Assessment of pathological complete response to preoperative chemoradiotherapy by means of multiple mathematical models of diffusion‐weighted MRI in locally advanced rectal cancer: A prospective single‐center study

• Published in: Journal of magnetic resonance imaging 2017-07, Vol.46 (1), p.175-183
• Main Authors: Zhu, Hai‐Bin, Zhang, Xiao‐Yan, Zhou, Xiao‐Hong, Li, Xiao‐Ting, Liu, Yu‐Liang, Wang, Shuai, Sun, Ying‐Shi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cancer; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Colorectal cancer; Computer Simulation; Correlation coefficient; Correlation coefficients; Diagnostic systems; Diffusion coefficient; diffusion‐weighted magnetic resonance imaging; Female; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Magnetic resonance imaging; Male; Mathematical models; Middle Aged; Models, Biological; Outcome Assessment (Health Care) - methods; pathological complete response; Patients; Polymerase chain reaction; Preoperative Care - methods; Radiation therapy; rectal cancer; Rectal Neoplasms - diagnostic imaging; Rectal Neoplasms - pathology; Rectal Neoplasms - therapy; Rectum; Reliability analysis; Reproducibility of Results; Sensitivity and Specificity; stretched‐exponential model; Treatment Outcome
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.25567

Purpose To assess stretched‐exponential, mono‐exponential and intravoxel incoherent motion (IVIM) models of diffusion‐weighted MRI(DWI) in predicting pathological complete response (pCR) to neoadjuvant chemoradiotherapy (CRT) in rectal cancer patients. Materials and Methods This prospective study recruited 98 consecutive patients with locally advanced rectal cancer who underwent 3 Tesla MR examination before, during and after CRT. The apparent diffusion coefficient (ADC), IVIM‐derived parameters (D, f, and D*), and stretched‐exponential model‐derived parameters (DDC and α) were measured. The parameters and their corresponding changes during and after CRT were compared between pCR and non‐pCR. Receiver‐operating characteristic curve analysis was performed to evaluate the diagnostic performance. Coefficient of variations and intraclass correlation coefficient were calculated to assess reliability and agreement. Results Nineteen patients achieved pCR while 79 did not. The pCR group had higher ADC and α (ADC2 and α2), and their changes (ΔADC2, and Δα2) at the endpoint than non‐pCR group. α2 and ADC2 yielded similar AUCs (P = 0.339), Δα2 and ΔADC2 yielded similar AUCs (P = 0.263) ADC and α presented substantial agreement, and α presented the minimum CV (5.0–7.0%). Conclusion ADC and α were useful for assessing pCR after CRT. α might be more useful because it demonstrated better diagnostic performance than IVIM‐derived parameters and better reliability than ADC. Level of Evidence: 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:175–183