Contrast-enhanced pelvic magnetic resonance imaging (MRI) for the prediction of treatment response in mucinous rectal cancer Journal Article
| Authors: | Homsi, M. E.; Yildirim, O.; Gangai, N.; Shia, J.; Gollub, M. J.; Mazaheri, Y. |
| Article Title: | Contrast-enhanced pelvic magnetic resonance imaging (MRI) for the prediction of treatment response in mucinous rectal cancer |
| Abstract: | Background: In mucinous rectal cancer, it can be difficult to differentiate between cellular and acellular mucin. The purpose of this study was to evaluate, in patients with mucinous rectal cancer, the value of static enhancement (enh) and pharmacokinetic parameters of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in predicting pathologic complete response. Methods: This retrospective cross-sectional study performed at Memorial Sloan Kettering Cancer Center included 43 patients (24 males and 19 females; mean age, 57 years) with mucinous rectal cancer who underwent MRI at baseline as well as after neoadjuvant chemoradiotherapy but before surgical resection between 2008 and 2019. Two radiologists independently segmented tumors on contrast-enhanced axial 3D T1-weighted images and sagittal DCE magnetic resonance images. On contrast-enhanced axial T1-weighted images, the static parameters enh and relative enhancement (renh) were estimated. On DCE images, the pharmacokinetic parameters Ktrans, kep, relative Ktrans (rKtrans), and relative kep (rkep) were estimated. Associations between all parameters with pathologic complete response were tested using Wilcoxon signedrank tests. Receiver operating characteristic (ROC) analysis was performed to assess the area under the curve (AUC) for each parameter. Results: Of the 43 patients who were included in the study, 42/43 (98%) had evaluable contrast-enhanced axial T1-weighted images and 35/43 (81%) had evaluable DCE images. Of the patients with evaluable contrast-enhanced axial T1-weighted images, 9/42 (21%) had pathologic complete response and 33/42 (79%) did not have pathologic complete response. For reader 1, enh(pre-neoadjuvant chemotherapy), enh(post-neoadjuvant chemotherapy), and renh were significant predictors of pathologic complete response [P=0.045 (AUC =0.73), 0.039 (AUC =0.74), and 0.0042, respectively]. For reader 2, enh(pre-neoadjuvant chemotherapy) and renh were significant predictors [P=0.021 (AUC =0.77) and 0.002, respectively]. For renh, the AUC was 0.83 for reader 1, and 0.82 for reader 2. Meanwhile, of those patients with evaluable DCE images, 9/35 (26%) had pathologic complete response and 26/35 (74%) did not have pathologic complete response. Ktrans(pre-neoadjuvant chemotherapy), kep(pre-neoadjuvant chemotherapy), and rkep were significant predictors [P=0.016 (AUC =0.73), 0.00057 (AUC =0.81), and 0.0096 (AUC =0.74), respectively]. Conclusions: Static and pharmacokinetic parameters of contrast-enhanced MRI show promise to predict neoadjuvant treatment response. Static enh parameters, which are simpler to assess, showed the strongest prediction. © Quantitative Imaging in Medicine and Surgery. All rights reserved. |
| Keywords: | adult; clinical article; controlled study; treatment response; middle aged; histopathology; fluorouracil; capecitabine; cancer radiotherapy; nuclear magnetic resonance imaging; pelvis; retrospective study; prediction; health care; radiologist; contrast enhancement; contrast medium; cross-sectional study; neoadjuvant chemotherapy; oxaliplatin; rectum cancer; diffusion weighted imaging; mucin; rectum anterior resection; rectum abdominoperineal resection; image segmentation; pathologic complete response; diagnostic test accuracy study; gadolinium pentetate meglumine; human; male; female; article; t1 weighted imaging; dynamic contrast enhanced imaging; contrast-enhanced magnetic resonance imaging (contrast-enhanced mri); mucinous rectal cancer |
| Journal Title: | Quantitative Imaging in Medicine and Surgery |
| Volume: | 14 |
| Issue: | 6 |
| ISSN: | 2223-4292 |
| Publisher: | AME Publishing Company |
| Date Published: | 2024-06-01 |
| Start Page: | 4110 |
| End Page: | 4122 |
| Language: | English |
| DOI: | 10.21037/qims-23-1463 |
| PROVIDER: | scopus |
| PMCID: | PMC11151230 |
| PUBMED: | 38846296 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author is Maria El Homsi -- Source: Scopus |
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