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Apparent diffusion coefficient (ADC) measured during diffusion-weighted imaging (DWI) shows promise for predicting rectal cancer response to neoadjuvant therapy. Changes in ADC, particularly post-treatment and the percentage change (Δ-ADC), are significant indicators of complete pathologic response.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Neoadjuvant therapy is standard for locally advanced rectal cancer.
  • Predicting treatment response is crucial for patient management.
  • Diffusion-weighted imaging (DWI) offers functional information about tissue characteristics.

Purpose of the Study:

  • To evaluate the utility of apparent diffusion coefficient (ADC) measurements from DWI in predicting complete pathologic response (pCR) in rectal cancer patients following neoadjuvant therapy.
  • To systematically review existing literature on ADC's role in assessing rectal cancer response.

Main Methods:

  • A systematic review of prospective and retrospective studies was performed.
  • Studies analyzed ADC values (pre-treatment, post-treatment, and Δ-ADC) in relation to pCR.
  • Pooled sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated for each ADC parameter.

Main Results:

  • Pathologic complete response was observed in 22.2% of patients.
  • Post-treatment ADC and Δ-ADC were significantly higher in complete responders compared to incomplete responders (p=0.00001 and p=0.016, respectively).
  • Δ-ADC demonstrated the highest diagnostic performance with an AUC of 0.895, followed by pre-treatment ADC (AUC=0.841).

Conclusions:

  • Apparent diffusion coefficient (ADC) derived from DWI is a valuable, non-invasive tool for predicting complete pathologic response in rectal cancer after neoadjuvant therapy.
  • Post-treatment ADC and particularly the percentage change (Δ-ADC) show significant potential for accurate response assessment.
  • ADC measurements can aid in tailoring treatment strategies for rectal cancer.