Value of adding dynamic contrast-enhanced MRI visual assessment to conventional MRI and clinical assessment in the diagnosis of complete tumour response to chemoradiotherapy for rectal cancer Journal Article
| Authors: | Gollub, M. J.; Blazic, I.; Felder, S.; Knezevic, A.; Gonen, M.; Garcia-Aguilar, J.; Paty, P. P.; Smith, J. J. |
| Article Title: | Value of adding dynamic contrast-enhanced MRI visual assessment to conventional MRI and clinical assessment in the diagnosis of complete tumour response to chemoradiotherapy for rectal cancer |
| Abstract: | Purpose: To determine if DCE-MRI adds diagnostic value to the combined use of T2WI and DWI-MRI in the determination of clinical complete response (cCR) after neoadjuvant treatment (NAT) in patients with locally advanced rectal cancer. Methods and materials: In this IRB-approved, HIPAA-compliant retrospective study, response was assessed using a 5-point confidence score by T2WI and DWI-MRI only (‘standard MRI’), then with addition of DCE-MRI. Review of digital rectal exams and endoscopy notes produced a clinical overall response score. The reference standard was CR by histopathology or cCR determined after a minimum of 18 months’ follow-up. Diagnostic accuracy and ROC curves were calculated for standard MRI and added DCE-MRI (to detect complete or good response), for clinical evaluation (to detect CR) and for MRI and clinical methods combined. Results: Of 65 patients undergoing NAT, 20 had cCR (31%). Sensitivity, specificity and area under the ROC (AUC) were 0.55, 0.87 and 0.69 for clinical evaluation; 0.42, 0.77 and 0.66 for standard MRI, and 0.53, 0.76 and 0.68 for added DCE-MRI, respectively. Combined clinical evaluation and standard MRI with DCE-MRI resulted in the highest specificity of 0.96 and highest AUC of 0.72. Conclusion: For the assessment of cCR after neoadjuvant therapy using clinical and multi-sequence MRI reading strategies, the addition of DCE-MRI increased specificity and PPV, but not significantly. Key Points: • The addition of dynamic contrast-enhanced MRI to standard MRI, including DWI-MRI, may not significantly improve accuracy of response assessment in rectal cancer treatment. • Clinical assessment consisting of digital rectal examination and endoscopy is the most accurate standalone test to assess response to chemoradiotherapy in rectal cancer. • Combining MRI using DWI and DCE with the clinical assessment may potentially improve the accuracy for response assessment in rectal cancer. © 2018, European Society of Radiology. |
| Keywords: | magnetic resonance imaging; chemoradiotherapy; rectal cancer |
| Journal Title: | European Radiology |
| Volume: | 29 |
| Issue: | 3 |
| ISSN: | 0938-7994 |
| Publisher: | Springer |
| Date Published: | 2019-03-01 |
| Start Page: | 1104 |
| End Page: | 1113 |
| Language: | English |
| DOI: | 10.1007/s00330-018-5719-1 |
| PUBMED: | 30242504 |
| PROVIDER: | scopus |
| PMCID: | PMC6358522 |
| DOI/URL: | |
| Notes: | Review -- Export Date: 1 March 2019 -- Source: Scopus |
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