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

2021 ◽  
Author(s):  
Roberta Fusco ◽  
Vincenza Granata ◽  
Mario Sansone ◽  
Daniela Rega ◽  
Paolo Delrio ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Dce Mri ◽  
Standardized Index

scholarly journals 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

2018 ◽  
Vol 10 ◽  
pp. 175883591880987 ◽  
Author(s):  
Antonella Petrillo ◽  
Roberta Fusco ◽  
Vincenza Granata ◽  
Salvatore Filice ◽  
Mario Sansone ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Nonparametric Tests ◽  
Preoperative Treatment ◽  
Tumour Regression Grade ◽  
Dce Mri ◽  
Standardized Index ◽  
Best Parameters

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.

scholarly journals Histogram Analysis of Perfusion Parameters from Dynamic Contrast-Enhanced MR Imaging with Tumor Characteristics and Therapeutic Response in Locally Advanced Rectal Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Dong Myung Yeo ◽  
Soon Nam Oh ◽  
Moon Hyung Choi ◽  
Sung Hak Lee ◽  
Myung Ah Lee ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Kras Mutation ◽  
Therapeutic Response ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Histogram Analysis ◽  
Tumor Characteristics ◽  
Dce Mri ◽  
Contrast Enhanced

Purpose. To explore the role of histogram analysis of perfusion parameters from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) based on entire tumor volume in discriminating tumor characteristics and predicting therapeutic response in rectal cancer. Materials and Methods. Thirty-seven DCE-MRIs of locally advanced rectal cancer patients who received chemoradiation therapy (CRT) before surgery were analyzed by pharmacokinetic model for quantification and histogram analysis of perfusion parameters. The results were correlated with tumor characteristics including EGFR expression, KRAS mutation, and CRT response based on the pathologic tumor regression grade (TRG). Results. The area under the contrast agent concentration-time curve (AUC) skewness was significantly lower in patients with node metastasis. The vp histogram parameters were significantly higher in group with perineural invasion (PNI). The receiver operating characteristics (ROC) curve analyses showed that mode vp revealed the best diagnostic performance of PNI. The values of Ktrans and kep were significantly higher in the group with KRAS mutation. ROC curve analyses showed that mean and mode Ktrans demonstrated excellent diagnostic performance of KRAS mutation. DCE-MRI parameters did not demonstrate statistical significance in correlating with TRG. Conclusion. These preliminary results suggest that a larger proportion of higher AUC skewness was present in LN metastasis group and a higher vp histogram value was present in rectal cancer with PNI. In addition, Ktrans and kep histogram parameters showed difference according to the KRAS mutation, demonstrating the utility of the histogram of perfusion parameters derived from DCE-MRI as potential imaging biomarkers of tumor characteristics and genetic features.

scholarly journals Multidisciplinary Management of Early-Stage Rectal Cancer

2012 ◽  
Vol 10 (12) ◽  
pp. 1577-1585 ◽  
Author(s):  
John G. Phillips ◽  
Theodore S. Hong ◽  
David P. Ryan
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
The United States ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Current Standard ◽  
Recurrence Rates

Because patients with locally advanced rectal cancer are at high risk for both recurrence and distant disease, they require adjuvant therapy. In the United States, the current standard of care is neoadjuvant chemoradiation followed by surgery and adjuvant chemotherapy. Neoadjuvant chemoradiation has been shown to improve local recurrence rates and decrease toxicity. However in the era of total mesorectal excision surgery, no study has shown a survival benefit to either chemoradiation or postoperative chemotherapy. Newer biologic therapies, although promising in initial early trials, have yet to show a significant benefit in adjuvant therapy for rectal cancer.

scholarly journals Magnetic resonance imaging evaluation in neoadjuvant therapy of locally advanced rectal cancer: a systematic review

2017 ◽  
Vol 51 (3) ◽  
pp. 252-262 ◽  
Author(s):  
Roberta Fusco ◽  
Mario Petrillo ◽  
Vincenza Granata ◽  
Salvatore Filice ◽  
Mario Sansone ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Diagnostic Accuracy ◽  
Locally Advanced ◽  
Therapy Response ◽  
Roc Curves ◽  
Response Assessment ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Dce Mri ◽  
Pet Ct

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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