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Diffusion-weighted MRI in locally advanced rectal cancer : pathological response prediction after neo-adjuvant
M Intven1, O Reerink, M E P Philippens
1Department of Radiotherapy, University Medical Center Utrecht, The Netherlands. M.Intven@UMCUtrecht.nl
Background And Purpose:
The aim of this study was to assess the predictive potential of diffusion-weighted magnetic resonance imaging (MRI) for the selection of favorable pathological responders after radiochemotherapy for locally advanced rectal cancer.
Patients And Methods:
In 59 patients with locally advanced rectal cancer, the apparent diffusion coefficient (ADC) in the tumor was obtained at 3 Tesla before radiochemotherapy and surgery. The predictive potential for pathological complete response (pCR) and good response (GR) was assessed. GR was defined as pCR and near-pCR based on the tumor regression grade.
Results:
The GR group consisted of 13 patients (22%) with 9 complete responders. Both the preradiochemotherapy ADC values and relative change in ADC (ΔADC) were predictive for pathological response. Preradiochemotherapy ADC values showed a positive predictive value of 42% for pCR and 67% for GR using a similar cut-off value of 0.97(*)10(-3) mm(2)/s. For ΔADC, the optimal threshold for predicting GR or pCR was a 41% increase of the ADC. With this threshold, positive predictive values of 64% and 91% were found for pCR and GR, respectively.
Conclusion:
Low preradiochemotherapy ADC values and high ΔADC correspond to pathological good response. Diffusion-weighted MRI may be used as an additional tool for selecting good treatment responders after radiochemotherapy.
