Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer

Comparison with T 2 weighted and PET/CT imaging

I. Song, Seong Hyun Kim, S. J. Lee, J. Y. Choi, Min Ju Kim, H. Rhim

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Abstract

Objectives: To evaluate the added value of diffusion-weighted imaging (DWI) in combination with T 2 weighted imaging (T2WI) compared with T2WI alone or positron emission tomography (PET)/CT for detecting viable tumour after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer. Methods: 50 consecutive patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. All patients underwent 3.0 T rectal MRI and PET/CT after completing CRT. For qualitative analysis, two radiologists independently reviewed T2WI alone and DWI with T2WI over a 1-month interval. One nuclear medicine physician reviewed PET/CT images using a five-point scale. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting viable tumour were assessed. For quantitative analysis, the apparent diffusion coefficients (ADCs) of the lesions were measured and compared between the viable tumour group and non-viable tumour groups. Results: For detecting viable tumours, DWI with T2WI improved diagnostic accuracies (Reviewer 1 detected 90%; Reviewer 2, 86%) over T2WI alone (Reviewer 1 detected 76%, p=0.5; Reviewer 2, 64%, p=0.013) or PET/CT (48%, p<0.001). The sensitivity of DWI with T2WI (Reviewer 1 detected 98%; Reviewer 2, 91%) was significantly higher than those of T2WI alone (Reviewer 1 detected 77%; Reviewer 2, 64%) or PET-CT (43%, p<0.05). Only for Reviewer 2 was the NPV of DWI with T2WI (43%) significantly different from that of PET/CT (17%, p<0.05). The specificities and PPVs of DWI with T2WI were not improved over those of T2WI alone or of PET/CT (both p>0.05). The mean ADC of the viable tumour group (0.93 × 10 -3 mm 2 sc -1) was significantly lower than that of the non-viable tumour group (1.55 × 10 -3 mm 2 sc -1, p<0.0001). Conclusion: Adding DWI to T2WI is helpful for detecting viable tumours after neoadjuvant CRT compared with T2WI alone or PET/CT in patients with locally advanced rectal cancer.

Original languageEnglish
Pages (from-to)577-586
Number of pages10
JournalBritish Journal of Radiology
Volume85
Issue number1013
DOIs
Publication statusPublished - 2012 May 1

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Neoadjuvant Therapy
Rectal Neoplasms
Positron-Emission Tomography
Neoplasms
Nuclear Medicine
Diagnostic Imaging
Retrospective Studies
Lymph Nodes
Physicians
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{c751fe7477df40a7aad39ad3baec6fdc,
title = "Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: Comparison with T 2 weighted and PET/CT imaging",
abstract = "Objectives: To evaluate the added value of diffusion-weighted imaging (DWI) in combination with T 2 weighted imaging (T2WI) compared with T2WI alone or positron emission tomography (PET)/CT for detecting viable tumour after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer. Methods: 50 consecutive patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. All patients underwent 3.0 T rectal MRI and PET/CT after completing CRT. For qualitative analysis, two radiologists independently reviewed T2WI alone and DWI with T2WI over a 1-month interval. One nuclear medicine physician reviewed PET/CT images using a five-point scale. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting viable tumour were assessed. For quantitative analysis, the apparent diffusion coefficients (ADCs) of the lesions were measured and compared between the viable tumour group and non-viable tumour groups. Results: For detecting viable tumours, DWI with T2WI improved diagnostic accuracies (Reviewer 1 detected 90{\%}; Reviewer 2, 86{\%}) over T2WI alone (Reviewer 1 detected 76{\%}, p=0.5; Reviewer 2, 64{\%}, p=0.013) or PET/CT (48{\%}, p<0.001). The sensitivity of DWI with T2WI (Reviewer 1 detected 98{\%}; Reviewer 2, 91{\%}) was significantly higher than those of T2WI alone (Reviewer 1 detected 77{\%}; Reviewer 2, 64{\%}) or PET-CT (43{\%}, p<0.05). Only for Reviewer 2 was the NPV of DWI with T2WI (43{\%}) significantly different from that of PET/CT (17{\%}, p<0.05). The specificities and PPVs of DWI with T2WI were not improved over those of T2WI alone or of PET/CT (both p>0.05). The mean ADC of the viable tumour group (0.93 × 10 -3 mm 2 sc -1) was significantly lower than that of the non-viable tumour group (1.55 × 10 -3 mm 2 sc -1, p<0.0001). Conclusion: Adding DWI to T2WI is helpful for detecting viable tumours after neoadjuvant CRT compared with T2WI alone or PET/CT in patients with locally advanced rectal cancer.",
author = "I. Song and Kim, {Seong Hyun} and Lee, {S. J.} and Choi, {J. Y.} and Kim, {Min Ju} and H. Rhim",
year = "2012",
month = "5",
day = "1",
doi = "10.1259/Bjr/68424021",
language = "English",
volume = "85",
pages = "577--586",
journal = "The British journal of radiology.",
issn = "0007-1285",
publisher = "British Institute of Radiology",
number = "1013",

}

TY - JOUR

T1 - Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer

T2 - Comparison with T 2 weighted and PET/CT imaging

AU - Song, I.

AU - Kim, Seong Hyun

AU - Lee, S. J.

AU - Choi, J. Y.

AU - Kim, Min Ju

AU - Rhim, H.

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Objectives: To evaluate the added value of diffusion-weighted imaging (DWI) in combination with T 2 weighted imaging (T2WI) compared with T2WI alone or positron emission tomography (PET)/CT for detecting viable tumour after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer. Methods: 50 consecutive patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. All patients underwent 3.0 T rectal MRI and PET/CT after completing CRT. For qualitative analysis, two radiologists independently reviewed T2WI alone and DWI with T2WI over a 1-month interval. One nuclear medicine physician reviewed PET/CT images using a five-point scale. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting viable tumour were assessed. For quantitative analysis, the apparent diffusion coefficients (ADCs) of the lesions were measured and compared between the viable tumour group and non-viable tumour groups. Results: For detecting viable tumours, DWI with T2WI improved diagnostic accuracies (Reviewer 1 detected 90%; Reviewer 2, 86%) over T2WI alone (Reviewer 1 detected 76%, p=0.5; Reviewer 2, 64%, p=0.013) or PET/CT (48%, p<0.001). The sensitivity of DWI with T2WI (Reviewer 1 detected 98%; Reviewer 2, 91%) was significantly higher than those of T2WI alone (Reviewer 1 detected 77%; Reviewer 2, 64%) or PET-CT (43%, p<0.05). Only for Reviewer 2 was the NPV of DWI with T2WI (43%) significantly different from that of PET/CT (17%, p<0.05). The specificities and PPVs of DWI with T2WI were not improved over those of T2WI alone or of PET/CT (both p>0.05). The mean ADC of the viable tumour group (0.93 × 10 -3 mm 2 sc -1) was significantly lower than that of the non-viable tumour group (1.55 × 10 -3 mm 2 sc -1, p<0.0001). Conclusion: Adding DWI to T2WI is helpful for detecting viable tumours after neoadjuvant CRT compared with T2WI alone or PET/CT in patients with locally advanced rectal cancer.

AB - Objectives: To evaluate the added value of diffusion-weighted imaging (DWI) in combination with T 2 weighted imaging (T2WI) compared with T2WI alone or positron emission tomography (PET)/CT for detecting viable tumour after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer. Methods: 50 consecutive patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. All patients underwent 3.0 T rectal MRI and PET/CT after completing CRT. For qualitative analysis, two radiologists independently reviewed T2WI alone and DWI with T2WI over a 1-month interval. One nuclear medicine physician reviewed PET/CT images using a five-point scale. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting viable tumour were assessed. For quantitative analysis, the apparent diffusion coefficients (ADCs) of the lesions were measured and compared between the viable tumour group and non-viable tumour groups. Results: For detecting viable tumours, DWI with T2WI improved diagnostic accuracies (Reviewer 1 detected 90%; Reviewer 2, 86%) over T2WI alone (Reviewer 1 detected 76%, p=0.5; Reviewer 2, 64%, p=0.013) or PET/CT (48%, p<0.001). The sensitivity of DWI with T2WI (Reviewer 1 detected 98%; Reviewer 2, 91%) was significantly higher than those of T2WI alone (Reviewer 1 detected 77%; Reviewer 2, 64%) or PET-CT (43%, p<0.05). Only for Reviewer 2 was the NPV of DWI with T2WI (43%) significantly different from that of PET/CT (17%, p<0.05). The specificities and PPVs of DWI with T2WI were not improved over those of T2WI alone or of PET/CT (both p>0.05). The mean ADC of the viable tumour group (0.93 × 10 -3 mm 2 sc -1) was significantly lower than that of the non-viable tumour group (1.55 × 10 -3 mm 2 sc -1, p<0.0001). Conclusion: Adding DWI to T2WI is helpful for detecting viable tumours after neoadjuvant CRT compared with T2WI alone or PET/CT in patients with locally advanced rectal cancer.

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