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Predictive role of diffusion-weighted MRI in the assessment of response to total neoadjuvant therapy in locally advanced rectal cancer

  • Magnetic Resonance
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Abstract

Objective

To investigate the predictive role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the assessment of response to total neoadjuvant therapy (TNT) in patients with locally advanced rectal cancer (LARC).

Methods

In this single-center retrospective study, patients with LARC who underwent staging MRI and TNT were enrolled. MRI-based staging, tumor volume, and DWI-ADC values were analyzed. Patients were classified as complete responders (pCR) and non-complete responders (non-pCR), according to post-surgical outcome. Pre-treatment ADC values were compared to pathological outcome, post-treatment downstaging, and reduction of tumor volume. The diagnostic accuracy of DWI-ADC in differentiating between pCR and non-pCR groups was calculated with receiver operating characteristic (ROC) analysis.

Results

A total of 36 patients were evaluated (pCR, n = 20; non-pCR, n = 16). Pre-treatment ADC values were significantly different between the two groups (p = 0.034), while no association was found between pre-TNT tumor volume and pathological response. ADC values showed significant correlations with loco-regional downstaging after therapy (r = −0.537, p = 0.022), and with the reduction of tumor volume (r = −0.480, p = 0.044). ADC values were able to differentiate pCR from non-pCR patients with a sensitivity of 75% and specificity of 70%.

Conclusions

ADC values on pre-treatment MRI were strongly associated with the outcome in patients with LARC, both in terms of pathological response and in loco-regional downstaging after TNT, suggesting the use of DW-MRI as a potential predictive tool of response to therapy.

Key Points

• ADC values of pre-TNT MRI examinations of patients with LARC were significantly associated with a pathological complete response (pCR) and with post-treatment regression of TNM staging.

• An ADC value of 1.042 ×10 −3 mm 2 /s was found to be the optimal cutoff value for discriminating between pCR and non-pCR patients, with a sensitivity of 75% and specificity of 70%.

• DW-MRI proved to have a potential predictive role in the assessment of response to therapy in patients with LARC, throughout the analysis of ADC map values.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under curve

ChT:

Chemotherapy

CRT:

Chemoradiotherapy

DWI:

Diffusion-weighted imaging

ICC:

Intraclass correlation coefficient

LARC:

Locally advanced rectal cancer

MRI:

Magnetic resonance imaging

pCR:

Pathological complete response

ROC:

Receiver operating characteristic

RT:

Radiotherapy

TME:

Total mesorectal excision

TNT:

Total neoadjuvant therapy

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Acknowledgements

We would like to acknowledge all the colleagues of the Department of Radiological, Oncological and Pathological Sciences, the Department of Radiotherapy, and the Department of General Surgery of Policlinico Umberto I Hospital for patients’ management and their contribution to this manuscript.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

    Franco Iafrate, Fabio Ciccarelli, Giorgio Maria Masci, Damiano Grasso, Francesco Marruzzo, Fabio Massimo Magliocca, Enrico Cortesi & Carlo Catalano

  2. Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

    Francesca De Felice & Vincenzo Tombolini

  3. Department of General Surgery, Surgical Specialties and Organ Transplantation, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Giancarlo D’Ambrosio

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  1. Franco Iafrate
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Correspondence to Franco Iafrate.

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The scientific guarantor of this publication is Franco Iafrate.

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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

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived due to the retrospective nature of the study.

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• performed at one institution

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Iafrate, F., Ciccarelli, F., Masci, G.M. et al. Predictive role of diffusion-weighted MRI in the assessment of response to total neoadjuvant therapy in locally advanced rectal cancer. Eur Radiol 33, 854–862 (2023). https://doi.org/10.1007/s00330-022-09086-7

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