Value of dynamic contrast-enhanced magnetic resonance imaging in predicting and evaluating response of neoadjuvant chemoradiotherapy in middle-low locally advanced rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Chuande ^1,2 ,  YIN Longlin ^1,2 , YANG Li ³ , SUN Ju ² , WANG Yishuang ² , WANG Kang ⁴

1. School of Medicine, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China;
2. Department of Radiology, Affiliated Hospital of University of Electronic Science and Technology of China, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;
3. Department of Radiology, Mianyang Central Hospital, Mianyang, Sichuan 621999, P. R. China;
4. Department of Gastrointestinal Surgery, Affiliated Hospital of University of Electronic Science and Technology of China, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;

Corresponding?author：

YIN Longlin, Email: yinlonglin@163.com

Keywords：

locally advanced rectal cancer; dynamic contrast enhanced MRI; neoadjuvant chemoradiotherapy

DOI：

10.7507/1007-9424.202004079

Video：

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Objective To study the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting and evaluating the efficacy of neoadjuvant chemoradiotherapy (NCRT) in the middle-low locally advanced rectal cancer (LARC).Methods The patients were included prospectively who were clinically diagnosed as the LARC and were scheduled to undergo the NCRT and total mesorectal excision (TME) in the Sichuan Provincial People’s Hospital from February 2018 to November 2019. The routine MRI and DCE-MRI were performed before and after the NCRT, then the TME was performed. According to the score of tumor regression grade (TRG), the patients with TGR score of 0, 1 or 2 were classified as the response to NCRT group, and those with TRG score of 3 were classified as the non-response to NCRT group; in addition, the patients with TGR score of 0 or 1 were classified as the good-response group, with TRG score of 2 or 3 were classified as the poor-response group. The differences of quantitative perfusion parameters of DCE-MRI between two groups were compared, including the volume transfer constant (K^trans), flux rate constant (K_ep), and extravascular extracellular volume fraction (V_e) and the change rates of these parameters (ΔK^trans, ΔK_ep, and ΔV_e).Results Forty-one patients who met the inclusion criteria were included in this study, including 27 cases in the response to NCRT group and 14 cases in the non-response to NCRT group; 11 cases in the the good-response group and 30 cases in the poor-response group. ① The values of K^trans before the NCRT and the ΔK^trans in the response to NCRT group were higher than those in the non-response to NCRT (P<0.05), while the other indexes had no significant differences between these two groups (P>0.05). The area under the receiver operating characteristic curve (AUCs) of K^trans and ΔK^trans in predicting the efficacy of NCRT were 0.954 and 0.709, respectively. When the optimal thresholds of K^trans and ΔK^trans were 0.122/min and –24.2%, the specificity and sensitivity were 85.7%, 96.3% and 100%, 51.7%, respectively. ② The K^trans value in the good-response group was higher before NCRT and which was lower after NCRT as compared with the poor-response group (P<0.05). The absolute value of the the ΔK^trans and ΔK_ep in the good-response group were higher than those in the poor-response group (P<0.05). The other indexes had no significant differences between these two groups (P>0.05). The AUC of K^trans before NCRT in predicting the efficacy of NCRT was 0.953. When the optimal thresholds of K^trans before NCRT was 0.158 /min, the specificity and sensitivity were 88.7% and 90.9%, respectively. The AUC of ΔK^trans in predicting the efficacy of NCRT was higher than that of the ΔK_ep (0.952 versus 0.764, Z=2.063, P=0.039). When the optimal threshold of ΔK^trans was –38.8%, the specificity and sensitivity were 76.7% and 100%, respectively.Conclusions DCE-MRI can predict and evaluate the effect of NCRT in patients with middle-low LARC, especially K^trans and ΔK^trans (change rate before and after NCRT) have a high diagnostic efficiency.

Citation： ZHANG Chuande, YIN Longlin, YANG Li, SUN Ju, WANG Yishuang, WANG Kang. Value of dynamic contrast-enhanced magnetic resonance imaging in predicting and evaluating response of neoadjuvant chemoradiotherapy in middle-low locally advanced rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(9): 1157-1162. doi: 10.7507/1007-9424.202004079 Copy

1.	Ciolina M, Caruso D, De Santis D, et al. Dynamic contrast-enhanced magnetic resonance imaging in locally advanced rectal cancer: role of perfusion parameters in the assessment of response to treatment. Radiol Med, 2019, 124(5): 331-338.
2.	Essig M, Shiroishi MS, Nguyen TB, et al. Perfusion MRI: the five most frequently asked technical questions. AJR Am J Roentgenol, 2013, 200(1): 24-34.
3.	肖曉娟, 余深平, 李子平. MR灌注成像在結直腸癌中的應用現狀. 國際醫學放射學雜志, 2015, 38(2): 138-142.
4.	Martens MH, Subhani S, Heijnen LA, et al. Can perfusion MRI predict response to preoperative treatment in rectal cancer? Radiother Oncol, 2015, 114(2): 218-223.
5.	董健, 謝宗源, 李垣婕, 等. 磁共振功能成像在進展期直腸癌新輔助放化療療效評估中的應用. 中國臨床研究, 2020, 33(6): 759-763.
6.	Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(7): 874-901.
7.	Tofts PS, Brix G, Buckley DL, et al. Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging, 1999, 10(3): 223-232.
8.	蔡三軍, 楊立峰. 局部進展期直腸癌新輔助治療的現狀與展望. 中國普外基礎與臨床雜志, 2018, 25(11): 1281-1285.
9.	Akce M, El-Rayes BF. Nonsurgical management of rectal cancer. J Oncol Pract, 2019, 15(3): 123-131.
10.	Remzi FH, Fazio VW, Gorgun E, et al. Quality of life, functional outcome, and complications of coloplasty pouch after low anterior resection. Dis Colon Rectum, 2005, 48(4): 735-743.
11.	S?o Juli?o GP, Habr-Gama A, Vailati BB, et al. New strategies in rectal cancer. Surg Clin North Am, 2017, 97(3): 587-604.
12.	Joye I, Haustermans K. Which patients with rectal cancer do not need radiotherapy? Semin Radiat Oncol, 2016, 26(3): 199-204.
13.	Srisajjakul S, Prapaisilp P, Bangchokdee S. Pitfalls in MRI of rectal cancer: What radiologists need to know and avoid. Clin Imaging, 2018, 50: 130-140.
14.	van der Paardt MP, Zagers MB, Beets-Tan RG, et al. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology, 2013, 269(1): 101-112.
15.	茍文梟, 印隆林, 王康. 動態對比增強磁共振成像定量參數及表觀擴散系數值評估直腸癌分化程度和T分期的應用價值研究. 中國普外基礎與臨床雜志, 2020, 27(7): 884-889.
16.	雷靜, 王海屹. 磁共振成像在新輔助治療后直腸癌再分期及療效評估中的應用. 中華胃腸外科雜志, 2018, 21(6): 637-641.
17.	Cooper RA, Carrington BM, Loncaster JA, et al. Tumour oxygenation levels correlate with dynamic contrast-enhanced magnetic resonance imaging parameters in carcinoma of the cervix. Radiother Oncol, 2000, 57(1): 53-59.
18.	Lim JS, Kim D, Baek SE, et al. Perfusion MRI for the prediction of treatment response after preoperative chemoradiotherapy in locally advanced rectal cancer. Eur Radiol, 2012, 22(8): 1693-1700.
19.	Tong T, Sun Y, Gollub MJ, et al. Dynamic contrast-enhanced MRI: Use in predicting pathological complete response to neoadjuvant chemoradiation in locally advanced rectal cancer. J Magn Reson Imaging, 2015, 42(3): 673-680.
20.	Gollub MJ, Tong T, Weiser M, et al. Limited accuracy of DCE-MRI in identification of pathological complete responders after chemoradiotherapy treatment for rectal cancer. Eur Radiol, 2017, 27(4): 1605-1612.
21.	de Lussanet QG, Backes WH, Griffioen AW, et al. Dynamic contrast-enhanced magnetic resonance imaging of radiation therapy-induced microcirculation changes in rectal cancer. Int J Radiat Oncol Biol Phys, 2005, 63(5): 1309-1315.
22.	Intven M, Reerink O, Philippens ME. Dynamic contrast enhanced MR imaging for rectal cancer response assessment after neo-adjuvant chemoradiation. J Magn Reson Imaging, 2015, 41(6): 1646-1653.
23.	Kim SH, Lee JM, Gupta SN, et al. Dynamic contrast-enhanced MRI to evaluate the therapeutic response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer. J Magn Reson Imaging, 2014, 40(3): 730-737.

1. Ciolina M, Caruso D, De Santis D, et al. Dynamic contrast-enhanced magnetic resonance imaging in locally advanced rectal cancer: role of perfusion parameters in the assessment of response to treatment. Radiol Med, 2019, 124(5): 331-338.
2. Essig M, Shiroishi MS, Nguyen TB, et al. Perfusion MRI: the five most frequently asked technical questions. AJR Am J Roentgenol, 2013, 200(1): 24-34.
3. 肖曉娟, 余深平, 李子平. MR灌注成像在結直腸癌中的應用現狀. 國際醫學放射學雜志, 2015, 38(2): 138-142.
4. Martens MH, Subhani S, Heijnen LA, et al. Can perfusion MRI predict response to preoperative treatment in rectal cancer? Radiother Oncol, 2015, 114(2): 218-223.
5. 董健, 謝宗源, 李垣婕, 等. 磁共振功能成像在進展期直腸癌新輔助放化療療效評估中的應用. 中國臨床研究, 2020, 33(6): 759-763.
6. Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(7): 874-901.
7. Tofts PS, Brix G, Buckley DL, et al. Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging, 1999, 10(3): 223-232.
8. 蔡三軍, 楊立峰. 局部進展期直腸癌新輔助治療的現狀與展望. 中國普外基礎與臨床雜志, 2018, 25(11): 1281-1285.
9. Akce M, El-Rayes BF. Nonsurgical management of rectal cancer. J Oncol Pract, 2019, 15(3): 123-131.
10. Remzi FH, Fazio VW, Gorgun E, et al. Quality of life, functional outcome, and complications of coloplasty pouch after low anterior resection. Dis Colon Rectum, 2005, 48(4): 735-743.
11. S?o Juli?o GP, Habr-Gama A, Vailati BB, et al. New strategies in rectal cancer. Surg Clin North Am, 2017, 97(3): 587-604.
12. Joye I, Haustermans K. Which patients with rectal cancer do not need radiotherapy? Semin Radiat Oncol, 2016, 26(3): 199-204.
13. Srisajjakul S, Prapaisilp P, Bangchokdee S. Pitfalls in MRI of rectal cancer: What radiologists need to know and avoid. Clin Imaging, 2018, 50: 130-140.
14. van der Paardt MP, Zagers MB, Beets-Tan RG, et al. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology, 2013, 269(1): 101-112.
15. 茍文梟, 印隆林, 王康. 動態對比增強磁共振成像定量參數及表觀擴散系數值評估直腸癌分化程度和T分期的應用價值研究. 中國普外基礎與臨床雜志, 2020, 27(7): 884-889.
16. 雷靜, 王海屹. 磁共振成像在新輔助治療后直腸癌再分期及療效評估中的應用. 中華胃腸外科雜志, 2018, 21(6): 637-641.
17. Cooper RA, Carrington BM, Loncaster JA, et al. Tumour oxygenation levels correlate with dynamic contrast-enhanced magnetic resonance imaging parameters in carcinoma of the cervix. Radiother Oncol, 2000, 57(1): 53-59.
18. Lim JS, Kim D, Baek SE, et al. Perfusion MRI for the prediction of treatment response after preoperative chemoradiotherapy in locally advanced rectal cancer. Eur Radiol, 2012, 22(8): 1693-1700.
19. Tong T, Sun Y, Gollub MJ, et al. Dynamic contrast-enhanced MRI: Use in predicting pathological complete response to neoadjuvant chemoradiation in locally advanced rectal cancer. J Magn Reson Imaging, 2015, 42(3): 673-680.
20. Gollub MJ, Tong T, Weiser M, et al. Limited accuracy of DCE-MRI in identification of pathological complete responders after chemoradiotherapy treatment for rectal cancer. Eur Radiol, 2017, 27(4): 1605-1612.
21. de Lussanet QG, Backes WH, Griffioen AW, et al. Dynamic contrast-enhanced magnetic resonance imaging of radiation therapy-induced microcirculation changes in rectal cancer. Int J Radiat Oncol Biol Phys, 2005, 63(5): 1309-1315.
22. Intven M, Reerink O, Philippens ME. Dynamic contrast enhanced MR imaging for rectal cancer response assessment after neo-adjuvant chemoradiation. J Magn Reson Imaging, 2015, 41(6): 1646-1653.
23. Kim SH, Lee JM, Gupta SN, et al. Dynamic contrast-enhanced MRI to evaluate the therapeutic response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer. J Magn Reson Imaging, 2014, 40(3): 730-737.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of dynamic contrast-enhanced magnetic resonance imaging in predicting and evaluating response of neoadjuvant chemoradiotherapy in middle-low locally advanced rectal cancer

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