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Diffusion-weighted MR volume and apparent diffusion coefficient for discriminating lymph node metastases and good response after chemoradiation therapy in locally advanced rectal cancer

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) volume and apparent diffusion coefficient values (ADCs) for assessing lymph node metastases (LNM) and good response after chemoradiation therapy (CRT) in patients with locally advanced rectal cancer (LARC).

Materials and methods

This retrospective study consisted of 61 patients with LARC who underwent pre- and post-CRT DW images. Two radiologists independently placed free-hand regions of interest in each tumor-containing section on DW images to calculate pre- and post-CRT tumor volume and tumor volume reduction rates (Δvolume). Regions of interest were drawn to include tumor on maximum cross-sectional slice to obtain ADCs. Areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate diagnostic performance in identifying LNM and good response after CRT using these parameters.

Results

Inter-observer agreement and intra-observer agreement were excellent for pre- and post-CRT DW MR volume (intraclass correlation coefficient [ICC], 0.889–0.948) and moderate for pre- and post-CRT ADCs (ICC, 0.535–0.811). AUCs for identifying LNM were 0.508 for pre-CRT DW MR volume versus 0.705 for pre-CRT ADC, 0.855 for post-CRT DW MR volume versus 0.679 for post-CRT ADC, and 0.887 for Δvolume versus 0.533 for ΔADC. AUCs for identifying good response were 0.518 for pre-CRT volume versus 0.506 for pre-CRT ADC, 0.975 for post-CRT volume versus 0.723 for post-CRT ADC, and 0.987 for Δvolume versus 0.655 for ΔADC.

Conclusion

DW MR Δvolume provided high diagnostic performance in discriminating LNM after CRT. DW MR Δvolume was equally as accurate as post-CRT DW MR volume for evaluating good response.

Key Points

• Inter-observer agreement and intra-observer agreement were excellent for pre- and post-CRT DW MR volume (intraclass correlation coefficient [ICC], 0.889–0.948) and moderate for pre- and post-CRT ADCs (ICC, 0.535–0.811).

• DW MR Δvolume provided high diagnostic performance in identifying LNM after CRT (AUC, 0.887) and good response (AUC, 0.987) and was significantly more accurate than pre-CRT DW MR volume (AUC, 0.508 and 0.518, respectively) and ADCs (AUC, 0.705 and 0.506, respectively).

• DW MR Δvolume (AUC, 0.987) was equally as accurate as post-CRT DW MR volume (AUC, 0.975) for evaluating good response, while pre-CRT DW MR volume and ADCs were not reliable for evaluating LNM and good response after CRT (AUC, 0.506–0.723).

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Abbreviations

ADCs:

Apparent diffusion coefficient values

AUC:

Area under the receiver operating characteristic curve

CRT:

Chemoradiation therapy

DW:

Diffusion-weighted

ICC:

Intraclass correlation coefficient

LARC:

Locally advanced rectal cancer

LNM:

Lymph node metastases

TRG:

Tumor regression grade

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Acknowledgments

The authors acknowledge Siyun Liu from General Electric Healthcare for her great support for the statistical analysis.

Funding

This study has received funding from the Key Research Project of Sichuan Province (No. 2019YFS0437).

Author information

Author notes

  1. Yi Yuan and Xiao-li Chen contributed equally to this study.

Authors and Affiliations

  1. Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Yi Yuan, Hong Pu, Guang-wen Chen & Hang Li

  2. Department of Radiology, Affiliated Cancer Hospital of Medical School, University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, 610000, China

    Xiao-li Chen

  3. Department of Pathology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Yi-Sha Liu

  4. Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Hao Liu

  5. Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Kang Wang

Authors
  1. Yi Yuan
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Corresponding author

Correspondence to Hang Li.

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Guarantor

The scientific guarantor of this publication is Hang Li.

Conflict of interest

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.

Statistics and biometry

Yi Yuan kindly provided statistical advice for this manuscript. We consulted an expert in statistics or biometry named Siyun Liu who comes from General Electric Healthcare Company for her great support for precision-recall curves. This expert is not one of the authors.

Informed consent

Only if the study is on human subjects: Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Yuan, Y., Pu, H., Chen, Gw. et al. Diffusion-weighted MR volume and apparent diffusion coefficient for discriminating lymph node metastases and good response after chemoradiation therapy in locally advanced rectal cancer. Eur Radiol 31, 200–211 (2021). https://doi.org/10.1007/s00330-020-07101-3

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  • DOI: https://doi.org/10.1007/s00330-020-07101-3

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