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Multiparametric MRI in the assessment of response of rectal cancer to neoadjuvant chemoradiotherapy: A comparison of morphological, volumetric and functional MRI parameters

  • Gastrointestinal
  • Published:
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Abstract

Purpose

To compare morphological and functional MRI metrics and determine which ones perform best in assessing response to neoadjuvant chemoradiotherapy (CRT) in rectal cancer.

Materials and methods

This retrospective study included 24 uniformly-treated patients with biopsy-proven rectal adenocarcinoma who underwent MRI, including diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) sequences, before and after completion of CRT. On all MRI exams, two experienced readers independently measured longest and perpendicular tumour diameters, tumour volume, tumour regression grade (TRG) and tumour signal intensity ratio on T2-weighted imaging, as well as tumour volume and apparent diffusion coefficient on DW-MRI and tumour volume and transfer constant Ktrans on DCE-MRI. These metrics were correlated with histopathological percent tumour regression in the resected specimen (%TR). Inter-reader agreement was assessed using the concordance correlation coefficient (CCC).

Results

For both readers, post-treatment DW-MRI and DCE-MRI volumetric tumour assessments were significantly associated with %TR; DCE-MRI volumetry showed better inter-reader agreement (CCC=0.700) than DW-MRI volumetry (CCC=0.292). For one reader, mrTRG, post-treatment T2 tumour volumetry and assessments of volume change made with T2, DW-MRI and DCE-MRI were also significantly associated with %TR.

Conclusion

Tumour volumetry on post-treatment DCE-MRI and DW-MRI correlated well with %TR, with DCE-MRI volumetry demonstrating better inter-reader agreement.

Key Points

• Volumetry on post-treatment DCE-/DW-MRI sequences correlated well with histopathological tumour regression.

• DCE-MRI volumetry demonstrated good inter-reader agreement.

• Inter-reader agreement was higher for DCE-MRI volumetry than for DW-MRI volumetry.

• DCE-MRI volumetry merits further investigation as a metric for evaluating treatment response.

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Acknowledgments

The authors thank Ada Muellner, MS for editing the manuscript. The research of Kaitlin M. Woo and Mithat Gönen was partly supported by NIH/NCI Cancer Center Support Grant P30 CA008748. The scientific guarantor of this publication is Dr. Marc J. Gollub. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Mithat Gönen PhD and Kaitlin M. Woo MS kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, experimental, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Andreas M. Hötker, Lisa Tarlinton & Marc J. Gollub

  2. Department of Diagnostic and Interventional Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Andreas M. Hötker

  3. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Yousef Mazaheri

  4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Kaitlin M. Woo & Mithat Gönen

  5. Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Leonard B. Saltz

  6. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Karyn A. Goodman

  7. Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Julio Garcia-Aguilar

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  1. Andreas M. Hötker
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Correspondence to Andreas M. Hötker.

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Hötker, A.M., Tarlinton, L., Mazaheri, Y. et al. Multiparametric MRI in the assessment of response of rectal cancer to neoadjuvant chemoradiotherapy: A comparison of morphological, volumetric and functional MRI parameters. Eur Radiol 26, 4303–4312 (2016). https://doi.org/10.1007/s00330-016-4283-9

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  • DOI: https://doi.org/10.1007/s00330-016-4283-9

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