Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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How to Combine Diffusion-Weighted and T2-Weighted Imaging for MRI Assessment of Pathologic Complete Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer?

  • Jong Keon Jang (Department of Radiology and Research Institute of Radiology, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Chul-min Lee (Department of Radiology and Research Institute of Radiology, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Seong Ho Park (Department of Radiology and Research Institute of Radiology, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jong Hoon Kim (Department of Radiation Oncology, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jihun Kim (Department of Pathology, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Seok-Byung Lim (Department of Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Chang Sik Yu (Department of Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jin Cheon Kim (Department of Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2020.11.29
  • Accepted : 2021.03.17
  • Published : 2021.09.01
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Abstract

Objective: Adequate methods of combining T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) to assess complete response (CR) to chemoradiotherapy (CRT) for rectal cancer are obscure. We aimed to determine an algorithm for combining T2WI and DWI to optimally suggest CR on MRI using visual assessment. Materials and Methods: We included 376 patients (male:female, 256:120; mean age ± standard deviation, 59.7 ± 11.1 years) who had undergone long-course CRT for rectal cancer and both pre- and post-CRT high-resolution rectal MRI during 2017-2018. Two experienced radiologists independently evaluated whether a tumor signal was absent, representing CR, on both post-CRT T2WI and DWI, and whether the pre-treatment DWI showed homogeneous hyperintensity throughout the lesion. Algorithms for combining T2WI and DWI were as follows: 'AND,' if both showed CR; 'OR,' if any one showed CR; and 'conditional OR,' if T2WI showed CR or DWI showed CR after the pre-treatment DWI showed homogeneous hyperintensity. Their efficacies for diagnosing pathologic CR (pCR) were determined in comparison with T2WI alone. Results: Sixty-nine patients (18.4%) had pCR. AND had a lower sensitivity without statistical significance (vs. 62.3% [43/69]; 59.4% [41/69], p = 0.500) and a significantly higher specificity (vs. 87.0% [267/307]; 90.2% [277/307], p = 0.002) than those of T2WI. Both OR and conditional OR combinations resulted in a large increase in sensitivity (vs. 62.3% [43/69]; 81.2% [56/69], p < 0.001; and 73.9% [51/69], p = 0.008, respectively) and a large decrease in specificity (vs. 87.0% [267/307]; 57.0% [175/307], p < 0.001; and 69.1% [212/307], p < 0.001, respectively) as compared with T2WI, ultimately creating additional false interpretations of CR more frequently than additional identification of patients with pCR. Conclusion: AND combination of T2WI and DWI is an appropriate strategy for suggesting CR using visual assessment of MRI after CRT for rectal cancer.

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References

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