Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer

Young Chul Kim, Joon Seok Lim, Ki Chang Keum, Kyung Ah Kim, Sungmin Myoung, Sang Joon Shin, Myeong Jin Kim, Namkyu Kim, Jinsuck Suh, Ki Whang Kim

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Abstract

Purpose: To compare diffusion-weighted imaging (DWI) and magnetic resonance (MR) volumetry for predicting treatment outcomes of locally advanced rectal cancers with preoperative chemoradiotherapy (CRT). Materials and Methods: This prospective study was approved by our Institutional Review Board. Thirty-four patients underwent three MR examinations: pre-CRT (before CRT), early CRT (2 weeks after CRT initiation), and post-CRT (before surgery). The tumor apparent diffusion coefficient (ADC), ADC increase rate, and volume reduction rate were compared between responders and nonresponders using three reference standards: downstaging, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and tumor regression grade (TRG). For DWI and volumetry, differences between responders and nonresponders were assessed by receiver operating characteristic analysis. Results: The median early tumor volume reduction rate of responders, subgrouped by downstaging and mRECIST (47.97% and 53.97%, respectively), was significantly higher than that of nonresponders (20.94% and 20.36%; P = 0.0024 and 0.0001, respectively), but there were no significant differences in pre-CRT ADC and early ADC increase rate using all references. When using the downstaging and mRECIST, the diagnostic performance of early tumor volume reduction rate (Az = 0.81 and 0.94, respectively) was higher than that of pre-CRT ADC (Az = 0.55 and 0.62; P = 0.033 and 0.007) and early ADC increase rate (Az = 0.58 and 0.64; P = 0.055 and 0.01) for predicting the treatment outcome. For TRG, there were no significant differences between DWI and volumetry. Conclusion: Early tumor volume reduction rate at the second week after CRT initiation may be a better indicator than DWI based on the mean ADC measurements for predicting CRT treatment outcome.

Original languageEnglish
Pages (from-to)570-576
Number of pages7
JournalJournal of Magnetic Resonance Imaging
Volume34
Issue number3
DOIs
Publication statusPublished - 2011 Sep 1

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Diffusion Magnetic Resonance Imaging
Chemoradiotherapy
Rectal Neoplasms
Magnetic Resonance Spectroscopy
Tumor Burden
Neoplasms
Research Ethics Committees
ROC Curve
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Kim, Young Chul ; Lim, Joon Seok ; Keum, Ki Chang ; Kim, Kyung Ah ; Myoung, Sungmin ; Shin, Sang Joon ; Kim, Myeong Jin ; Kim, Namkyu ; Suh, Jinsuck ; Kim, Ki Whang. / Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer. In: Journal of Magnetic Resonance Imaging. 2011 ; Vol. 34, No. 3. pp. 570-576.
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abstract = "Purpose: To compare diffusion-weighted imaging (DWI) and magnetic resonance (MR) volumetry for predicting treatment outcomes of locally advanced rectal cancers with preoperative chemoradiotherapy (CRT). Materials and Methods: This prospective study was approved by our Institutional Review Board. Thirty-four patients underwent three MR examinations: pre-CRT (before CRT), early CRT (2 weeks after CRT initiation), and post-CRT (before surgery). The tumor apparent diffusion coefficient (ADC), ADC increase rate, and volume reduction rate were compared between responders and nonresponders using three reference standards: downstaging, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and tumor regression grade (TRG). For DWI and volumetry, differences between responders and nonresponders were assessed by receiver operating characteristic analysis. Results: The median early tumor volume reduction rate of responders, subgrouped by downstaging and mRECIST (47.97{\%} and 53.97{\%}, respectively), was significantly higher than that of nonresponders (20.94{\%} and 20.36{\%}; P = 0.0024 and 0.0001, respectively), but there were no significant differences in pre-CRT ADC and early ADC increase rate using all references. When using the downstaging and mRECIST, the diagnostic performance of early tumor volume reduction rate (Az = 0.81 and 0.94, respectively) was higher than that of pre-CRT ADC (Az = 0.55 and 0.62; P = 0.033 and 0.007) and early ADC increase rate (Az = 0.58 and 0.64; P = 0.055 and 0.01) for predicting the treatment outcome. For TRG, there were no significant differences between DWI and volumetry. Conclusion: Early tumor volume reduction rate at the second week after CRT initiation may be a better indicator than DWI based on the mean ADC measurements for predicting CRT treatment outcome.",
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Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer. / Kim, Young Chul; Lim, Joon Seok; Keum, Ki Chang; Kim, Kyung Ah; Myoung, Sungmin; Shin, Sang Joon; Kim, Myeong Jin; Kim, Namkyu; Suh, Jinsuck; Kim, Ki Whang.

In: Journal of Magnetic Resonance Imaging, Vol. 34, No. 3, 01.09.2011, p. 570-576.

Research output: Contribution to journalArticle

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T1 - Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer

AU - Kim, Young Chul

AU - Lim, Joon Seok

AU - Keum, Ki Chang

AU - Kim, Kyung Ah

AU - Myoung, Sungmin

AU - Shin, Sang Joon

AU - Kim, Myeong Jin

AU - Kim, Namkyu

AU - Suh, Jinsuck

AU - Kim, Ki Whang

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N2 - Purpose: To compare diffusion-weighted imaging (DWI) and magnetic resonance (MR) volumetry for predicting treatment outcomes of locally advanced rectal cancers with preoperative chemoradiotherapy (CRT). Materials and Methods: This prospective study was approved by our Institutional Review Board. Thirty-four patients underwent three MR examinations: pre-CRT (before CRT), early CRT (2 weeks after CRT initiation), and post-CRT (before surgery). The tumor apparent diffusion coefficient (ADC), ADC increase rate, and volume reduction rate were compared between responders and nonresponders using three reference standards: downstaging, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and tumor regression grade (TRG). For DWI and volumetry, differences between responders and nonresponders were assessed by receiver operating characteristic analysis. Results: The median early tumor volume reduction rate of responders, subgrouped by downstaging and mRECIST (47.97% and 53.97%, respectively), was significantly higher than that of nonresponders (20.94% and 20.36%; P = 0.0024 and 0.0001, respectively), but there were no significant differences in pre-CRT ADC and early ADC increase rate using all references. When using the downstaging and mRECIST, the diagnostic performance of early tumor volume reduction rate (Az = 0.81 and 0.94, respectively) was higher than that of pre-CRT ADC (Az = 0.55 and 0.62; P = 0.033 and 0.007) and early ADC increase rate (Az = 0.58 and 0.64; P = 0.055 and 0.01) for predicting the treatment outcome. For TRG, there were no significant differences between DWI and volumetry. Conclusion: Early tumor volume reduction rate at the second week after CRT initiation may be a better indicator than DWI based on the mean ADC measurements for predicting CRT treatment outcome.

AB - Purpose: To compare diffusion-weighted imaging (DWI) and magnetic resonance (MR) volumetry for predicting treatment outcomes of locally advanced rectal cancers with preoperative chemoradiotherapy (CRT). Materials and Methods: This prospective study was approved by our Institutional Review Board. Thirty-four patients underwent three MR examinations: pre-CRT (before CRT), early CRT (2 weeks after CRT initiation), and post-CRT (before surgery). The tumor apparent diffusion coefficient (ADC), ADC increase rate, and volume reduction rate were compared between responders and nonresponders using three reference standards: downstaging, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and tumor regression grade (TRG). For DWI and volumetry, differences between responders and nonresponders were assessed by receiver operating characteristic analysis. Results: The median early tumor volume reduction rate of responders, subgrouped by downstaging and mRECIST (47.97% and 53.97%, respectively), was significantly higher than that of nonresponders (20.94% and 20.36%; P = 0.0024 and 0.0001, respectively), but there were no significant differences in pre-CRT ADC and early ADC increase rate using all references. When using the downstaging and mRECIST, the diagnostic performance of early tumor volume reduction rate (Az = 0.81 and 0.94, respectively) was higher than that of pre-CRT ADC (Az = 0.55 and 0.62; P = 0.033 and 0.007) and early ADC increase rate (Az = 0.58 and 0.64; P = 0.055 and 0.01) for predicting the treatment outcome. For TRG, there were no significant differences between DWI and volumetry. Conclusion: Early tumor volume reduction rate at the second week after CRT initiation may be a better indicator than DWI based on the mean ADC measurements for predicting CRT treatment outcome.

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