression grade (TRG) were confirmed as the golden standard. Non-parametric test, sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS Ninety-eight patients (62%) were classified as responders (TRG ≤ 2), while 60 (38%) were classified as non-responders. Sensitivity, specificity, and accuracy were 52, 78, and 62% for mMRI, and 81, 85, and 82% for qMRI, respectively. CONCLUSIONS TIC visual inspection may be one of the potential biomarkers over morphological analysis using DCE-MRI data to assess pathological response after pCRT in LARC.
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Palmisano A, Esposito A, Rancoita PMV, Di Chiara A, Passoni P, Slim N, Campolongo M, Albarello L, Fiorino C, Rosati R, Del Maschio A, De Cobelli F. Could perfusion heterogeneity at dynamic contrast-enhanced MRI be used to predict rectal cancer sensitivity to chemoradiotherapy? Clin Radiol 2018; 73:911.e1-911.e7. [PMID: 30029837 DOI: 10.1016/j.crad.2018.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 06/04/2018] [Indexed: 12/16/2022]
Abstract
AIM To evaluate whether perfusion heterogeneity of rectal cancer prior to chemoradiotherapy (CRT) using histogram analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) quantitative parameters can predict response to treatment. MATERIALS AND METHODS Twenty-one patients with histologically proven rectal adenocarcinoma were enrolled prospectively. All patients underwent 1.5 T DCE-MRI before CRT. Tumour volumes were drawn on Ktrans and Ve maps, using T2-weighted (W) images as reference, and the following first-order texture parameters of Ve and Ktrans values were extracted: 25th, 50th, 75th percentile, mean, standard deviation, skewness, and kurtosis. After CRT, patients underwent surgery and according with Rödel's tumour regression grade (TRG), they were classified as poor responders "non-GR" (TRG 0-2) and good responders "GR" (TRG 3-4). Differences between GR and non-GR in DCE-MRI first-order texture parameters were evaluated using the Mann-Whitney test, and their role in the prediction of response was investigated using receiver operating characteristic (ROC) curve analysis. RESULTS Sixteen (76%) patients were classified as GR and five (24%) were non-GR. Skewness and kurtosis of Ve was significantly higher in non-GR (4.886±1.320 and 36.402±24.486, respectively) than in GR patients (1.809±1.280, p=0.003 and 6.268±8.130, p= 0.011). Ve skewness <3.635 was able to predict GR with an area under the ROC curve (AUC) of 0.988, sensitivity 93.8%, specificity 80%, and accuracy 90.5%. Ve kurtosis <21.095 was able to predict response with an AUC of 0.963, sensitivity 93.8%, specificity 80%, and accuracy 90.5%. Other parameters were not different between groups or predictors of response. CONCLUSION Ve skewness and kurtosis seem to be promising in the prediction of response to CRT in rectal cancer patients.
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Affiliation(s)
- A Palmisano
- Unit of Clinical Research in Radiology, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - A Esposito
- Unit of Clinical Research in Radiology, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - P M V Rancoita
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - A Di Chiara
- Unit of Clinical Research in Radiology, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - P Passoni
- Unit of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - N Slim
- Unit of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - M Campolongo
- Unit of Clinical Research in Radiology, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Milan, Italy
| | - L Albarello
- Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - C Fiorino
- Medical Physics, San Raffaele Hospital, Milan, Italy
| | - R Rosati
- Vita-Salute San Raffaele University, Milan, Italy; Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - A Del Maschio
- Unit of Clinical Research in Radiology, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - F De Cobelli
- Unit of Clinical Research in Radiology, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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García-Figueiras R, Baleato-González S, Padhani AR, Luna-Alcalá A, Marhuenda A, Vilanova JC, Osorio-Vázquez I, Martínez-de-Alegría A, Gómez-Caamaño A. Advanced Imaging Techniques in Evaluation of Colorectal Cancer. Radiographics 2018; 38:740-765. [PMID: 29676964 DOI: 10.1148/rg.2018170044] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Imaging techniques are clinical decision-making tools in the evaluation of patients with colorectal cancer (CRC). The aim of this article is to discuss the potential of recent advances in imaging for diagnosis, prognosis, therapy planning, and assessment of response to treatment of CRC. Recent developments and new clinical applications of conventional imaging techniques such as virtual colonoscopy, dual-energy spectral computed tomography, elastography, advanced computing techniques (including volumetric rendering techniques and machine learning), magnetic resonance (MR) imaging-based magnetization transfer, and new liver imaging techniques, which may offer additional clinical information in patients with CRC, are summarized. In addition, the clinical value of functional and molecular imaging techniques such as diffusion-weighted MR imaging, dynamic contrast material-enhanced imaging, blood oxygen level-dependent imaging, lymphography with contrast agents, positron emission tomography with different radiotracers, and MR spectroscopy is reviewed, and the advantages and disadvantages of these modalities are evaluated. Finally, the future role of imaging-based analysis of tumor heterogeneity and multiparametric imaging, the development of radiomics and radiogenomics, and future challenges for imaging of patients with CRC are discussed. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Roberto García-Figueiras
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Sandra Baleato-González
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Anwar R Padhani
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Antonio Luna-Alcalá
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Ana Marhuenda
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Joan C Vilanova
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Iria Osorio-Vázquez
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Anxo Martínez-de-Alegría
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
| | - Antonio Gómez-Caamaño
- From the Departments of Radiology (R.G.F., S.B.G., I.O.V., A.M.d.A.) and Radiation Oncology (A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Health Time, Jaén, Spain (A.L.A.); Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.A.); Department of Radiology, IVO (Instituto Valenciano de Oncología), Valencia, Spain (A.M.); and Department of Radiology, Clínica Girona and IDI, Girona, Spain (J.C.V.)
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Delli Pizzi A, Basilico R, Cianci R, Seccia B, Timpani M, Tavoletta A, Caposiena D, Faricelli B, Gabrielli D, Caulo M. Rectal cancer MRI: protocols, signs and future perspectives radiologists should consider in everyday clinical practice. Insights Imaging 2018; 9:405-412. [PMID: 29675627 PMCID: PMC6108973 DOI: 10.1007/s13244-018-0606-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 12/18/2022] Open
Abstract
Abstract Magnetic resonance imaging (MRI) allows to non-invasively evaluate rectal cancer staging and to assess the presence of “prognostic signs” such as the distance from the anorectal junction, the mesorectal fascia infiltration and the extramural vascular invasion. Moreover, MRI plays a crucial role in the assessment of treatment response after chemo-radiation therapy, especially considering the growing interest in the new conservative policy (wait and see, minimally invasive surgery). We present a practical overview regarding the state of the art of the MRI protocol, the main signs that radiologists should consider for their reports during their clinical activity and future perspectives. Teaching Points • MRI protocol for rectal cancer staging and re-staging. • MRI findings that radiologists should consider for reports during everyday clinical activity. • Perspectives regarding the development of latest technologies.
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Affiliation(s)
- Andrea Delli Pizzi
- ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy.
| | - Raffaella Basilico
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Roberta Cianci
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Barbara Seccia
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Mauro Timpani
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Alessandra Tavoletta
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Daniele Caposiena
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Barbara Faricelli
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Daniela Gabrielli
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100, Chieti, Italy
| | - Massimo Caulo
- ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy
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22
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Petrillo A, Fusco R, Petrillo M, Granata V, Delrio P, Bianco F, Pecori B, Botti G, Tatangelo F, Caracò C, Aloj L, Avallone A, Lastoria S. Standardized Index of Shape (DCE-MRI) and Standardized Uptake Value (PET/CT): Two quantitative approaches to discriminate chemo-radiotherapy locally advanced rectal cancer responders under a functional profile. Oncotarget 2018; 8:8143-8153. [PMID: 28042958 PMCID: PMC5352389 DOI: 10.18632/oncotarget.14106] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/21/2016] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate dynamic contrast enhanced-MRI (DCE-MRI) in the preoperative chemo-radiotherapy (CRT) assessment for locally advanced rectal cancer (LARC) compared to18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Methods 75 consecutive patients with LARC were enrolled in a prospective study. DCE-MRI analysis was performed measuring SIS: linear combination of percentage change (Δ) of maximum signal difference (MSD) and wash-out slope (WOS). 18F-FDG PET/CT analysis was performed using SUV maximum (SUVmax). Tumor regression grade (TRG) were estimated after surgery. Non-parametric tests, receiver operating characteristic were evaluated. Results 55 patients (TRG1-2) were classified as responders while 20 subjects as non responders. ΔSIS reached sensitivity of 93%, specificity of 80% and accuracy of 89% (cut-off 6%) to differentiate responders by non responders, sensitivity of 93%, specificity of 69% and accuracy of 79% (cut-off 30%) to identify pathological complete response (pCR). Therapy assessment via ΔSUVmax reached sensitivity of 67%, specificity of 75% and accuracy of 70% (cut-off 60%) to differentiate responders by non responders and sensitivity of 80%, specificity of 31% and accuracy of 51% (cut-off 44%) to identify pCR. Conclusions CRT response assessment by DCE-MRI analysis shows a higher predictive ability than 18F-FDG PET/CT in LARC patients allowing to better discriminate significant and pCR.
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Affiliation(s)
- Antonella Petrillo
- Radiology Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Roberta Fusco
- Radiology Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Mario Petrillo
- Radiology Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Vincenza Granata
- Radiology Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Paolo Delrio
- Gastrointestinal Surgical Oncology Unit, Department of Abdominal Oncology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Francesco Bianco
- Gastrointestinal Surgical Oncology Unit, Department of Abdominal Oncology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Biagio Pecori
- Radiotherapy Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Gerardo Botti
- Scientific Director, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Fabiana Tatangelo
- Diagnostic Pathology Unit, Department of Diagnostic and Laboratory Pathology "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Corradina Caracò
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Luigi Aloj
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Antonio Avallone
- Gastrointestinal Medical Oncology Unit, Department of Abdominal Oncology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
| | - Secondo Lastoria
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", 80131, Naples, Italy
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Monitoring early changes in rectal tumor morphology and volume during 5 weeks of preoperative chemoradiotherapy – An evaluation with sequential MRIs. Radiother Oncol 2018; 126:431-436. [DOI: 10.1016/j.radonc.2017.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 12/18/2022]
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Zhang C, Ye F, Liu Y, Ouyang H, Zhao X, Zhang H. Morphologic predictors of pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Oncotarget 2017; 9:4862-4874. [PMID: 29435147 PMCID: PMC5797018 DOI: 10.18632/oncotarget.23419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/02/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the value of morphological parameters that can be obtained conveniently by MRI for predicting pathologically complete response (pCR) in patients with rectal cancer. Materials and Methods A cohort of 101 patients was examined using MRI before and after Neoadjuvant chemoradiotherapy (nCRT). Morphological parameters including maximum tumor area (MTA), maximum tumor length (MTL) and maximum tumor thickness (MTT), as well as cylindrical approximated tumor volume (CATV), distance to anal verge (DTA), and the reduction rates were evaluated by two experienced readers independently. Results Post-nCRT MTA and MTL, reduction rates and pre-nCRT DTA were proved to be significantly different between pCR and non-pCR with the AUCs of 0.672-0.853. The sensitivity and specificity for assessing pCR were 61.1-89.9% and 59.0-80.7% respectively. No significant correlation between pre-nCRT size measurements and pCR was obtained. Conclusion The convenient morphological measurements may be useful for predicting pCR with moderate sensitivity and specificity. Combining these predictors with the aim of building diagnostic model should be explored.
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Affiliation(s)
- Chongda Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Yuan Liu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Hongmei Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
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MR imaging perfusion and diffusion analysis to assess preoperative Short Course Radiotherapy response in locally advanced rectal cancer: Standardized Index of Shape by DCE-MRI and intravoxel incoherent motion-derived parameters by DW-MRI. Med Oncol 2017; 34:198. [DOI: 10.1007/s12032-017-1059-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023]
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26
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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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Fusco R, Petrillo M, Granata V, Filice S, Sansone M, Catalano O, Petrillo A. Magnetic Resonance Imaging Evaluation in Neoadjuvant Therapy of Locally Advanced Rectal Cancer: A Systematic Review. Radiol Oncol 2017; 51:252-262. [PMID: 28959161 PMCID: PMC5611989 DOI: 10.1515/raon-2017-0032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to present an update concerning several imaging modalities in diagnosis, staging and pre-surgery treatment response assessment in locally advanced rectal cancer (LARC). Modalities include: traditional morphological magnetic resonance imaging (MRI), functional MRI such as dynamic contrast enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI). A systematic review about the diagnostic accuracy in neoadjuvant therapy response assessment of MRI, DCE-MRI, DWI and Positron Emission Tomography/Computed Tomography (PET/CT) has been also reported. Methods Several electronic databases were searched including PubMed, Scopus, Web of Science, and Google Scholar. All the studies included in this review reported findings about therapy response assessment in LARC by means of MRI, DCE-MRI, DWI and PET/CT with details about diagnostic accuracy, true and false negatives, true and false positives. Forest plot and receiver operating characteristic (ROC) curves analysis were performed. Risk of bias and the applicability at study level were calculated. Results Twenty-five papers were identified. ROC curves analysis demonstrated that multimodal imaging integrating morphological and functional MRI features had the best accuracy both in term of sensitivity and specificity to evaluate preoperative therapy response in LARC. DCE-MRI following to PET/CT showed high diagnostic accuracy and their results are also more reliable than conventional MRI and DWI alone. Conclusions Morphological MRI is the modality of choice for rectal cancer staging permitting a correct assessment of the disease extent, of the lymph node involvement, of the mesorectal fascia and of the sphincter complex for surgical planning. Multimodal imaging and functional DCE-MRI may also help in the assessment of treatment response allowing to guide the surgeon versus conservative strategies and/or tailored approach such as “wait and see” policy.
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Affiliation(s)
- Roberta Fusco
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Mario Petrillo
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Vincenza Granata
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Salvatore Filice
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies, Università degli Studi di Napoli Federico II, Via Claudio, Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Antonella Petrillo
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
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28
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Dijkhoff RAP, Beets-Tan RGH, Lambregts DMJ, Beets GL, Maas M. Value of DCE-MRI for staging and response evaluation in rectal cancer: A systematic review. Eur J Radiol 2017; 95:155-168. [PMID: 28987662 DOI: 10.1016/j.ejrad.2017.08.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/11/2017] [Accepted: 08/08/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE Aim was to perform a systematic review to evaluate the clinical value of dynamic contrast-enhanced (DCE) MRI in rectal cancer. METHODS AND MATERIALS A systematic search was performed on Pubmed, Embase and the Cochrane library. Studies that evaluated DCE-MRI for tumour aggressiveness, primary staging and restaging after chemoradiation (CRT) were included. Information on population, DCE technique, DCE parameters and outcome (angiogenesis, staging and response) were extracted. RESULTS 19 studies were identified; 10 evaluated quantitative analyses, 6 semiquantitative analyses and 3 evaluated both. 8 studies evaluated correlation between DCE-parameters and angiogenesis or tumour aggressiveness, 11 studies evaluated response prediction pre- and post-CRT. Semiquantitative washin parameters showed a significantly positive correlation with angiogenesis, while for quantitative analyses conflicting results were found. Conflicting results were also reported for the correlation between DCE parameters and tumour aggressiveness: both higher and lower vascularity in more aggressive tumours are reported, while some studies report no correlation. Six studies showed a predictive value of Ktrans for response. A high Ktrans pre-CRT was significantly correlated with a complete/good response, but the reported pre-CRT Ktrans varied substantially (0.36-1.93). After CRT a reduction in Ktrans of 32%-36% was significantly associated with response. For semiquantitative analyses pre-CRT late slope was reported to be significantly lower in good responders, however only few studies exist on semiquantitative analyses of post-CRT DCE-MRI. CONCLUSION DCE-MRI in rectal cancer is promising mainly for prediction and assessment of response to CRT, where a high pre-CRT Ktrans and a decrease in Ktrans are significantly predictive for response.
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Affiliation(s)
- Rebecca A P Dijkhoff
- Department of Radiology, The Netherlands Cancer Institute, PO Box 90203 1066 CX Amsterdam, The Netherlands.
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, PO Box 90203 1066 CX Amsterdam, The Netherlands.
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, PO Box 90203 1066 CX Amsterdam, The Netherlands.
| | - Geerard L Beets
- Department of Surgery, The Netherlands Cancer Institute, PO Box 90203 1066 CX Amsterdam, The Netherlands.
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, PO Box 90203 1066 CX Amsterdam, The Netherlands.
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Whisenant JG, Dortch RD, Grissom W, Kang H, Arlinghaus LR, Yankeelov TE. Bloch-Siegert B1-Mapping Improves Accuracy and Precision of Longitudinal Relaxation Measurements in the Breast at 3 T. ACTA ACUST UNITED AC 2016; 2:250-259. [PMID: 28044146 PMCID: PMC5201175 DOI: 10.18383/j.tom.2016.00133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Variable flip angle (VFA) sequences are a popular method of calculating T1 values, which are required in a quantitative analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). B1 inhomogeneities are substantial in the breast at 3 T, and these errors negatively impact the accuracy of the VFA approach, thus leading to large errors in the DCE-MRI parameters that could limit clinical adoption of the technique. This study evaluated the ability of Bloch–Siegert B1 mapping to improve the accuracy and precision of VFA-derived T1 measurements in the breast. Test–retest MRI sessions were performed on 16 women with no history of breast disease. T1 was calculated using the VFA sequence, and B1 field variations were measured using the Bloch–Siegert methodology. As a gold standard, inversion recovery (IR) measurements of T1 were performed. Fibroglandular tissue and adipose tissue from each breast were segmented using the IR images, and the mean T1 was calculated for each tissue. Accuracy was evaluated by percent error (%err). Reproducibility was assessed via the 95% confidence interval (CI) of the mean difference and repeatability coefficient (r). After B1 correction, %err significantly (P < .001) decreased from 17% to 8.6%, and the 95% CI and r decreased from ±94 to ±38 milliseconds and from 276 to 111 milliseconds, respectively. Similar accuracy and reproducibility results were observed in the adipose tissue of the right breast and in both tissues of the left breast. Our data show that Bloch–Siegert B1 mapping improves accuracy and precision of VFA-derived T1 measurements in the breast.
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Affiliation(s)
- Jennifer G Whisenant
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee; Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee
| | - Richard D Dortch
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee; Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - William Grissom
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee; Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Hakmook Kang
- Department of Biostatistics and Center for Quantitative Sciences, Vanderbilt University, Nashville, Tennessee
| | - Lori R Arlinghaus
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee; Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee
| | - Thomas E Yankeelov
- Institute for Computational and Engineering Sciences, and the Departments of Biomedical Engineering and Internal Medicine, The University of Texas at Austin, Austin, Texas
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García-Figueiras R, Baleato-González S, Padhani AR, Marhuenda A, Luna A, Alcalá L, Carballo-Castro A, Álvarez-Castro A. Advanced imaging of colorectal cancer: From anatomy to molecular imaging. Insights Imaging 2016; 7:285-309. [PMID: 27136925 PMCID: PMC4877344 DOI: 10.1007/s13244-016-0465-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Imaging techniques play a key role in the management of patients with colorectal cancer. The introduction of new advanced anatomical, functional, and molecular imaging techniques may improve the assessment of diagnosis, prognosis, planning therapy, and assessment of response to treatment of these patients. Functional and molecular imaging techniques in clinical practice may allow the assessment of tumour-specific characteristics and tumour heterogeneity. This paper will review recent developments in imaging technologies and the evolving roles for these techniques in colorectal cancer. TEACHING POINTS • Imaging techniques play a key role in the management of patients with colorectal cancer. • Advanced imaging techniques improve the evaluation of these patients. • Functional and molecular imaging allows assessment of tumour hallmarks and tumour heterogeneity.
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Affiliation(s)
- Roberto García-Figueiras
- />Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Sandra Baleato-González
- />Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Anwar R. Padhani
- />Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England, HA6 2RN UK
| | - Ana Marhuenda
- />Department of Radiology, IVO (Instituto Valenciano de Oncología), C/ Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Antonio Luna
- />Department of Radiology, Advanced Medical Imaging, Clinica Las Nieves, SERCOSA, Grupo Health Time, C/ Carmelo Torres 2, 23007 Jaén, Spain
- />Case Western Reserve University, Cleveland, OH USA
| | - Lidia Alcalá
- />Department of Radiology, Advanced Medical Imaging, Clinica Las Nieves, SERCOSA, Grupo Health Time, C/ Carmelo Torres 2, 23007 Jaén, Spain
| | - Ana Carballo-Castro
- />Department of Radiotherapy, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Ana Álvarez-Castro
- />Department of Gastroenterology, Colorectal Cancer Group, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, Santiago de Compostela, 15706 Spain
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