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Goedegebuure EP, Arico FM, Lahaye MJ, Maas M, Beets GL, Peters FP, van Leerdam ME, Beets-Tan RGH, Lambregts DMJ. Defining the tumor location in rectal cancer - Practice variations and impact on treatment decision making. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109700. [PMID: 40106891 DOI: 10.1016/j.ejso.2025.109700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 01/27/2025] [Accepted: 02/12/2025] [Indexed: 03/22/2025]
Abstract
OBJECTIVE To summarize differences in current guideline recommendations for rectal tumor localization and generate an overview of published MRI measurement methods and their correlation with endoscopy. SUMMARYOF BACKGROUND DATA Rectal tumor location is a well-known factor that impacts treatment planning, but there is currently no consensus on the optimal method to define it. METHODS A literature search was conducted to retrieve clinical and radiological rectal cancer guidelines as well as original research studies on MRI-based measurements. Guidelines were assessed for definitions, landmarks, modalities and measurement methods to define tumor location, and how these impact treatment planning. Research studies were evaluated to compare MRI-methods and their correlation with endoscopy. RESULTS 18 clinical and 6 radiological guidelines were retrieved. In 83 % of clinical guidelines tumor location (low/middle/high) is included in the treatment algorithm as a factor impacting surgical and/or neoadjuvant treatment. Measurement cut-offs and landmarks vary significantly with the anal verge being the most commonly used landmark (28 %). Thirty-nine percent of clinical guidelines offer no definitions to define rectal tumor location. The majority of research studies (67 %) reported good-excellent agreement between MRI and endoscopy, though measurement differences of up to 2.5 cm were reported. CONCLUSION There is substantial variation in definitions and landmarks recommended in current guidelines to measure and classify rectal tumor location. This may affect treatment planning as well as trial inclusions, highlighting the need for standardized methods that better align between clinical and radiological guidelines.
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Affiliation(s)
- Elisabeth P Goedegebuure
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW Research Institute for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
| | - Francesco M Arico
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW Research Institute for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW Research Institute for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
| | - Geerard L Beets
- GROW Research Institute for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Femke P Peters
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- GROW Research Institute for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands; Director of Imaging Innovation Research - The Netherlands Cancer Institute, Amsterdam, the Netherlands; Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW Research Institute for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands.
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Liu IC, Gearhart S, Hu C, Chung H, Gabre-Kidan A, Najjar P, Christenson ES, Azad NS, Lee V, Zaheer A, Birkness-Gartman JE, Narang AK, Meyer J. Sustained Organ Preservation in Patients With Rectal Cancer After Sequential Short-Course Radiation Therapy and Chemotherapy. Am Surg 2025:31348251341945. [PMID: 40340411 DOI: 10.1177/00031348251341945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025]
Abstract
BackgroundNonoperative management in patients with rectal cancer with complete response to radiation therapy and chemotherapy is of increasing interest. Most of the data on nonoperative management have centered around patients treated with long-course chemoradiotherapy. The ability of short-course radiation-based treatment courses to achieve durable complete responses with sustained organ preservation is less defined. This study updates our institution's long-term experience with nonoperative management following upfront short-course radiation therapy and sequential/consolidation chemotherapy.MethodsWe retrospectively reviewed patients with nonmetastatic rectal cancer treated with sequential short-course radiation therapy and chemotherapy who reached complete response and were subsequently followed with nonoperative management. We report on disease control outcomes, including rates of regrowth and results of salvage surgery. We investigated characteristics associated with local tumor regrowth.ResultsOur study included 52 patients. The 2-year freedom from local regrowth for the entire cohort was 75%. Notably, patients with high-risk disease characteristics at diagnosis exhibited a trend toward a higher rate of local tumor regrowth. No patient with sustained clinical complete response developed metastatic disease. Of the twelve patients undergoing surgical salvage for regrowth of disease, ten were resected with complete/near-complete total mesorectal surgical specimens with negative margins.ConclusionsThe optimal approach to achieving sustained organ preservation through the use of radiation therapy and chemotherapy is not well defined. Our findings show the viability of neoadjuvant therapy incorporating short-course radiation therapy to achieve durable complete responses.
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Affiliation(s)
- I-Chia Liu
- Department of Radiation Oncology & Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Gearhart
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Haniee Chung
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alodia Gabre-Kidan
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Najjar
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric S Christenson
- Department of Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Nilofer S Azad
- Department of Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Valerie Lee
- Department of Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Atif Zaheer
- Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Amol K Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zhang T, Hu Y, Li H, Wang J, Xu Q, Xu Y, Sun H. Stage pT0-T1 rectal cancers: emphasis on submucosal high intensity on high-resolution T2-weighted imaging and other morphological features. Acta Radiol 2025; 66:558-566. [PMID: 39988912 DOI: 10.1177/02841851251316435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
BackgroundIdentification and staging of rectal cancer are mainly based on the difference in signal intensity (SI) between the tumor and normal structures of the intestinal wall on T2-weighted imaging. However, differentiating stage pT0-T1 from pT2 rectal tumors is difficult using routine magnetic resonance imaging (MRI) sequences.PurposeTo summarize and explore whether MRI findings from routine imaging can help differentiate pT0-T1 from pT2 rectal tumors.Material and MethodsA total of 110 patients with pT0-T2 rectal cancer underwent preoperative pelvic MRI examinations and tumor resection without preoperative chemoradiotherapy. MRI findings of rectal lesions (including tumor location, shape, longitudinal length, maximum cross-section, submucosal high intensity [SHI], extramural fibrotic scarring, wall shrinkage, lesion-to-wall signal intensity ratio, and presence of lymph node with short axis over 3 mm) and clinical characteristics were analyzed by univariate and multivariate analyses to screen the independent factors associated with pathological results.ResultsOf all the lesions, 32 tumors were proved to be pT0-T1 and 78 tumors were pT2. Univariate and multivariate logistic regression analyses revealed that tumor shape (odds ratio [OR] = 24.607, P < 0.001), SHI (OR = 6.129, P = 0.002), and extramural fibrotic scarring (OR = 0.110, P = 0.007) were independent factors distinguishing pT0-T1 tumors from pT2 tumors. If the rectal lesion has a cauliflower-like shape with SHI and no extramural fibrotic scarring, it is more likely to be a pT0-T1 tumor.ConclusionThe imaging features obtained from the routine MRI sequence showed potential value for differentiating pT0-T1 from pT2 rectal tumors.
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Affiliation(s)
- Tongyin Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, PR China
- Graduate School, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, PR China
| | - Yuwan Hu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, PR China
- Graduate School, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, PR China
| | - Haoyu Li
- Department of Radiology, China-Japan Friendship Hospital, Beijing, PR China
- Graduate School, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, PR China
| | - Juan Wang
- Department of Radiology, Civil Aviation General Hospital, Beijing, PR China
| | - Qiaoyu Xu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, PR China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, PR China
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Cotte E, Arquilliere J, Artru P, Bachet JB, Benhaim L, Bibeau F, Christou N, Conroy T, Doyen J, Hoeffel C, Meillan N, Mirabel X, Pioche M, Rivin Del Campo E, Vendrely V, Huguet F, Bouché O. Rectal cancer - French intergroup clinical practice guidelines for diagnosis, treatment, and follow-up (TNCD, SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFP, RENAPE, SNFCP, AFEF, SFR, and GRECCAR). Dig Liver Dis 2025; 57:669-679. [PMID: 39694751 DOI: 10.1016/j.dld.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 10/23/2024] [Accepted: 12/01/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND This article summarizes the French intergroup guidelines regarding rectal adenocarcinoma (RA) management published in September 2023, available on the French Society of Gastroenterology website. METHODS This work was supervised by French medical and surgical societies involved in RA management. Recommendations were rated from A to C according to the literature until September 2023. RESULTS Based on the pretreatment work-up, RA treatment was divided into four groups. T1N0 can be treated by endoscopic or surgical excision alone if there is no risk factor for lymph node involvement. For T2N0, radical surgery with total mesorectal excision is recommended, but rectal conservation is possible for small tumors (<4cm) after complete/subcomplete response following chemoradiotherapy. For T12N+ or T3+any N, total neoadjuvant treatment (TNT) followed by radical surgery is the gold standard, but rectal conservation is possible for small tumors after complete/subcomplete response following TNT. T3N2 or T+any N are an indication for TNT followed by radical surgery. Immunotherapy shows promise for dMMR/MSI RA. For metastatic tumors, recommendations are based on less robust evidence and chemotherapy plays a major role. CONCLUSION These guidelines aim at providing a personalized therapeutic strategy and are constantly being optimized. Each case should be discussed by a multidisciplinary team.
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Affiliation(s)
- Eddy Cotte
- Department of Digestive and Oncological Surgery, Lyon-Sud University Hospital, Pierre-Bénite, France.
| | - Justine Arquilliere
- Department of Digestive and Oncological Surgery, Lyon-Sud University Hospital, Pierre-Bénite, France
| | - Pascal Artru
- Department of Digestive Oncology, Jean Mermoz Private Hospital, Lyon, France
| | - Jean Baptiste Bachet
- Department of Hepato-Gastro-Enterology, Pitié-Salpêtrière Hospital Group, Assistance Publique-Hôpitaux de Paris, Pierre & Marie Curie University, Paris, France
| | - Leonor Benhaim
- Department of Visceral and Surgical Oncology, Gustave Roussy Hospital, Cancer Campus, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Frederic Bibeau
- Department of Pathology, Besançon University Hospital, Besançon, France
| | - Niki Christou
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - Thierry Conroy
- Department of Medical Oncology, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France and Lorraine University, Inserm INSPIIRE, Nancy, France
| | - Jérome Doyen
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Nice- Sophia, Nice, France
| | - Christine Hoeffel
- Department of Medical Imaging, Reims University Hospital, CRESTIC, URCA, Reims, France
| | - Nicolas Meillan
- Department of Radiation Oncology, Victor Dupouy Hospital, Argenteuil, France; Radiation Epidemiology Group, INSERM Unit 1018, Villejuif, F-94805, France
| | - Xavier Mirabel
- Academic Department of Radiation Oncology, Oscar Lambret Center, Lille, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Véronique Vendrely
- Department of Radiation Oncology, Haut-Lévêque Hospital, Bordeaux University, INSERM 1218-BRIC, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Olivier Bouché
- Department of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
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Huang H, Xu W, Feng L, Zhong ME, Ye Y, Liu Y, Ye H, Li Z, Cui Y, Liu Z, Zhao K, Yan L, Liang C. Development and evaluation of the mrTE scoring system for MRI-detected tumor deposits and extramural venous invasion in rectal cancer. Abdom Radiol (NY) 2025:10.1007/s00261-025-04840-z. [PMID: 39954064 DOI: 10.1007/s00261-025-04840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 02/03/2025] [Accepted: 02/07/2025] [Indexed: 02/17/2025]
Abstract
PURPOSE Tumor deposits (TDs) and extramural venous invasion (EMVI) in locally advanced rectal cancer (LARC) are MRI-detectable markers that reflect the invasive and metastatic potential of tumors. However, both mrTDs and mrEMVI are closely associated with peritumoral vascular signals, and they show a high degree of statistical correlation. We developed a novel scoring system that integrates mrTDs and mrEMVI into a single parameter, simplifying the assessment process and capturing the prognostic value of both factors simultaneously. METHODS We retrospectively included LARC patients who received neoadjuvant chemoradiotherapy at five centers and proposed a novel MRI-based scoring system, mrTE (derived from mrTDs and mrEMVI), to integrate the prognostic significance of mrEMVI and mrTDs in rectal cancer. The prognostic value of different mrTE scores was evaluated using Kaplan-Meier curves and the Cox model. The predictive accuracy of the new scoring system was evaluated using the integrated area under the ROC curve (iAUC). RESULTS A total of 1188 patients with LARC were included in the evaluation cohort to assess the reliability of the novel imaging scoring system. Based on the mrTE scores ranging from 0 to 2, the patients were categorized into three groups. The 3-year disease-free survival rates for the groups were 88.1%, 78.1%, and 51.9% (score 1 vs 0: HR 2.00, 95% CI 1.36-2.93, p < 0.001; score 2 vs 0: HR 4.75, 95% CI 3.61-6.26, p < 0.001). The mrTE scoring system demonstrated superior performance in predicting DFS compared to other clinical and imaging markers, with a higher predictive accuracy (iAUC = 0.707). CONCLUSIONS The mrTE scoring system simplifies the clinical assessment of relevant MR markers and has proven to be an effective tool for predicting the prognosis of LARC patients.
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Affiliation(s)
- Haitao Huang
- School of Medicine, South China University of Technology, Guangzhou, China
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Weixiong Xu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Lili Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Min-Er Zhong
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China
| | - Yunrui Ye
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yulin Liu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huifen Ye
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesFudan University Shanghai Cancer Center, Shanghai, China
| | - Zhenhui Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yanfen Cui
- Department of Radiology, Shanxi Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Ke Zhao
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
- Medical Research Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Lifen Yan
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Changhong Liang
- School of Medicine, South China University of Technology, Guangzhou, China.
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
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Zhou M, Huang H, Bao D, Chen M, Lu F. Assessment of prognostic indicators and KRAS mutations in rectal cancer using a fractional-order calculus MR diffusion model: whole tumor histogram analysis. Abdom Radiol (NY) 2025; 50:569-578. [PMID: 39152230 DOI: 10.1007/s00261-024-04523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/04/2024] [Accepted: 08/10/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This study aims to explore the relationship between apparent diffusion coefficient (ADC) and fractional-order calculus (FROC)-specific parameters with prognostic indicators and Kirsten rat sarcoma viral oncogene homologue (KRAS) mutation status in rectal cancer. METHODS One hundred fifty-eight patients with rectal cancer were retrospectively enrolled. Histogram measurements of ADC, diffusion coefficient (D), intravoxel diffusion heterogeneity (β), and a microstructural quantity (μ) were estimated for the whole-tumor volume. The relationships between histogram measurements and prognostic indicators were evaluated. The efficacy of histogram measurements, both conducted singly and in conjunction, for evaluating different KRAS mutation statuses was also assessed. The performance of mean and median histogram measurements in evaluating various KRAS mutation statuses was assessed using Receiver Operating Characteristic (ROC) curve analysis. A p-value of less than 0.05 was considered statistically significant. RESULTS The histogram measurements of ADC, D, β, and μ differed significantly between well-moderately differentiated groups and poorly differentiated groups, T1-2 and T3-4 subgroups, lymph node metastasis (LNM)-negative and LNM-positive subgroups, extranodal extension (ENE)-negative and ENE-positive subgroups, tumor deposit (TD)-negative and TD-positive subgroups, and lymphovascular invasion (LVI)-negative and LVI-positive subgroups. The combination of Dmean, βmean, and μmean achieved the highest performance [The area under the ROC curve (AUC) = 0.904] in evaluating the KRAS mutation status. CONCLUSION When assessing parameters from the FROC model as potential biomarkers through histograms, they surpass traditional ADC values in distinguishing prognostic indicators and determining KRAS mutation status in rectal cancer.
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Affiliation(s)
- Mi Zhou
- Department of Radiology, Sichuan Provincial Orthpaedics Hospital, Chengdu, 610041, People's Republic of China.
| | - Hongyun Huang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, People's Republic of China
| | - Deying Bao
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, People's Republic of China
| | - Meining Chen
- Department of MR Scientific Marketing, Siemens Healthineers, Shanghai, 200135, China
| | - Fulin Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, People's Republic of China
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Zhou M, Chen M, Luo M, Chen M, Huang H. Pathological prognostic factors of rectal cancer based on diffusion-weighted imaging, intravoxel incoherent motion, and diffusion kurtosis imaging. Eur Radiol 2025; 35:979-988. [PMID: 39143248 DOI: 10.1007/s00330-024-11025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 06/13/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVES To explore diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for assessing pathological prognostic factors in patients with rectal cancer. MATERIALS AND METHODS A total of 162 patients (105 males; mean age of 61.8 ± 13.1 years old) scheduled to undergo radical surgery were enrolled in this prospective study. The pathological prognostic factors included histological differentiation, lymph node metastasis (LNM), and extramural vascular invasion (EMVI). The DWI, IVIM, and DKI parameters were obtained and correlated with prognostic factors using univariable and multivariable logistic regression. Their assessment value was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS Multivariable logistic regression analyses showed that higher mean kurtosis (MK) (odds ratio (OR) = 194.931, p < 0.001) and lower apparent diffusion coefficient (ADC) (OR = 0.077, p = 0.025) were independently associated with poorer differentiation tumors. Higher perfusion fraction (f) (OR = 575.707, p = 0.023) and higher MK (OR = 173.559, p < 0.001) were independently associated with LNMs. Higher f (OR = 1036.116, p = 0.024), higher MK (OR = 253.629, p < 0.001), lower mean diffusivity (MD) (OR = 0.125, p = 0.038), and lower ADC (OR = 0.094, p = 0.022) were independently associated with EMVI. The area under the ROC curve (AUC) of MK for histological differentiation was significantly higher than ADC (0.771 vs. 0.638, p = 0.035). The AUC of MK for LNM positivity was higher than f (0.770 vs. 0.656, p = 0.048). The AUC of MK combined with MD (0.790) was the highest among f (0.663), MK (0.779), MD (0.617), and ADC (0.610) in assessing EMVI. CONCLUSION The DKI parameters may be used as imaging biomarkers to assess pathological prognostic factors of rectal cancer before surgery. CLINICAL RELEVANCE STATEMENT Diffusion kurtosis imaging (DKI) parameters, particularly mean kurtosis (MK), are promising biomarkers for assessing histological differentiation, lymph node metastasis, and extramural vascular invasion of rectal cancer. These findings suggest DKI's potential in the preoperative assessment of rectal cancer. KEY POINTS Mean kurtosis outperformed the apparent diffusion coefficient in assessing histological differentiation in resectable rectal cancer. Perfusion fraction and mean kurtosis are independent indicators for assessing lymph node metastasis in rectal cancer. Mean kurtosis and mean diffusivity demonstrated superior accuracy in assessing extramural vascular invasion.
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Affiliation(s)
- Mi Zhou
- Department of Radiology, Sichuan Provincial Orthopaedics Hospital, 610041, Chengdu, China
| | - Mengyuan Chen
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 610072, Chengdu, China
| | - Mingfang Luo
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 610072, Chengdu, China
| | - Meining Chen
- Department of MR Scientific Marketing, Siemens Healthineers, 200135, Shanghai, China
| | - Hongyun Huang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 610072, Chengdu, China.
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Chen F, Zhang S, Fu C, Grimm R, Lu J, Shao C, Shen F, Chen L. Predicting disease-free survival in locally advanced rectal cancer using a prognostic model based on pretreatment b-value threshold map and postoperative pathologic features. Jpn J Radiol 2025; 43:236-246. [PMID: 39432017 DOI: 10.1007/s11604-024-01674-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 09/29/2024] [Indexed: 10/22/2024]
Abstract
PURPOSE Disease-free survival (DFS) after neoadjuvant chemoradiotherapy (nCRT) is an important factor in affecting the quality of life and determining the subsequent treatment procedures for patients with locally advanced rectal cancer (LARC). This study aimed to develop a novel prognostic model for predicting the DFS in patients with LARC following nCRT and to verify its effectiveness. MATERIALS AND METHODS Patients with LARC who underwent magnetic resonance imaging (MRI) and nCRT at our institution between November 2017 and March 2022 were enrolled in this retrospective study. Clinicopathologic data and MRI indicators of all patients were collected and evaluated. All patients were divided into DFS and non-DFS groups according to the presence or absence of local recurrence or distant metastasis. The differences in the b-value threshold (bthreshold) and apparent diffusion coefficient (ADC) values between the DFS and non-DFS groups were compared. The Cox analyses were used to determine the risk factors in predicting the DFS. A merged model was established based on the risk factors, and a nomogram was constructed. The predictive performances of the merged model were validated using the receiver-operating characteristic (ROC) and decision curve analysis (DCA). RESULTS Of the 524 patients enrolled, 132 who underwent surgical resection post-nCRT were included in the final analysis. The post-neoadjuvant therapy pathological N stage, extramural venous invasion (EMVI), and bthreshold were independent factors in predicting the DFS. The C-index of the model was 0.688. The area under the curve (AUC) of the nomogram in predicting the 1-, 3-, and 5-year survival rates of patients was 0.731, 0.723, and 0.779, respectively. The DCA demonstrated that the merged model had a greater advantage than either the "all" or the "none" scheme when the threshold probability was between 0.1 and 0.65. CONCLUSION A merged model based on the bthreshold value and clinicopathological features showed the potential to predict the prognosis of patients with LARC after nCRT and surgery.
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Affiliation(s)
- Fangying Chen
- Department of Radiology, Changhai Hospital, Naval Medical University, NO.168 Changhai Road, Shanghai, 200433, China
| | - Shaoting Zhang
- Department of Radiology, Changhai Hospital, Naval Medical University, NO.168 Changhai Road, Shanghai, 200433, China
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Robert Grimm
- MR Applications Predevelopment, Siemens Healthineers Ltd., Erlangen, Germany
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Naval Medical University, NO.168 Changhai Road, Shanghai, 200433, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, Naval Medical University, NO.168 Changhai Road, Shanghai, 200433, China.
| | - Fu Shen
- Department of Radiology, Changhai Hospital, Naval Medical University, NO.168 Changhai Road, Shanghai, 200433, China.
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Naval Medical University, NO.168 Changhai Road, Shanghai, 200433, China.
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9
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Zhang C, Chen J, Liu Y, Yang Y, Xu Y, You R, Li Y, Liu L, Yang L, Li H, Wang G, Li W, Li Z. Amide proton transfer-weighted MRI for assessing rectal adenocarcinoma T-staging and perineural invasion: a prospective study. Eur Radiol 2025; 35:968-978. [PMID: 39122854 DOI: 10.1007/s00330-024-11000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 06/19/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To investigate the value of the pre-operative amide proton transfer-weighted (APTw) MRI to assess the prognostic factors in rectal adenocarcinoma (RA). METHODS This prospective study ran from January 2022 to September 2023 and consecutively enrolled participants with RA who underwent pre-operative MRI and radical surgery. The APTw signal intensity (SI) values of RA with various tumor (T), node (N) stages, perineural invasion (PNI), and tumor grade were compared by Mann-Whitney U-test or t-test. The receiver operating characteristic curve was used to evaluate the diagnostic performance of the APTw SI values. RESULTS A total of 51 participants were enrolled (mean age, 58 years ± 10 [standard deviation], 26 men). There were 24 in the T1-T2 stage and 9 with positive PNI. The APTw SI max, 99th, and 95th values were significantly higher in T3-T4 stage tumor than in T1-T2; the median (interquartile range) (M (IQR)) was (4.0% (3.6-4.9%) vs 3.4% (2.9- 4.3%), p = 0.017), (3.7% (3.2-4.1%) vs 3.2% (2.8-3.8%), p = 0.013), and (3.3% (2.8-3.8%) vs 2.9% (2.3-3.5%), p = 0.033), respectively. These indicators also differed significantly between the PNI groups, with the M (IQR) (4.5% (3.6-5.7%) vs 3.7% (3.2-4.2%), p = 0.017), (4.1% (3.4-4.8%) vs 3.3% (3.0-3.9%), p = 0.022), and (3.7% (2.7-4.2%) vs 2.9% (2.6-3.5%), p = 0.045), respectively. CONCLUSION Pre-operative APTw MRI has potential value in the assessment of T-staging and PNI determination in RA. CLINICAL RELEVANCE STATEMENT Pre-operative amide proton transfer-weighted MRI provides a quantitative method for noninvasive assessment of T-staging and PNI in RA aiding in precision treatment planning. KEY POINTS The efficacy of APTw MRI in RA needs further investigation. T3-T4 stage and PNI positive APTw signal intensities were higher than T1-T2 and non-PNI, respectively. APTw MRI provides a quantitative method for assessment of T staging and PNI in RA.
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Affiliation(s)
- Caixia Zhang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jianyou Chen
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yifan Liu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yinrui Yang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | | | - Ruimin You
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yanli Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Lizhu Liu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Ling Yang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Huaxiu Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Guanshun Wang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China.
| | - Wenliang Li
- Department of Colorectal Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China.
| | - Zhenhui Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China.
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10
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Nougaret S, Gormly K, Lambregts DMJ, Reinhold C, Goh V, Korngold E, Denost Q, Brown G. MRI of the Rectum: A Decade into DISTANCE, Moving to DISTANCED. Radiology 2025; 314:e232838. [PMID: 39772798 DOI: 10.1148/radiol.232838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
Over the past decade, advancements in rectal cancer research have reshaped treatment paradigms. Historically, treatment for locally advanced rectal cancer has focused on neoadjuvant long-course chemoradiotherapy, followed by total mesorectal excision. Interest in organ preservation strategies has been strengthened by the introduction of total neoadjuvant therapy with improved rates of complete clinical response. The administration of systemic induction chemotherapy and consolidation chemoradiotherapy in the neoadjuvant setting has introduced a new dimension to the treatment landscape and patients now face a more intricate decision-making process, given the expanded therapeutic options. This complexity underlines the importance of shared decision-making and brings to light the crucial role of radiologists. MRI, especially high-spatial-resolution T2-weighted imaging, is heralded as the reference standard for rectal cancer management because of its exceptional ability to provide staging and prognostic insights. A key evolution in MRI interpretation for rectal cancer is the transition from the DISTANCE mnemonic to the more encompassing DISTANCED-DIS, distal tumor boundary; T, T stage; A, anal sphincter complex; N, nodal status; C, circumferential resection margin; E, extramural venous invasion; D, tumor deposits. This nuanced shift in the mnemonic captures a wider range of diagnostic indicators. It also emphasizes the escalating role of radiologists in steering well-informed decisions in the realm of rectal cancer care.
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Affiliation(s)
- Stephanie Nougaret
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Kirsten Gormly
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Doenja M J Lambregts
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Caroline Reinhold
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Vicky Goh
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Elena Korngold
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Quentin Denost
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
| | - Gina Brown
- From the Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090 Montpellier, France (S.N.); PINKCC Laboratory, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Jones Radiology, South Australia, Australia (K.G.); The University of Adelaide, South Australia, Australia (K.G.); Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (D.M.J.L.); GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands (D.M.J.L.); Department of Radiology, McGill University, Montreal, Quebec, Canada (C.R.); Department of Radiology, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom (V.G.); School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, United Kingdom (V.G.); Department of Radiology, Oregon Health & Science University, Portland, Ore (E.K.); Bordeaux Colorectal Institute, Bordeaux, France (Q.D.); Department of Radiology, Royal Marsden, London, United Kingdom (G.B.); Department of Radiology, Imperial College London, London, United Kingdom (G.B.)
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11
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Miranda J, Heiselman JS, Firat C, Chakraborty J, Vanguri RS, Assuncao AN, Nincevic J, Kim TH, Rodriguez L, Urganci N, Gonen M, Garcia-Aguilar J, Gollub MJ, Shia J, Horvat N. Deformable Mapping of Rectal Cancer Whole-Mount Histology with Restaging MRI at Voxel Scale: A Feasibility Study. Radiol Imaging Cancer 2024; 6:e240073. [PMID: 39452890 PMCID: PMC11615632 DOI: 10.1148/rycan.240073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 07/24/2024] [Accepted: 09/09/2024] [Indexed: 10/26/2024]
Abstract
Purpose To develop a radiology-pathology coregistration method for 1:1 automated spatial mapping between preoperative rectal MRI and ex vivo rectal whole-mount histology (WMH). Materials and Methods This retrospective study included consecutive patients with rectal adenocarcinoma who underwent total neoadjuvant therapy followed by total mesorectal excision with preoperative rectal MRI and WMH from January 2019 to January 2022. A gastrointestinal pathologist and a radiologist established three corresponding levels for each patient at rectal MRI and WMH, subsequently delineating external and internal rectal wall contours and the tumor bed at each level and defining eight point-based landmarks. An advanced deformable image coregistration model based on the linearized iterative boundary reconstruction (LIBR) approach was compared with rigid point-based registration (PBR) and state-of-the-art deformable intensity-based multiscale spectral embedding registration (MSERg). Dice similarity coefficient (DSC), modified Hausdorff distance (MHD), and target registration error (TRE) across patients were calculated to assess the coregistration accuracy of each method. Results Eighteen patients (mean age, 54 years ± 13 [SD]; nine female) were included. LIBR demonstrated higher DSC versus PBR for external and internal rectal wall contours and tumor bed (external: 0.95 ± 0.03 vs 0.86 ± 0.04, respectively, P < .001; internal: 0.71 ± 0.21 vs 0.61 ± 0.21, P < .001; tumor bed: 0.61 ± 0.17 vs 0.52 ± 0.17, P = .001) and versus MSERg for internal rectal wall contours (0.71 ± 0.21 vs 0.63 ± 0.18, respectively; P < .001). LIBR demonstrated lower MHD versus PBR for external and internal rectal wall contours and tumor bed (external: 0.56 ± 0.25 vs 1.68 ± 0.56, respectively, P < .001; internal: 1.00 ± 0.35 vs 1.62 ± 0.59, P < .001; tumor bed: 2.45 ± 0.99 vs 2.69 ± 1.05, P = .03) and versus MSERg for internal rectal wall contours (1.00 ± 0.35 vs 1.62 ± 0.59, respectively; P < .001). LIBR demonstrated lower TRE (1.54 ± 0.39) versus PBR (2.35 ± 1.19, P = .003) and MSERg (2.36 ± 1.43, P = .03). Computation time per WMH slice for LIBR was 35.1 seconds ± 12.1. Conclusion This study demonstrates feasibility of accurate MRI-WMH coregistration using the advanced LIBR method. Keywords: MR Imaging, Abdomen/GI, Rectum, Oncology Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Canan Firat
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Jayasree Chakraborty
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Rami S. Vanguri
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Antonildes N. Assuncao
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Josip Nincevic
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Tae-Hyung Kim
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Lee Rodriguez
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Nil Urganci
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Mithat Gonen
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Julio Garcia-Aguilar
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Marc J. Gollub
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Jinru Shia
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
| | - Natally Horvat
- From the Departments of Radiology (J.M., J.N., T.H.K., L.R., M.J.G.,
N.H.), Surgery (J.S.H., J.C., M.G., J.G.A.), and Pathology (C.F., N.U., J.S.),
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065;
Department of Radiology, University of São Paulo, São Paulo,
Brazil (J.M., A.N.A., N.H.); Department of Medicine, Division of Precision
Medicine, NYU Grossman School of Medicine, New York, NY (R.S.V.); Department of
Biomedical Engineering, Vanderbilt University, Nashville, Tenn (J.S.H.);
Research and Education Institute, Hospital Sirio-Libanes, São Paulo,
Brazil (A.N.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn
(J.M., N.H.)
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12
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Lu H, Yuan Y, Liu M, Li Z, Ma X, Xia Y, Shi F, Lu Y, Lu J, Shen F. Predicting pathological complete response following neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer using merged model integrating MRI-based radiomics and deep learning data. BMC Med Imaging 2024; 24:289. [PMID: 39448917 PMCID: PMC11515279 DOI: 10.1186/s12880-024-01474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 10/21/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND To construct and compare merged models integrating clinical factors, MRI-based radiomics features and deep learning (DL) models for predicting pathological complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). METHODS Totally 197 patients with LARC administered surgical resection after nCRT were assigned to cohort 1 (training and test sets); meanwhile, 52 cases were assigned to cohort 2 as a validation set. Radscore and DL models were established for predicting pCR applying pre- and post-nCRT MRI data, respectively. Different merged models integrating clinical factors, Radscore and DL model were constituted. Their predictive performances were validated and compared by receiver operating characteristic (ROC) and decision curve analyses (DCA). RESULTS Merged models were established integrating selected clinical factors, Radscore and DL model for pCR prediction. The areas under the ROC curves (AUCs) of the pre-nCRT merged model were 0.834 (95% CI: 0.737-0.931) and 0.742 (95% CI: 0.650-0.834) in test and validation sets, respectively. The AUCs of the post-nCRT merged model were 0.746 (95% CI: 0.636-0.856) and 0.737 (95% CI: 0.646-0.828) in test and validation sets, respectively. DCA showed that the pretreatment algorithm could yield enhanced clinically benefit than the post-nCRT approach. CONCLUSIONS The pre-nCRT merged model including clinical factors, Radscore and DL model constitutes an effective non-invasive tool for pCR prediction in LARC.
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Affiliation(s)
- Haidi Lu
- Department of Radiology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yuan Yuan
- Department of Radiology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Minglu Liu
- Department of Radiology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhihui Li
- Department of Radiology, RuiJin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaolu Ma
- Department of Radiology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yuwei Xia
- Shanghai United Imaging Intelligence, Co., Ltd, Shanghai, China
| | - Feng Shi
- Shanghai United Imaging Intelligence, Co., Ltd, Shanghai, China
| | - Yong Lu
- Department of Radiology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Fu Shen
- Department of Radiology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
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13
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Wang J, Hu S, Liang P, Hu X, Shen Y, Peng Y, Kamel I, Li Z. R2* mapping and reduced field-of-view diffusion-weighted imaging for preoperative assessment of nonenlarged lymph node metastasis in rectal cancer. NMR IN BIOMEDICINE 2024; 37:e5174. [PMID: 38712650 DOI: 10.1002/nbm.5174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/08/2024]
Abstract
The aim of the current study is to investigate the diagnostic value of R2* mapping versus reduced field-of-view diffusion-weighted imaging (rDWI) of the primary lesion of rectal cancer for preoperative prediction of nonenlarged lymph node metastasis (NLNM). Eighty-one patients with pathologically confirmed rectal cancer underwent preoperative R2* mapping and rDWI sequences before total mesorectal excisions and accompanying regional lymph node dissections. Two radiologists independently performed whole-tumor measurements of R2* and apparent diffusion coefficient (ADC) parameters on primary lesions of rectal cancer. Patients were divided into positive (NLNM+) and negative (NLNM-) groups based on their pathological analysis. The tumor location, maximum diameter of the tumor, and maximum short diameter of the lymph node were assessed. R2* and ADC, pT stage, tumor grade, status of mesorectal fascia, and extramural vascular invasion were also studied for their potential relationships with NLNM using multivariate logistic regression analysis. The NLNM+ group had significantly higher R2* (43.56 ± 8.43 vs. 33.87 ± 9.57, p < 0.001) and lower ADC (1.00 ± 0.13 vs. 1.06 ± 0.22, p = 0.036) than the NLNM- group. R2* and ADC were correlated to lymph node metastasis (r = 0.510, p < 0.001 for R2*; r = -0.235, p = 0.035 for ADC). R2* and ADC showed good and moderate diagnostic abilities in the assessment of NLNM status with corresponding area-under-the-curve values of 0.795 and 0.636. R2* provided a significantly better diagnostic performance compared with ADC for the prediction of NLNM status (z = 1.962, p = 0.0498). The multivariate logistic regression analysis demonstrated that R2* was a compelling factor of lymph node metastasis (odds ratio = 56.485, 95% confidence interval: 5.759-554.013; p = 0.001). R2* mapping had significantly higher diagnostic performance than rDWI from the primary tumor of rectal cancer in the prediction of NLNM status.
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Affiliation(s)
- Jing Wang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shan Hu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yang Peng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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14
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Liu QM, Chen Y, Fan WJ, Wu XH, Zhang ZW, Lu BL, Ma YR, Liu YY, Wu YZ, Yu SP, Wen ZQ. Value of orthogonal axial MR images in preoperative T staging of gastric cancer. Abdom Radiol (NY) 2024; 49:3337-3353. [PMID: 38755454 DOI: 10.1007/s00261-024-04322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To assess the value of orthogonal axial images (OAI) of MRI in gastric cancer T staging. METHODS This retrospective study enrolled 133 patients (median age, 63 [range, 24-85] years) with gastric adenocarcinoma who underwent both CT and MRI followed by surgery. MRI lacking or incorporating OAI and CT images were evaluated, respectively. Diagnostic performance (accuracy, sensitivity, and specificity) for each T stage, overall diagnostic accuracy and rates of over- and understaging were quantified employing pathological T stage as a reference standard. The McNemar's test was performed to compare the overall accuracy. RESULTS Among patients with pT1-pT4 disease, MRI with OAI (accuracy: 88.7-94.7%, sensitivity: 66.7-93.0%, specificity: 91.5-100.0%) exhibited superior diagnostic performance compared to MRI without OAI (accuracy: 81.2-88.7%, sensitivity: 46.2-83.1%, specificity: 85.5-99.1%) and CT (accuracy: 88.0-92.5%, sensitivity: 53.3-90.1%, specificity: 88.7-98.1%). The overall accuracy of MRI with OAI was significantly higher (83.5%) than that of MRI without OAI (67.7%) (p < .001). However, there was no significant difference in the overall accuracy of MRI with OAI and CT (78.9%) (p = .35). The over- and understaging rates of MRI with OAI (12.0, 4.5%) were lower than those of MRI without OAI (21.8, 10.5%) and CT (12.8, 8.3%). CONCLUSION OAI play a pivotal role in the T staging of gastric cancer. MRI incorporating OAI demonstrated commendable performance for gastric cancer T-staging, with a slight tendency toward its superiority over CT.
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Affiliation(s)
- Quan-Meng Liu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yan Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Wen-Jie Fan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518017, China
| | - Xue-Han Wu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518017, China
| | - Zhi-Wen Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Bao-Lan Lu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yu-Ru Ma
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yi-Yan Liu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yun-Zhu Wu
- MR Scientific Marketing, SIEMENS Healthineers Ltd., Shanghai, 210031, China
| | - Shen-Ping Yu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
| | - Zi-Qiang Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
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15
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Curcean S, Curcean A, Martin D, Fekete Z, Irimie A, Muntean AS, Caraiani C. The Role of Predictive and Prognostic MRI-Based Biomarkers in the Era of Total Neoadjuvant Treatment in Rectal Cancer. Cancers (Basel) 2024; 16:3111. [PMID: 39272969 PMCID: PMC11394290 DOI: 10.3390/cancers16173111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/02/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
The role of magnetic resonance imaging (MRI) in rectal cancer management has significantly increased over the last decade, in line with more personalized treatment approaches. Total neoadjuvant treatment (TNT) plays a pivotal role in the shift from traditional surgical approach to non-surgical approaches such as 'watch-and-wait'. MRI plays a central role in this evolving landscape, providing essential morphological and functional data that support clinical decision-making. Key MRI-based biomarkers, including circumferential resection margin (CRM), extramural venous invasion (EMVI), tumour deposits, diffusion-weighted imaging (DWI), and MRI tumour regression grade (mrTRG), have proven valuable for staging, response assessment, and patient prognosis. Functional imaging techniques, such as dynamic contrast-enhanced MRI (DCE-MRI), alongside emerging biomarkers derived from radiomics and artificial intelligence (AI) have the potential to transform rectal cancer management offering data that enhance T and N staging, histopathological characterization, prediction of treatment response, recurrence detection, and identification of genomic features. This review outlines validated morphological and functional MRI-derived biomarkers with both prognostic and predictive significance, while also exploring the potential of radiomics and artificial intelligence in rectal cancer management. Furthermore, we discuss the role of rectal MRI in the 'watch-and-wait' approach, highlighting important practical aspects in selecting patients for non-surgical management.
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Affiliation(s)
- Sebastian Curcean
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Andra Curcean
- Department of Imaging, Affidea Center, 15c Ciresilor Street, 400487 Cluj-Napoca, Romania
| | - Daniela Martin
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Zsolt Fekete
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Alexandru Irimie
- Department of Oncological Surgery and Gynecological Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Oncological Surgery, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Alina-Simona Muntean
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Cosmin Caraiani
- Department of Medical Imaging and Nuclear Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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16
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Zhou M, Bao D, Huang H, Chen M, Jiang W. Utilization of diffusion-weighted derived mathematical models to predict prognostic factors of resectable rectal cancer. Abdom Radiol (NY) 2024; 49:3282-3293. [PMID: 38744701 DOI: 10.1007/s00261-024-04239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This study explored models of monoexponential diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI), stretched exponential (SEM), fractional-order calculus (FROC), and continuous-time random-walk (CTRW) as diagnostic tools for assessing pathological prognostic factors in patients with resectable rectal cancer (RRC). METHODS RRC patients who underwent radical surgery were included. The apparent diffusion coefficient (ADC), the mean kurtosis (MK) and mean diffusion (MD) from the DKI model, the distributed diffusion coefficient (DDC) and α from the SEM model, D, β and u from the FROC model, and D, α and β from the CTRW model were assessed. RESULTS There were a total of 181 patients. The area under the receiver operating characteristic (ROC) curve (AUC) of CTRW-α for predicting histology type was significantly higher than that of FROC-u (0.780 vs. 0.671, p = 0.043). The AUC of CTRW-α for predicting pT stage was significantly higher than that of FROC-u and ADC (0.786 vs.0.683, p = 0.043; 0.786 vs. 0.682, p = 0.030), the difference in predictive efficacy of FROC-u between ADC and MK was not statistically significant [0.683 vs. 0.682, p = 0.981; 0.683 vs. 0.703, p = 0.720]; the difference between the predictive efficacy of MK and ADC was not statistically significant (p = 0.696). The AUC of CTRW (α + β) (0.781) was significantly higher than that of FROC-u (0.781 vs. 0.625, p = 0.003) in predicting pN stage but not significantly different from that of MK (p = 0.108). CONCLUSION The CTRW and DKI models may serve as imaging biomarkers to predict pathological prognostic factors in RRC patients before surgery.
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Affiliation(s)
- Mi Zhou
- Department of Radiology, Sichuan Provincial Orthopedic Hospital, Chengdu, China.
| | - Deying Bao
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Hongyun Huang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Meining Chen
- Department of MR Scientific Marketing, Siemens Healthineers, Shanghai, 200135, China
| | - Wenli Jiang
- Department of Radiology, Second Affiliated Hospital of Chongqing University of Medical Sciences, Chongqing, 400010, China
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17
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Li Z, Yuan Y, Liu M, Bo T, Ma X, Wang H, Chen C, Shi X, Wang H, Bai C, Ni X, Shao C, Lu Y, Lu J, Shen F. Rectal adenocarcinoma: Ex vivo 9.4T MRI-correlation with histopathologic treatment response to neoadjuvant chemoradiotherapy. Cancer Med 2024; 13:e70075. [PMID: 39087899 PMCID: PMC11293138 DOI: 10.1002/cam4.70075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/24/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES To determine the imaging details and diagnostic information of the treatment response to neoadjuvant chemoradiotherapy (nCRT) of rectal adenocarcinoma at 9.4T magnetic resonance imaging (MRI) by ex vivo. METHODS Fifteen cases with locally advanced rectal cancer (LARC) followed by radical surgery after nCRT between September 2022 and February 2023 were recruited. Resected specimens were fixed in a perfluoropolyether-filled test tube and scanned with a 3.0T and 9.4T MRI system ex vivo. The residual tumor depth and MRI-based tumor regression grade (TRG) were subjectively assessed and then compared with the pathological findings. RESULTS The ex vivo 9.4T T2WI without fat suppression clearly differentiated tumor tissue, fibrosis and normal rectal wall, which clearly corresponded to the pathologic tissues of the rectal specimens. The TRG could be accurately assessed on ex vivo 9.4T images in 13/15 specimens (86.7%), while in 11/15 specimens (73.3%) on ex vivo 3.0T images. CONCLUSION Ex vivo 9.4T MR imaging clearly displayed the components of rectal wall and proved excellent diagnostic performance for evaluating the treatment response to nCRT, which allow radiologists to understand and then assess more accurately the TRG of LARC after nCRT.
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Affiliation(s)
- Zhihui Li
- Department of Radiology, Ruijin Hospital Luwan BranchShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yuan Yuan
- Department of Radiology, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Minglu Liu
- Department of Radiology, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Tingting Bo
- Department of Radiology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Clinical Neuroscience Center, Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xiaolu Ma
- Department of Radiology, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Hanqi Wang
- Department of Radiology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chen Chen
- United Imaging HealthcareShanghaiChina
| | - Xiaohui Shi
- Department of Colorectal Surgery, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Hao Wang
- Department of Colorectal Surgery, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Chenguang Bai
- Department of Pathology, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Xiang Ni
- Department of Pathology, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Chengwei Shao
- Department of Radiology, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Yong Lu
- Department of Radiology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jianping Lu
- Department of Radiology, Changhai HospitalThe Navy Medical UniversityShanghaiChina
| | - Fu Shen
- Department of Radiology, Changhai HospitalThe Navy Medical UniversityShanghaiChina
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18
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Kaur H, Gabriel H, Awiwi MO, Maheshwari E, Lopes Vendrami C, Konishi T, Taggart MW, Magnetta M, Kelahan LC, Lee S. Anatomic Basis of Rectal Cancer Staging: Clarifying Controversies and Misconceptions. Radiographics 2024; 44:e230203. [PMID: 38900679 DOI: 10.1148/rg.230203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Rectal MRI provides a detailed depiction of pelvic anatomy; specifically, the relationship of the tumor to key anatomic structures, including the mesorectal fascia, anterior peritoneal reflection, and sphincter complex. However, anatomic inconsistencies, pitfalls, and confusion exist, which can have a strong impact on interpretation and treatment. These areas of confusion include the definition of the rectum itself, specifically differentiation of the rectum from the anal canal and the sigmoid colon, and delineation of the high versus low rectum. Other areas of confusion include the relative locations of the mesorectal fascia and peritoneum and their significance in staging and treatment, the difference between the mesorectal fascia and circumferential resection margin, involvement of the sphincter complex, and evaluation of lateral pelvic lymph nodes. The impact of these anatomic inconsistencies and sources of confusion is significant, given the importance of MRI in depicting the anatomic relationship of the tumor to critical pelvic structures, to triage surgical resection and neoadjuvant chemoradiotherapy with the goal of minimizing local recurrence. Evolving treatment paradigms also place MRI central in management of rectal cancer. ©RSNA, 2024.
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Affiliation(s)
- Harmeet Kaur
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Helena Gabriel
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Muhammad O Awiwi
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Ekta Maheshwari
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Camila Lopes Vendrami
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Tsuyoshi Konishi
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Melissa W Taggart
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Michael Magnetta
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Linda C Kelahan
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
| | - Sonia Lee
- From the Departments of Abdominal Imaging (H.K.), Colon and Rectal Surgery (T.K.), and Anatomical Pathology (M.W.T.), University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1473, Houston, TX 77230-1402; Department of Radiology, Northwestern University, Chicago, Ill (H.G., C.L.V., L.C.K.); Department of Radiology, University of Texas Health Science Center, Houston, Tex (M.O.A.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.M.); Department of Radiology, Endeavor Health Medical Group, Evanston, Ill (M.M.); and Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, Calif (S.L.)
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19
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Arp DT, Appelt AL, Brøndum RF, Mikalone R, Nielsen MS, Poulsen LØ. Individual lymph node position variation for rectal cancer patients treated with long course chemoradiotherapy. Phys Imaging Radiat Oncol 2024; 31:100599. [PMID: 39006757 PMCID: PMC11245935 DOI: 10.1016/j.phro.2024.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/16/2024] Open
Abstract
Background and purpose Delivery of high precision radiotherapy lymph node boosts requires detailed information on the interfraction positional variation of individual lymph nodes. In this study we characterized interfraction positional shifts of suspected malignant lymph nodes for rectal cancer patients receiving long course radiotherapy. Furthermore, we investigated parameters which could affect the magnitude of the position variation. Materials and Methods Fourteen patients from a prospective clinical imaging study with a total of 61 suspected malignant lymph nodes in the mesorectum, presacral, and lateral regions, were included. The primary gross tumor volume (GTVp) and all suspected malignant lymph nodes were delineated on six magnetic resonance imaging scans per patient. Positional variation was calculated as systematic and random errors, based on shifts of center-of-mass, and estimated relative to either bony structures or the GTVp using a hierarchical linear mixed model. Results Depending on location and direction, systematic and random variations (relative to bony structures) were within 0.6-2.8 mm and 0.6-2.9 mm, respectively. Systematic and random variations increased when evaluating position relative to GTVp (median increase of 0.6 mm and 0.5 mm, respectively). Correlations with scan time-point and relative bladder volume were found in some directions. Conclusions Using linear mixed modeling, we estimated systematic and random positional variation for suspected malignant lymph nodes in rectal cancer patients treated with long course radiotherapy. Statistically significant correlations of the magnitude of the lymph node shifts were found related to scan time-point and relative bladder volume.
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Affiliation(s)
- Dennis Tideman Arp
- Department of Medical Physics, Oncology, Aalborg University Hospital, Aalborg 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg 9000, Denmark
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS2 9JT, UK
- Leeds Cancer Centre, St James's University Hospital, Leeds LS9 7TF, UK
| | - Rasmus Froberg Brøndum
- Center for Clinical Data Science, Aalborg University and Aalborg University Hospital, Aalborg 9000, Denmark
| | - Rasa Mikalone
- Department of Radiology, Aalborg University Hospital, Aalborg 9000, Denmark
| | - Martin Skovmos Nielsen
- Department of Medical Physics, Oncology, Aalborg University Hospital, Aalborg 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg 9000, Denmark
| | - Laurids Østergaard Poulsen
- Department of Clinical Medicine, Aalborg University, Aalborg 9000, Denmark
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg 9000, Denmark
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20
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Salmerón-Ruiz A, Luengo Gómez D, Medina Benítez A, Láinez Ramos-Bossini AJ. Primary staging of rectal cancer on MRI: an updated pictorial review with focus on common pitfalls and current controversies. Eur J Radiol 2024; 175:111417. [PMID: 38484688 DOI: 10.1016/j.ejrad.2024.111417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 10/04/2024]
Abstract
Magnetic resonance imaging (MRI) plays a pivotal role in primary staging of rectal cancer, enabling the determination of appropriate management strategies and prediction of patient outcomes. However, inconsistencies and pitfalls exist in various aspects, including rectal anatomy, MRI protocols and strategies for artifact resolution, as well as in T- and N-staging, all of which limit the diagnostic value of MRI. This narrative and pictorial review offers a comprehensive overview of factors influencing primary staging of rectal cancer and the role of MRI in assessing them. It highlights the significance of the circumferential resection margin and its relationship with the mesorectal fascia, as well as the prognostic role of extramural venous invasion and tumor deposits. Special attention is given to tumors of the lower rectum due to their complex anatomy and the challenges they pose in MRI staging. The review also addresses current controversies in rectal cancer staging and the need for personalized risk stratification. In summary, this review provides valuable insights into the role of MRI in the primary staging of rectal cancer, emphasizing key aspects for accurate assessment to enhance patient outcomes.
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Affiliation(s)
- A Salmerón-Ruiz
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain
| | - D Luengo Gómez
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain
| | - A Medina Benítez
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain
| | - A J Láinez Ramos-Bossini
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain.
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21
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Yang SY, Bae H, Seo N, Han K, Han YD, Cho MS, Hur H, Min BS, Kim NK, Lee KY, Lim JS. Pretreatment MRI-detected extramural venous invasion as a prognostic and predictive biomarker for neoadjuvant chemoradiotherapy in non-metastatic rectal cancer: a propensity score matched analysis. Eur Radiol 2024; 34:3686-3698. [PMID: 37994967 DOI: 10.1007/s00330-023-10300-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES This study evaluated pretreatment magnetic resonance imaging (MRI)-detected extramural venous invasion (pmrEMVI) as a predictor of survival after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS Medical records of 1184 patients with rectal adenocarcinoma who underwent TME between January 2011 and December 2016 were reviewed. MRI data were collected from a computerized radiologic database. Cox proportional hazards analysis was used to assess local, systemic recurrence, and disease-free survival risk based on pretreatment MRI-assessed tumor characteristics. After propensity score matching (PSM) for pretreatment MRI features, nCRT therapeutic outcomes according to pmrEMVI status were evaluated. Cox proportional hazards analysis was used to identify risk factors for early recurrence in patients receiving nCRT. RESULTS Median follow-up was 62.8 months. Among all patients, the presence of pmrEMVI was significantly associated with worse disease-free survival (DFS; HR 1.827, 95% CI 1.285-2.597, p = 0.001) and systemic recurrence (HR 2.080, 95% CI 1.400-3.090, p < 0.001) but not local recurrence. Among patients with pmrEMVI, nCRT provided no benefit for oncological outcomes before or after PSM. Furthermore, pmrEMVI( +) was the only factor associated with early recurrence on multivariate analysis in patients receiving nCRT. CONCLUSIONS pmrEMVI is a poor prognostic factor for DFS and SR in patients with non-metastatic rectal cancer and also serves as a predictive biomarker of poor DFS and SR following nCRT in LARC. Therefore, for patients who are positive for pmrEMVI, consideration of alternative treatment strategies may be warranted. CLINICAL RELEVANCE STATEMENT This study demonstrated the usefulness of pmrEMVI as a predictive biomarker for nCRT, which may assist in initial treatment decision-making in patients with non-metastatic rectal cancer. KEY POINTS • Pretreatment MRI-detected extramural venous invasion (pmrEMVI) was significantly associated with worse disease-free survival and systemic recurrence in patients with non-metastatic rectal cancer. • pmrEMVI is a predictive biomarker of poor DFS following nCRT in patients with LARC. • The presence of pmrEMVI was the only factor associated with early recurrence on multivariate analysis in patients receiving nCRT.
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Affiliation(s)
- Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Heejin Bae
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Kyunghwa Han
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Yoon Dae Han
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Min Soo Cho
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea.
| | - Joon Seok Lim
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea.
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22
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Peng L, Wang D, Zhuang Z, Chen X, Xue J, Zhu H, Zhang L. Preoperative Noninvasive Evaluation of Tumor Budding in Rectal Cancer Using Multiparameter MRI Radiomics. Acad Radiol 2024; 31:2334-2345. [PMID: 38135624 DOI: 10.1016/j.acra.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the value of a multiparametric magnetic resonance imaging (MRI)-based model integrating radiomics features with clinical and MRI semantic features for preoperative evaluation of tumor budding (TB) in rectal cancer. MATERIALS AND METHODS A total of 120 patients with pathologically confirmed rectal cancer were retrospectively analyzed. The patients were randomized into training and validation cohorts in a 6:4 ratio. Radiomics features were extracted and selected from preoperative T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted imaging (T1CE) sequences, after which the corresponding radiomics score (RS) was calculated, and the radiomics models (T2WI model, DWI model, and T1CE model) were constructed. Logistic regression analysis was selected to develop a combined model integrated RST2WI, RSDWI, RST1CE, and clinical and MRI semantic features. The efficacy of each model in diagnosing TB grade was observed by the receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) was used to assess the clinical benefits of the models. RESULTS Seven features were extracted and selected from each T2WI, DWI, and T1CE sequence to calculate the corresponding RS and construct the corresponding radiomics model. MRI reported N stage was an independent risk factor for TB. The area under the ROC curve of the combined model was 0.961 and 0.891 in the training and validation cohorts, respectively. The combined model showed better performance than the other models. DCA showed that the net benefit of the combined model was better than that of the other models in the vast majority of threshold probabilities. CONCLUSION A combined model integrating radiomics features and MRI semantic features allows for noninvasive preoperative evaluation of TB grading in patients with rectal cancer.
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Affiliation(s)
- Lin Peng
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.)
| | - Dongqing Wang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.); School of Medicine, Jiangsu University, Zhenjiang, 212001, China (D.W., X.C., J.X.)
| | - Zijian Zhuang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.)
| | - Xingchi Chen
- School of Medicine, Jiangsu University, Zhenjiang, 212001, China (D.W., X.C., J.X.)
| | - Jing Xue
- School of Medicine, Jiangsu University, Zhenjiang, 212001, China (D.W., X.C., J.X.)
| | - Haitao Zhu
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.)
| | - Lirong Zhang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China (L.P., D.W., Z.Z., H.Z., L.Z.).
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23
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Ju Y, Zheng L, Qi W, Tian G, Lu Y. Development of a joint prediction model based on both the radiomics and clinical factors for preoperative prediction of circumferential resection margin in middle-low rectal cancer using T2WI images. Med Phys 2024; 51:2563-2577. [PMID: 37987563 DOI: 10.1002/mp.16827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES A circumferential resection margin (CRM) is an independent risk factor for local recurrence, distant metastasis, and poor overall survival of rectal cancer. In this study, we developed and validated a radiomics prediction model to predict perioperative surgical margins in patients with middle and low rectal cancer following neoadjuvant treatment and for decisions about treatment plans for patients. METHODS This study retrospectively analyzed 275 patients from center 1(training cohort) and 120 patients from center 2(verification cohort) with rectal cancer diagnosed at two centers from July 2020 to July 2022 who underwent neoadjuvant therapy and had their CRM status confirmed by preoperative high-resolution magnetic resonance imaging (MRI) scans. Radiomics signatures were extracted and screened from MRI images and a radiomics signature was built by the least absolute shrinkage and selection operator (LASSO) logistic regression model, which was combined with clinical signatures to construct a nomogram. The receiver operating characteristic (ROC) curve and area under the curve (AUC) value, sensitivity, specificity, positive predictive value, negative predictive value, and calibration curve were used to evaluate the predictive performance of the model. RESULTS In our research, the combined model has the best performance. In the training group, the radiomics model based on high-spatial-resolution T2-weighted imaging (HR-T2WI), clinical model and combined model demonstrated an AUC of 0.819 (0.802-0.833), 0.843 (0.822-0.861), and 0.910 (0.880-0.940), respectively. In the validation group, they demonstrated an AUC of 0.745 (0.715-0.788), 0.827 (0.798-0.850), and 0.848 (0.779-0.917), respectively. The calibration curve confirmed the clinical applicability of the model. CONCLUSIONS The individualized prediction model established by combining radiomics signatures and clinical signatures can efficiently and objectively predict perioperative margin invasion in patients with middle and low rectal cancer.
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Affiliation(s)
- Yiheng Ju
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Longbo Zheng
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Qi
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Shandong First Medical University, Shandong, China
| | - Guangye Tian
- College of Control Science and Technology, Shandong University, Shandong, China
| | - Yun Lu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Gastrointestinal Surgery, Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
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24
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El Khababi N, Beets-Tan RGH, Tissier R, Lahaye MJ, Maas M, Curvo-Semedo L, Dresen RC, van Griethuysen JJM, Nougaret S, Beets GL, van Triest B, Taylor SA, Lambregts DMJ. Outcomes and potential impact of a virtual hands-on training program on MRI staging confidence and performance in rectal cancer. Eur Radiol 2024; 34:1746-1754. [PMID: 37646807 PMCID: PMC10873460 DOI: 10.1007/s00330-023-10167-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To explore the potential impact of a dedicated virtual training course on MRI staging confidence and performance in rectal cancer. METHODS Forty-two radiologists completed a stepwise virtual training course on rectal cancer MRI staging composed of a pre-course (baseline) test with 7 test cases (5 staging, 2 restaging), a 1-day online workshop, 1 month of individual case readings (n = 70 cases with online feedback), a live online feedback session supervised by two expert faculty members, and a post-course test. The ESGAR structured reporting templates for (re)staging were used throughout the course. Results of the pre-course and post-course test were compared in terms of group interobserver agreement (Krippendorf's alpha), staging confidence (perceived staging difficulty), and diagnostic accuracy (using an expert reference standard). RESULTS Though results were largely not statistically significant, the majority of staging variables showed a mild increase in diagnostic accuracy after the course, ranging between + 2% and + 17%. A similar trend was observed for IOA which improved for nearly all variables when comparing the pre- and post-course. There was a significant decrease in the perceived difficulty level (p = 0.03), indicating an improved diagnostic confidence after completion of the course. CONCLUSIONS Though exploratory in nature, our study results suggest that use of a dedicated virtual training course and web platform has potential to enhance staging performance, confidence, and interobserver agreement to assess rectal cancer on MRI virtual training and could thus be a good alternative (or addition) to in-person training. CLINICAL RELEVANCE STATEMENT Rectal cancer MRI reporting quality is highly dependent on radiologists' expertise, stressing the need for dedicated training/teaching. This study shows promising results for a virtual web-based training program, which could be a good alternative (or addition) to in-person training. KEY POINTS • Rectal cancer MRI reporting quality is highly dependent on radiologists' expertise, stressing the need for dedicated training and teaching. • Using a dedicated virtual training course and web-based platform, encouraging first results were achieved to improve staging accuracy, diagnostic confidence, and interobserver agreement. • These exploratory results suggest that virtual training could thus be a good alternative (or addition) to in-person training.
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Affiliation(s)
- Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Renaud Tissier
- Biostatistics Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar E Universitario de Coimbra EPE, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raphaëla C Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | - Stephanie Nougaret
- Medical Imaging Department, Montpellier Cancer Institute, Montpellier Cancer Research Institute (U1194), University of Montpellier, Montpellier, France
| | - Geerard L Beets
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stuart A Taylor
- Department of Radiology, University College London Hospitals Biomedical Research Centre, London, UK
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands.
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands.
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25
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El Homsi M, Bane O, Fauveau V, Hectors S, Vietti Violi N, Sylla P, Ko HB, Cuevas J, Carbonell G, Nehlsen A, Vanguri R, Viswanath S, Jambawalikar S, Shaish H, Taouli B. Prediction of locally advanced rectal cancer response to neoadjuvant chemoradiation therapy using volumetric multiparametric MRI-based radiomics. Abdom Radiol (NY) 2024; 49:791-800. [PMID: 38150143 DOI: 10.1007/s00261-023-04128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/06/2023] [Accepted: 11/12/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE To assess the role of pretreatment multiparametric (mp)MRI-based radiomic features in predicting pathologic complete response (pCR) of locally advanced rectal cancer (LARC) to neoadjuvant chemoradiation therapy (nCRT). METHODS This was a retrospective dual-center study including 98 patients (M/F 77/21, mean age 60 years) with LARC who underwent pretreatment mpMRI followed by nCRT and total mesorectal excision or watch and wait. Fifty-eight patients from institution 1 constituted the training set and 40 from institution 2 the validation set. Manual segmentation using volumes of interest was performed on T1WI pre-/post-contrast, T2WI and diffusion-weighted imaging (DWI) sequences. Demographic information and serum carcinoembryonic antigen (CEA) levels were collected. Shape, 1st and 2nd order radiomic features were extracted and entered in models based on principal component analysis used to predict pCR. The best model was obtained using a k-fold cross-validation method on the training set, and AUC, sensitivity and specificity for prediction of pCR were calculated on the validation set. RESULTS Stage distribution was T3 (n = 79) or T4 (n = 19). Overall, 16 (16.3%) patients achieved pCR. Demographics, MRI TNM stage, and CEA were not predictive of pCR (p range 0.59-0.96), while several radiomic models achieved high diagnostic performance for prediction of pCR (in the validation set), with AUCs ranging from 0.7 to 0.9, with the best model based on high b-value DWI demonstrating AUC of 0.9 [95% confidence intervals: 0.67, 1], sensitivity of 100% [100%, 100%], and specificity of 81% [66%, 96%]. CONCLUSION Radiomic models obtained from pre-treatment MRI show good to excellent performance for the prediction of pCR in patients with LARC, superior to clinical parameters and CEA. A larger study is needed for confirmation of these results.
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Affiliation(s)
- Maria El Homsi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, USA.
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York av, New York, USA.
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valentin Fauveau
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefanie Hectors
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naik Vietti Violi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Patricia Sylla
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Huai-Bin Ko
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Columbia University Medical Center, New York, NY, USA
| | - Jordan Cuevas
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guillermo Carbonell
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Anthony Nehlsen
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rami Vanguri
- Department of Epidemiology & Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Satish Viswanath
- Department of Radiology, Case Western University, Cleveland, OH, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Tang C, Xu J, Lin M, Qiu S, Wang H, Zuo X, Liu M, Wang P. Risk Factors for Distant Metastasis in T3 T4 Rectal Cancer. Clin Med Insights Oncol 2024; 18:11795549241227423. [PMID: 38322665 PMCID: PMC10845996 DOI: 10.1177/11795549241227423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024] Open
Abstract
Background Distant metastasis is the leading cause of death in patients with rectal cancer. This study aims to comprehensively analyze the risk factors of distant metastasis in T3 T4 rectal cancer using magnetic resonance imaging (MRI), pathological features, and serum indicators. Methods The clinicopathological data of 146 cases of T3 T4 rectal cancer after radical resection from January 2015 to March 2023 were retrospectively analyzed. Pre- and postoperative follow-up data of all cases were collected to screen for distant metastatic lesions. Univariate and multivariate Logistic regression methods were used to analyze the relationship between MRI features, pathological results, serum test indexes, and distant metastasis. Results Of the 146 included patients, synchronous or metachronous distance metastasis was confirmed in 43 (29.4%) cases. The patients' baseline data and univariate analysis showed that mrEMVI, maximum tumor diameter, mr T Stage, pathological N stage, number of lymph node metastasis, cancer nodules, preoperative serum CEA, (Carcinoembryonic antigen) and CA199 were associated with distant metastasis. In the multiple logistic regression model, mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter, and preoperative serum CEA were identified as independent risk factors for distant metastasis: mrEMVI [odds ratio (OR) = 3.06], pathological N stage (OR = 6.52 for N1 vs N0; OR = 63.47 for N2 vs N0), preoperative serum CEA (OR = 0.27), tumor maximum diameter (OR = 1.03), number of lymph nodes metastasis (OR = 0.62). And, the receiver operating characteristic (ROC) curve was plotted and the area under the curve was calculated (area under the curve [AUC) = 0.817, 95% CI = 0.744-0.890, P < .001]. Conclusions mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter and preoperative serum CEA are the independent risk factors for distant metastasis in T3 T4 rectal cancer. A comprehensive analysis of the risk factors for distant metastasis in rectal cancer can provide a reliable basis for formulating individualized treatment strategies, follow-up plans, and evaluating prognosis.
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Affiliation(s)
- Cui Tang
- Department of Radiology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jinming Xu
- Department of Radiology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Moubin Lin
- Department of General Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shixiong Qiu
- Department of Radiology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Huan Wang
- Department of Clinical Research Center, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoming Zuo
- Department of Pathology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mengxiao Liu
- MR Scientific Marketing, Diagnostic Imaging, Siemens Healthcare Ltd., Shanghai, China
| | - Peijun Wang
- Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Jia Z, Guo L, Yuan W, Dai J, Lu J, Li Z, Du X, Chen W, Liu X. Performance of dual-layer spectrum CT virtual monoenergetic images to assess early rectal adenocarcinoma T-stage: comparison with MR. Insights Imaging 2024; 15:11. [PMID: 38228903 PMCID: PMC10792143 DOI: 10.1186/s13244-023-01593-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/09/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES To evaluate the image quality and utility of virtual monoenergetic images (VMI) of dual-layer spectrum computed tomography (DLSCT) in assessing preoperative T-stage for early rectal adenocarcinoma (ERA). METHODS This retrospective study included 67 ERA patients (mean age 62 ± 11.1 years) who underwent DLSCT and MR examination. VMI 40-200 keV and poly energetic image (PEI) were reconstructed. The image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and tumor contrast of different energy levels were calculated and compared, respectively. Two radiologists independently assess the image quality of the VMIs and PEI using 5-point scales. The diagnostic accuracies of DLSCT and HR-MRI for ERA T-staging were evaluated and compared. RESULTS The maximum noise was observed at VMI 40 keV, and noise at VMI 40-200 keV in the arterial and venous phases showed no significant difference (all p > 0.05). The highest SNR and CNR were obtained at VMI 40 keV, significantly greater than other energy levels and PEI (all p < 0.05). Tumor contrast was more evident than PEI at 40-100 keV in the arterial phase and at 40 keV in the venous phase (all p < 0.05). When compared with PEI, VMI 40 keV yielded the highest scores for overall image quality, tumor visibility, and tumor margin delineation, especially in the venous phase (p < 0.05). The overall diagnostic accuracy of DLSCT and HR-MRI for T-stage was 65.67 and 71.64% and showed no significant difference (p > 0.05). CONCLUSIONS VMI 40 keV improves image quality and accuracy in identifying lesions, providing better diagnostic information for ERA staging. CRITICAL RELEVANCE STATEMENT Low-keV VMI from DLSCT can improve tumor staging accuracy for early rectal carcinoma, helping guide surgical intervention decisions, and has shed new light on the potential breakthroughs of assessing preoperative T-stage in RC. KEYPOINTS • Compared with PEI, low-keV VIM derived from DLSCT, particularly at the 40 keV, significantly enhanced the objective and subjective image quality of ERA. • Using VMI 40 keV helped increase lesion detectability, leading to improved diagnostic accuracy for ERA. • Low-keV VMI from DLSCT has shed new light on the potential breakthroughs of assessing preoperative T-stage in RC.
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Affiliation(s)
- Ziqi Jia
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Guo
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - WenJing Yuan
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - JianHao Dai
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - JianYe Lu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - ZhiQiang Li
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohua Du
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weicui Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xian Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Wada DT, Wada LS, Machado CVB, Lourenço MR, de Nadai TR, Cipriano FEG, Fabro AT, Koenigkam-Santos M. Look-Locker T1 relaxometry and high-resolution T2 in the evaluation of lung lesions: a single-center prospective study. Radiol Bras 2024; 57:e20240033. [PMID: 39399790 PMCID: PMC11469640 DOI: 10.1590/0100-3984.2024.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/18/2024] [Accepted: 07/08/2024] [Indexed: 10/15/2024] Open
Abstract
Objective To explore the feasibility of two magnetic resonance imaging (MRI) sequences-high-resolution T2-weighted (HR T2) and Look-Locker T1 (LL T1) relaxometry-for the investigation focal lung lesions (FLLs). As a secondary objective, we analyzed the diagnostic accuracy of these sequences. Materials and Methods This was a prospective observational study involving 39 subjects with FLLs scanned in a 1.5-T MRI system with LL T1 relaxometry and HR T2 sequences focused on the FLL region, in addition to a conventional protocol. All images were evaluated by two radiologists, working independently, who were blinded to other findings. Results Most of the examinations (31 of the LL T1 relaxometry sequences and 36 of the HR T2 sequences) were of adequate diagnostic quality. Nondiagnostic examinations were considered so mainly because of limited coverage of the sequences. Of the FLLs studied, 19 were malignant, 17 were benign, and three were excluded from the accuracy analysis because there was no definitive diagnosis. Although LL T1 relaxometry could not distinguish between benign and malignant lesions, the signal intensity at its first inversion time (160 ms) differed between the two groups. The HR T2 sequence was considered the best sequence for assessing specific morphological characteristics, especially pseudocavities and pleural tags. We found that MRI showed better accuracy than did computed tomography (86% vs. 74%). Conclusion Both MRI sequences are feasible for the evaluation of FLLs. Images at 160 ms of the LL T1 relaxometry sequence helped distinguish between benign and malignant lesions, and the HR T2 sequence was considered the best sequence for evaluating specific morphological characteristics.
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Affiliation(s)
- Danilo Tadao Wada
- Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Li Siyuan Wada
- Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Camila Vilas Boas Machado
- Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Mateus Repolês Lourenço
- Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Tales Rubens de Nadai
- Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Alexandre Todorovic Fabro
- Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcel Koenigkam-Santos
- Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
- Faculdade de Medicina de Bauru da Universidade de São Paulo
(FMBRU-USP), Bauru, SP, Brazil
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Miranda J, Causa Andrieu P, Nincevic J, Gomes de Farias LDP, Khasawneh H, Arita Y, Stanietzky N, Fernandes MC, De Castria TB, Horvat N. Advances in MRI-Based Assessment of Rectal Cancer Post-Neoadjuvant Therapy: A Comprehensive Review. J Clin Med 2023; 13:172. [PMID: 38202179 PMCID: PMC10780006 DOI: 10.3390/jcm13010172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Rectal cancer presents significant diagnostic and therapeutic challenges, with neoadjuvant therapy playing a pivotal role in improving resectability and patient outcomes. MRI serves as a critical tool in assessing treatment response. However, differentiating viable tumor tissue from therapy-induced changes on MRI remains a complex task. In this comprehensive review, we explore treatment options for rectal cancer based on resectability status, focusing on the role of MRI in guiding therapeutic decisions. We delve into the nuances of MRI-based evaluation of treatment response following neoadjuvant therapy, paying particular attention to emerging techniques like radiomics. Drawing from our insights based on the literature, we provide essential recommendations for post-neoadjuvant therapy management of rectal cancer, all within the context of MRI-based findings.
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Affiliation(s)
- Joao Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
- Department of Radiology, University of Sao Paulo, R. Dr. Ovidio Pires de Campos, 75 Cerqueira Cesar, Sao Paulo 05403-010, Brazil
| | - Pamela Causa Andrieu
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Josip Nincevic
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
| | - Lucas de Padua Gomes de Farias
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91—Bela Vista, Sao Paulo 01308-050, Brazil;
- Department of Radiology, Allianca Saude, Av. Pres. Juscelino Kubitschek, 1830, Sao Paulo 01308-050, Brazil
| | - Hala Khasawneh
- Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA;
| | - Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Nir Stanietzky
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
| | - Tiago Biachi De Castria
- Department of Gastrointestinal Oncology, Moffit Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
- Morsani College of Medicine, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
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Ma S, Lu H, Jing G, Li Z, Zhang Q, Ma X, Chen F, Shao C, Lu Y, Wang H, Shen F. Deep learning-based clinical-radiomics nomogram for preoperative prediction of lymph node metastasis in patients with rectal cancer: a two-center study. Front Med (Lausanne) 2023; 10:1276672. [PMID: 38105891 PMCID: PMC10722265 DOI: 10.3389/fmed.2023.1276672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background Precise preoperative evaluation of lymph node metastasis (LNM) is crucial for ensuring effective treatment for rectal cancer (RC). This research aims to develop a clinical-radiomics nomogram based on deep learning techniques, preoperative magnetic resonance imaging (MRI) and clinical characteristics, enabling the accurate prediction of LNM in RC. Materials and methods Between January 2017 and May 2023, a total of 519 rectal cancer cases confirmed by pathological examination were retrospectively recruited from two tertiary hospitals. A total of 253 consecutive individuals were selected from Center I to create an automated MRI segmentation technique utilizing deep learning algorithms. The performance of the model was evaluated using the dice similarity coefficient (DSC), the 95th percentile Hausdorff distance (HD95), and the average surface distance (ASD). Subsequently, two external validation cohorts were established: one comprising 178 patients from center I (EVC1) and another consisting of 88 patients from center II (EVC2). The automatic segmentation provided radiomics features, which were then used to create a Radscore. A predictive nomogram integrating the Radscore and clinical parameters was constructed using multivariate logistic regression. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were employed to evaluate the discrimination capabilities of the Radscore, nomogram, and subjective evaluation model, respectively. Results The mean DSC, HD95 and ASD were 0.857 ± 0.041, 2.186 ± 0.956, and 0.562 ± 0.194 mm, respectively. The nomogram, which incorporates MR T-stage, CEA, CA19-9, and Radscore, exhibited a higher area under the ROC curve (AUC) compared to the Radscore and subjective evaluation in the training set (0.921 vs. 0.903 vs. 0.662). Similarly, in both external validation sets, the nomogram demonstrated a higher AUC than the Radscore and subjective evaluation (0.908 vs. 0.735 vs. 0.640, and 0.884 vs. 0.802 vs. 0.734). Conclusion The application of the deep learning method enables efficient automatic segmentation. The clinical-radiomics nomogram, utilizing preoperative MRI and automatic segmentation, proves to be an accurate method for assessing LNM in RC. This approach has the potential to enhance clinical decision-making and improve patient care. Research registration unique identifying number UIN Research registry, identifier 9158, https://www.researchregistry.com/browse-the-registry#home/registrationdetails/648e813efffa4e0028022796/.
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Affiliation(s)
- Shiyu Ma
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Haidi Lu
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Guodong Jing
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Zhihui Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qianwen Zhang
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Xiaolu Ma
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Fangying Chen
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Yong Lu
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Colorectal Surgery, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
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Mayaud A, Grange R, Leroy B, Phelip JM, Sotton S, Boutet C, Magné N. MRI in rectal cancer: An institutional real life analysis of technical parameters. Bull Cancer 2023; 110:1244-1250. [PMID: 37858424 DOI: 10.1016/j.bulcan.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/19/2023] [Accepted: 08/13/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION MRI plays a key role in the preoperative staging of rectal cancers and choice of neoadjuvant radiochemotherapy. Yet, the acquisition and interpretation of rectum magnetic resonance imaging (MRI) turn out to be unequal, impacting patients'care. The present study aims at evaluating the quality of the acquisition of technical parameters of the rectal MRI performed by comparing them according to the various guidelines. METHODS The medical MRI reports of all consecutive patients with locally advanced rectal cancer treated in a curative intent, by preoperative RCT and completion surgery were retrospectively reviewed over two periods (January 2010-December 2014 and January 2018 and December 2020) according to international 2012 and 2016 ESGAR and 2017 SAR MRI recommendation reports. RESULTS During the first period (69 MRI performed), 58% of these MRI abided by the recommendations and 75% of essential criteria could be found in 25.5% of MRI reportings. During the second period (73 MRI performed), the protocol used by 6.8% of MR images abided by the 2016 Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations and 39.7% abided by the Society of Abdominal Radiology (SAR) recommendations. 75% of essential criteria could be found in 52.3% of MRI reportings and 90% of essential criteria could be found in 6.2% of MRI reportings. DISCUSSION In an era of increasing individualized patient care and conservative treatment focused on tumour response and prognostic factors, the present study showed that compliance to MRI protocols and reporting guidelines needs improving to upgrade patient care.
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Affiliation(s)
- Alexandre Mayaud
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Rémi Grange
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Bertrand Leroy
- Saint-Étienne Teaching Hospital (CHU), Digestive Surgery Department, Saint-Étienne, France
| | - Jean-Marc Phelip
- Saint-Étienne Teaching Hospital (CHU), Gastroenterology Department, Saint-Étienne, France
| | - Sandrine Sotton
- Lucien Neuwirth Cancer Centre (ICLN), Teaching and Research Department, Saint-Priest-en Jarez, France
| | - Claire Boutet
- Saint-Étienne Teaching Hospital (CHU), Radiology Department, Saint-Étienne, France
| | - Nicolas Magné
- Bergonié Institut, Radiotherapy Department, Bordeaux, France.
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Tian C, Ma X, Lu H, Wang Q, Shao C, Yuan Y, Shen F. Deep learning models for preoperative T-stage assessment in rectal cancer using MRI: exploring the impact of rectal filling. Front Med (Lausanne) 2023; 10:1326324. [PMID: 38105894 PMCID: PMC10722089 DOI: 10.3389/fmed.2023.1326324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Background The objective of this study was twofold: firstly, to develop a convolutional neural network (CNN) for automatic segmentation of rectal cancer (RC) lesions, and secondly, to construct classification models to differentiate between different T-stages of RC. Additionally, it was attempted to investigate the potential benefits of rectal filling in improving the performance of deep learning (DL) models. Methods A retrospective study was conducted, including 317 consecutive patients with RC who underwent MRI scans. The datasets were randomly divided into a training set (n = 265) and a test set (n = 52). Initially, an automatic segmentation model based on T2-weighted imaging (T2WI) was constructed using nn-UNet. The performance of the model was evaluated using the dice similarity coefficient (DSC), the 95th percentile Hausdorff distance (HD95), and the average surface distance (ASD). Subsequently, three types of DL-models were constructed: Model 1 trained on the total training dataset, Model 2 trained on the rectal-filling dataset, and Model 3 trained on the non-filling dataset. The diagnostic values were evaluated and compared using receiver operating characteristic (ROC) curve analysis, confusion matrix, net reclassification index (NRI), and decision curve analysis (DCA). Results The automatic segmentation showed excellent performance. The rectal-filling dataset exhibited superior results in terms of DSC and ASD (p = 0.006 and 0.017). The DL-models demonstrated significantly superior classification performance to the subjective evaluation in predicting T-stages for all test datasets (all p < 0.05). Among the models, Model 1 showcased the highest overall performance, with an area under the curve (AUC) of 0.958 and an accuracy of 0.962 in the filling test dataset. Conclusion This study highlighted the utility of DL-based automatic segmentation and classification models for preoperative T-stage assessment of RC on T2WI, particularly in the rectal-filling dataset. Compared with subjective evaluation, the models exhibited superior performance, suggesting their noticeable potential for enhancing clinical diagnosis and treatment practices.
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Affiliation(s)
- Chang Tian
- School of Information Science and Technology and School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Xiaolu Ma
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Haidi Lu
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Qian Wang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Yuan Yuan
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
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Inoue A, Tanabe M, Ihara K, Hideura K, Higashi M, Benkert T, Imai H, Yamane M, Yamaguchi T, Ueda T, Ito K. Evaluation of diffusion-weighted magnetic resonance imaging of the rectal cancers: comparison between modified reduced field-of-view single-shot echo-planar imaging with tilted two-dimensional radiofrequency excitation pulses and conventional full field-of-view readout-segmented echo-planar imaging. LA RADIOLOGIA MEDICA 2023; 128:1192-1198. [PMID: 37606795 DOI: 10.1007/s11547-023-01699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE To evaluate the image quality qualitatively and quantitatively, as well as apparent diffusion coefficient (ADC) values of modified reduced field-of-view diffusion-weighted magnetic resonance imaging (MRI) using spatially tailored two-dimensional radiofrequency pulses with tilted excitation plane (tilted r-DWI) based on single-shot echo planar imaging (SS-EPI) compared with full-size field-of-view DWI (f-DWI) using readout segmented (RS)-EPI in patients with rectal cancer. MATERIALS AND METHODS Twenty-two patients who underwent an MRI for further evaluation of rectal cancer were included in this retrospective study. All MR images were analyzed to compare image quality, lesion conspicuity, and artifacts between f-DWI with RS-EPI and tilted r-DWI with SS-EPI. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and ADC values were also compared. The Wilcoxon signed-rank test or paired t test was performed to compare the qualitative and quantitative assessments. RESULTS All image quality scores, except aliasing artifacts, were significantly higher (p < 0.01 for all) in tilted r-DWI than f-DWI with RS-EPI. CNR in tilted r-DWI was significantly higher than in f-DWI with RS-EPI (p < 0.01), while SNR was not significantly different. Regarding the ADC values, no significant difference was observed between tilted r-DWI and f-DWI with RS-EPI (p = 0.27). CONCLUSION Tilted r-DWI provides a better image quality with fewer artifacts and higher rectal lesion conspicuity than f-DWI with RS-EPI, indicating the feasibility of this MR sequence in evaluating rectal cancer in clinical practice.
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Affiliation(s)
- Atsuo Inoue
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Kenichiro Ihara
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Keiko Hideura
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Mayumi Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Hiroshi Imai
- MR Research and Collaboration, Siemens Healthcare K.K., Tokyo, Japan
| | - Masatoshi Yamane
- Department of Radiological Technology, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Takahiro Yamaguchi
- Department of Radiological Technology, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Takaaki Ueda
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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Xia Q, Cheng W, Bi J, Ren AP, Chen X, Li T. Value of biplane transrectal ultrasonography plus micro-flow imaging in preoperative T staging and rectal cancer diagnosis in combination with CEA/CA199 and MRI. BMC Cancer 2023; 23:860. [PMID: 37700269 PMCID: PMC10496222 DOI: 10.1186/s12885-023-11370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Rectal cancer is one of the most common malignant tumors and has a high incidence rate and fatality rate. Accurate preoperative T staging of rectal cancer is critical for the selection of appropriate rectal cancer treatment. Various pre-operative imaging methods are available, and the identification of the most accurate method for clinical use is essential for patient care. We investigated the value of biplane transrectal ultrasonography (TRUS) combined with MFI in preoperative staging of rectal cancer and explored the value of combining TRUS plus MFI with CEA/CA199 and MRI. METHODS A total of 87 patients from Daping Hospital with rectal cancer who underwent TRUS examination plus MFI were included. Grades of MFI were determined by Alder classification. Among the total patients, 64 underwent MRI and serum CEA/CA199 tests additionally within one week of TRUS. Pathological results were used as the gold standard for cancer staging. Concordance rates between TRUS, MRI, and CEA/CA199 for tumors at different stages were compared. RESULTS There were no significant differences between the Alder classification and pathological T staging. The concordance rate of TRUS and MFI for rectal cancer T staging was 72.4% (K = 0.615, p < 0.001). Serum CEA and CA199 levels were significantly different in tumors at different stages and increased progressively by pathological stage (p < 0.001); the accuracy rate was 71.88% (K = 0.599, p < 0.001), while that of MRI was 51.56% (K = 0.303, p < 0.001), indicating that TRUS had higher consistency in the preoperative T staging of rectal cancer. The combination of TRUS, MRI, and CEA/CA199 yielded an accuracy rate of 90.6%, which was higher than that of any method alone. CONCLUSIONS Preoperative T staging of rectal cancer from biplane TRUS plus MFI was highly consistent with postoperative pathological T staging. TRUS combined with MRI and serum CEA/CA199 had a greater value in the diagnosis of rectal cancer and a higher diagnostic rate than any examination alone.
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Affiliation(s)
- Qin Xia
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Wei Cheng
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Jie Bi
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - An-Ping Ren
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Xiao Chen
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Tao Li
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China.
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Zhao R, Zhao W, Zhu Y, Wan L, Chen S, Zhao Q, Zhao X, Zhang H. Implication of MRI Risk Stratification System on the Survival Benefits of Adjuvant Chemotherapy After Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer. Acad Radiol 2023; 30 Suppl 1:S164-S175. [PMID: 37369619 DOI: 10.1016/j.acra.2023.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the implication of a Magnetic resonance imaging (MRI) risk stratification system on the selection of patients with locally advanced rectal cancer (LARC) who can benefit from adjuvant chemotherapy (ACT) after neoadjuvant chemoradiotherapy (NCRT). MATERIALS AND METHODS This retrospective study included 328 patients with LARC who underwent NCRT and surgery. The median follow-up duration was 79 months (Interquartile range, 66-94 months). Cox logistic regression analysis was used to identify MRI risk factors and develop a risk stratification system to stratify patients into groups with high and low risks. Kaplan-Meier curves of distant metastasis-free survival (DMFS) and overall survival (OS) were used to show the benefits of ACT and stratify results based on the MRI risk stratification system and postoperative pathological staging. RESULTS An MRI risk stratification system was built based on four MRI risk factors, including MRI-identified T3b-T4 stage, N1-N2 stage, extramural venous invasion, and tumor deposits. 74 (22.6%) patients with 3-4 MRI risk factors were classified into the MRI high-risk group. ACT could significantly improve 5-year DMFS (19.2% versus 52.1%; p < 0.001) and OS (34.6% versus 75.0%; p < 0.001) for patients in the MRI high-risk group, while ACT had no survival benefit for patients in the MRI low-risk group. The benefits of ACT were not observed in patients with any pathological staging subgroups (ypT0-2N0, ypT3-4N0, and ypN+). CONCLUSION Patients in the MRI high-risk group could benefit from ACT, regardless of postoperative pathological staging. Baseline MRI should be considered more in ACT decision-making.
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Affiliation(s)
- Rui Zhao
- Department of Diagnositic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.Z., L.W., S.C., Q.Z., X.Z., H.Z.)
| | - Wei Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (W.Z.)
| | - Yumeng Zhu
- Beijing No. 4 High School International Campus, China (Y.Z.)
| | - Lijuan Wan
- Department of Diagnositic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.Z., L.W., S.C., Q.Z., X.Z., H.Z.)
| | - Shuang Chen
- Department of Diagnositic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.Z., L.W., S.C., Q.Z., X.Z., H.Z.)
| | - Qing Zhao
- Department of Diagnositic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.Z., L.W., S.C., Q.Z., X.Z., H.Z.)
| | - Xinming Zhao
- Department of Diagnositic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.Z., L.W., S.C., Q.Z., X.Z., H.Z.)
| | - Hongmei Zhang
- Department of Diagnositic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.Z., L.W., S.C., Q.Z., X.Z., H.Z.).
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Niu S, Chen Y, Peng F, Wen J, Xiong J, Yang Z, Peng J, Bao Y, Ding L. The role of MRI after neochemoradiotherapy in predicting pathological tumor regression grade and clinical outcome in patients with locally advanced rectal adenocarcinoma. Front Oncol 2023; 13:1118518. [PMID: 37377906 PMCID: PMC10292078 DOI: 10.3389/fonc.2023.1118518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Objective To evaluate the predictive value of tumor regression grade assessed by MRI (mr-TRG) after neoadjuvant chemoradiotherapy (neo-CRT) for postoperative pathological TRG (pTRG) and prognosis in patients with locally advanced rectal adenocarcinoma (LARC). Materials and methods This was a retrospective study from a single center experience. The patients who were diagnosed with LARC and received neo-CRT in our department between January 2016 and July 2021 were enrolled. The agreement between mrTRG and pTRG was assessed with the weighted κ test. Overall survival (OS), progress-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were calculated by Kaplan-Meier analysis and log-rank test. Results From January 2016 to July 2021, 121 LARC patients received neo-CRT in our department. Among them, 54 patients had complete clinical data, including MRI of pre- and post-neo-CRT, postoperative tumor samples, and follow-up. The median follow-up time was 34.6 months (range: 4.4-70.6 months). The estimated 3-year OS, PFS, LRFS and DMFS were 78.5%, 70.7%, 89.0%, and 75.2%, respectively. The median time from the completion of neo-CRT to preoperative MRI and surgery was 7.1 weeks and 9.7 weeks, respectively. Out of 54 patients, 5 patients achieved mrTRG1 (9.3%), 37 achieved mrTRG2 (68.5%), 8 achieved mrTRG3 (14.8%), 4 achieved mrTRG4 (7.4%), and no patient achieved mrTRG5 after neo-CRT. Regarding pTRG, 12 patients achieved pTRG0 (22.2%), 10 achieved pTRG1 (18.5%), 26 achieved pTRG2 (48.1%), and 6 achieved pTRG3 (11.1%). The agreement between three-tier mrTRG (mrTRG1 vs. mrTRG2-3 vs. mrTRG4-5) and pTRG (pTRG0 vs. pTRG1-2 vs. pTRG3) was fair (weighted kappa=0.287). In a dichotomous classification, the agreement between mrTRG(mrTRG1 vs. mrTRG2-5)and pTRG(pTRG0 vs. pTRG1-3) also resulted in fair agreement (weighted kappa=0.391). The sensitivity, specificity, positive, and negative predictive values of favorable mrTRG (mrTRG 1-2) for pathological complete response (PCR) were 75.0%, 21.4%, 21.4%, and 75.0%, respectively. In univariate analysis, favorable mrTRG (mrTRG1-2) and downstaging N were significantly associated with better OS, while favorable mrTRG (mrTRG1-2), downstaging T, and downstaging N were significantly associated with superior PFS (p<0.05). In multivariate analysis, downstaging N was an independent prognostic factor for OS. Meanwhile, downstaging T and downstaging N remained independent prognostic factors for PFS. Conclusions Although the consistency between mrTRG and pTRG is only fair, favorable mrTRG after neo-CRT may be used as a potential prognostic factor for LARC patients.
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Affiliation(s)
- Shaoqing Niu
- Department of Radiation Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Chen
- Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fang Peng
- Department of Radiation Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Wen
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianqi Xiong
- Department of Radiation Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuangzhuang Yang
- Department of Radiation Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianjun Peng
- Gastrointestinal Surgery Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Bao
- Department of Radiation Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Ding
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Miranda J, Horvat N, Assuncao AN, de M Machado FA, Chakraborty J, Pandini RV, Saraiva S, Nahas CSR, Nahas SC, Nomura CH. MRI-based radiomic score increased mrTRG accuracy in predicting rectal cancer response to neoadjuvant therapy. Abdom Radiol (NY) 2023; 48:1911-1920. [PMID: 37004557 PMCID: PMC10942660 DOI: 10.1007/s00261-023-03898-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To develop a magnetic resonance imaging (MRI)-based radiomics score, i.e., "rad-score," and to investigate the performance of rad-score alone and combined with mrTRG in predicting pathologic complete response (pCR) in patients with locally advanced rectal cancer following neoadjuvant chemoradiation therapy. METHODS This retrospective study included consecutive patients with LARC who underwent neoadjuvant chemoradiotherapy followed by surgery from between July 2011 to November 2015. Volumes of interest of the entire tumor on baseline rectal MRI and of the tumor bed on restaging rectal MRI were manually segmented on T2-weighted images. The radiologist also provided the ymrTRG score on the restaging MRI. Radiomic score (rad-score) was calculated and optimal cut-off points for both mrTRG and rad-score to predict pCR were selected using Youden's J statistic. RESULTS Of 180 patients (mean age = 63 years; 60% men), 33/180 (18%) achieved pCR. High rad-score (> - 1.49) yielded an area under the curve (AUC) of 0.758, comparable to ymrTRG 1-2 which yielded an AUC of 0.759. The combination of high rad-score and ymrTRG 1-2 yielded a significantly higher AUC of 0.836 compared with ymrTRG 1-2 and high rad-score alone (p < 0.001). A logistic regression model incorporating both high rad-score and mrTRG 1-2 was built to calculate adjusted odds ratios for pCR, which was 4.85 (p < 0.001). CONCLUSION Our study demonstrates that a rectal restaging MRI-based rad-score had comparable diagnostic performance to ymrTRG. Moreover, the combined rad-score and ymrTRG model yielded a significant better diagnostic performance for predicting pCR.
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Affiliation(s)
- Joao Miranda
- Department of Radiology, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA.
| | - Antonildes N Assuncao
- Department of Radiology, University of Sao Paulo, Sao Paulo, SP, Brazil
- Research and Education Institute, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | | | - Jayasree Chakraborty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Samya Saraiva
- Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | | | | | - Cesar Higa Nomura
- Department of Radiology, University of Sao Paulo, Sao Paulo, SP, Brazil
- Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
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Sandilos G, Menger A, Kooragayala K, Zhu C, Daneshpooy S, Gefen R, Kovacs J, Giugliano DN, Kwiatt ME, McClane SJ. Diagnostic accuracy of endoscopy in determining rectal tumor proximity to the peritoneal reflection. Int J Colorectal Dis 2023; 38:109. [PMID: 37097459 DOI: 10.1007/s00384-023-04392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Treatment of invasive rectal adenocarcinoma is stratified into upfront surgery versus neoadjuvant chemoradiotherapy, in part, based on tumor distance from the anal verge (AV). This study examines the correlation between tumor distance measurements (endoscopic and MRI) and relationship to the anterior peritoneal reflection (aPR) on MRI. METHODS A single-center retrospective study was performed at a tertiary center accredited by the National Accreditation Program for Rectal Cancer (NAPRC). 162 patients with invasive rectal cancer were seen between October of 2018 and April of 2022. Sensitivity and specificity were determined for MRI and endoscopic measurements in their ability to predict tumor location relative to the aPR. RESULTS One hundred nineteen patients had tumors endoscopically and radiographically measured from the AV. Pelvic MRI characterized tumors as above (intraperitoneal) or at/straddles/below the aPR (extraperitoneal). True positives were defined as extraperitoneal tumors [Formula: see text] 10 cm. True negatives were defined as intraperitoneal tumors > 10 cm. Endoscopy was 81.9% sensitive and 64.3% specific in predicting tumor location with respect to the aPR. MRI was 86.7% sensitive and 92.9% specific. Utilizing a 12 cm cutoff, sensitivity of both modalities increased (94.3%, 91.4%) but specificity decreased (50%, 64.3%). CONCLUSION For locally invasive rectal cancers, tumor position relative to the aPR is an important factor in determining the role of neoadjuvant therapy. These results suggest endoscopic tumor measurements do not accurately predict tumor location relative to the aPR, and may lead to incorrect treatment stratification recommendation. When the aPR is not identified, MRI-reported tumor distance may be a better predictor of this relationship.
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Affiliation(s)
- Georgianna Sandilos
- Department of Surgery, Cooper University Health Care, Ste 411, 3 Cooper Plaza, Camden, NJ, 08103, USA
| | - Austin Menger
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Keshav Kooragayala
- Department of Surgery, Cooper University Health Care, Ste 411, 3 Cooper Plaza, Camden, NJ, 08103, USA
| | - Clara Zhu
- Department of Surgery, Cooper University Health Care, Ste 411, 3 Cooper Plaza, Camden, NJ, 08103, USA
| | | | - Ron Gefen
- Department of Radiology, Cooper University Health Care, Camden, NJ, USA
| | - James Kovacs
- Department of Radiology, Cooper University Health Care, Camden, NJ, USA
| | - Danica N Giugliano
- Department of Surgery, Cooper University Health Care, Ste 411, 3 Cooper Plaza, Camden, NJ, 08103, USA
| | - Michael E Kwiatt
- Department of Surgery, Cooper University Health Care, Ste 411, 3 Cooper Plaza, Camden, NJ, 08103, USA
| | - Steven J McClane
- Department of Surgery, Cooper University Health Care, Ste 411, 3 Cooper Plaza, Camden, NJ, 08103, USA.
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Pollard JH, DiCamillo PA, Dundar A, Averill SL, Aswani Y. Gastrointestinal Malignancies. RADIOLOGY‐NUCLEAR MEDICINE DIAGNOSTIC IMAGING 2023:407-455. [DOI: 10.1002/9781119603627.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Gerard JP, Barbet N, Schiappa R, Magné N, Martel I, Mineur L, Deberne M, Zilli T, Dhadda A, Myint AS. Neoadjuvant chemoradiotherapy with radiation dose escalation with contact x-ray brachytherapy boost or external beam radiotherapy boost for organ preservation in early cT2-cT3 rectal adenocarcinoma (OPERA): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol 2023; 8:356-367. [PMID: 36801007 DOI: 10.1016/s2468-1253(22)00392-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Organ preservation after reaching clinical complete response on neoadjuvant therapy is gaining interest for rectal cancers, although the role of radiation dose escalation is still not known. We aimed to determine whether a contact x-ray brachytherapy boost, following or preceding neoadjuvant chemoradiotherapy, increases the probability of 3-year organ preservation for patients with early rectal cancers. METHODS OPERA was a multicentre, open-label, phase 3 randomised controlled trial done at 17 cancer centres that included operable patients, aged 18 years or older, with cT2, cT3a, or cT3b adenocarcinoma of low-mid rectum, tumours of less than 5 cm in diameter, and cN0 or cN1 smaller than 8 mm. All patients received neoadjuvant chemoradiotherapy and 45 Gy external beam radiotherapy in 25 fractions over 5 weeks with concurrent oral capecitabine (825 mg/m2 twice a day). Patients were randomly assigned (1:1) to receive a boost of external beam radiotherapy at 9 Gy in five fractions (group A) or a boost with contact x-ray brachytherapy (90 Gy in three fractions; group B). Randomisation was done centrally using an independent web-based system and stratified by trial centre, tumour classification (cT2 vs cT3a or cT3b), tumour distance from rectum (<6 cm from anal verge vs ≥6 cm), and tumour diameter (<3 cm vs ≥3 cm). Treatment in group B was stratified by tumour diameter, with the contact x-ray brachytherapy boost given before neoadjuvant chemoradiotherapy in patients with tumours smaller than 3 cm. The primary outcome was organ preservation at 3 years, analysed in the modified intention-to-treat population. This study was registered with ClinicalTrials.gov, NCT02505750, and is ongoing. FINDINGS Between June 14, 2015, and June 26, 2020, 148 patients were assessed for eligibility and were randomly assigned to group A (n=74) or group B (n=74). Seven patients withdrew their consent (five in group A and two in group B). 141 patients were included in the primary efficacy analysis, including 69 assigned to group A (29 with tumours <3 cm in diameter and 40 with tumours ≥3 cm) and 72 assigned to group B (32 with tumours <3 cm and 40 with tumours ≥3 cm). After a median follow-up of 38·2 months (IQR 34·2-42·5), the 3-year organ preservation rate was 59% (95% CI 48-72) in group A versus 81% (72-91) in group B (hazard ratio [HR] 0·36, 95% CI 0·19-0·70; p=0·0026). For patients with tumours less than 3 cm in diameter, 3-year organ preservation rates were 63% (95% CI 47-84) in group A versus 97% (91-100) in group B (HR 0·07, 95% CI 0·01-0·57; p=0·012). For patients with tumours of 3 cm or larger, 3-year organ preservation rates were 55% (95% CI 41-74) in group A versus 68% (54-85) in group B (HR 0·54, 95% CI 0·26-1·10; p=0·11). 21 (30%) patients in group A and 30 (42%) in group B had an early grade 2-3 adverse event (p=1·0). The most common early grade 2-3 adverse events were proctitis (four [6%] in group A, nine [13%] in group B) and radiation dermatitis (seven [10%] in group A, two [3%] in group B). The main late side-effect was grade 1-2 rectal bleeding due to telangiectasia, which was more frequent in group B (37 [63%] of 59) than in group A (five [12%] of 43; p<0·0001) and subsided after 3 years. INTERPRETATION Neoadjuvant chemoradiotherapy with a contact x-ray brachytherapy boost significantly improved the 3-year organ preservation rate, particularly for patients with tumours smaller than 3 cm who were treated with contact x-ray brachytherapy first, compared with neoadjuvant chemoradiotherapy with a boost via external beam radiotherapy. This approach could be discussed and offered to operable patients with early cT2-cT3 disease who are keen to avoid surgery and seek organ preservation. FUNDING The French Programme Hospitalier de Recherche Cinique.
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Affiliation(s)
| | - Nicolas Barbet
- Centre oncologie radiothérapie Bayard, Villeurbanne, France
| | - Renaud Schiappa
- Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Nicolas Magné
- Institut de Cancérologie de la Loire, Saint Etienne, France
| | - Isabelle Martel
- Le Centre Régional de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | | | | | - Thomas Zilli
- Hôpitaux Universitaires de Genève, Geneva, Switzerland
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Predictive value of modified MRI-based split scar sign (mrSSS) score for pathological complete response after neoadjuvant chemoradiotherapy for patients with rectal cancer. Int J Colorectal Dis 2023; 38:40. [PMID: 36790595 DOI: 10.1007/s00384-023-04330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To measure the diagnostic performance of modified MRI-based split scar sign (mrSSS) score for the prediction of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for patients with rectal cancer. METHODS The modified MRI-based split scar sign (mrSSS) score, which consists of T2-weighted images (T2WI)-based score and diffusion-weighted images (DWI)-based score. The sensitivity, specificity, and accuracy of modified mrSSS score, endoscopic gross type, and MRI-based tumor regression grading (mrTRG) score, in the prediction of pCR, were compared. The prognostic value of the modified mrSSS score was also studied. RESULTS A total of 189 patients were included in the study. The Kendall's coefficient of interobserver concordance of modified mrSSS score, T2WI -based score, and DWI-based score were 0.899, 0.890, and 0.789 respectively. And the maximum and minimum k value of the modified mrSSS score was 0.797 (0.742-0.853) and 0.562 (0.490-0.634). The sensitivity, specificity, and accuracy of prediction of pCR were 0.66, 0.97, and 0.90 for modified mrSSS score; 0.37, 0.89, and 0.78 for endoscopic gross type (scar); and 0.24, 0.92, and 0.77 for mrTRG score (mrTRG = 1). The modified mrSSS score had significantly higher sensitivity than the endoscopic gross type and the mrTRG score in predicting pCR. Patients with lower modified mrSSS scores had significantly longer disease-free survival (P < 0.05). CONCLUSION The modified mrSSS score showed satisfactory interobserver agreement and higher sensitivity in predicting pCR after nCRT in patients with rectal cancer. The modified mrSSS score is also a predictor of disease-free survival.
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Chen F, Zhang S, Ma X, Chen Y, Wang Z, Zhu Y, Bai C, Fu C, Grimm R, Shao C, Lu J, Shen F, Chen L. Prediction of tumor budding in patients with rectal adenocarcinoma using b-value threshold map. Eur Radiol 2023; 33:1353-1363. [PMID: 35997838 DOI: 10.1007/s00330-022-09087-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the feasibility of b-value threshold (bThreshold) map in preoperative evaluation of tumor budding (TB) in patients with locally advanced rectal cancer (LARC). METHODS Patients with LARC were enrolled and underwent diffusion-weighted imaging (DWI). Contrast-to-noise ratio (CNR) between the lesions and normal tissues was assessed using DWI and bThreshold maps. TB was counted and scored using hematoxylin and eosin staining. Reproducibility for the apparent diffusion coefficient (ADC), bThreshold values, and region-of-interest (ROI) sizes were compared. Differences in ADC and bThreshold values with low-intermediate and high TB grades and the correlations between mean ADC and bThreshold values with TB categories were analyzed. Diagnostic performance of ADC and bThreshold values was assessed using area under the curve (AUC) and decision curve analysis. RESULTS Fifty-one patients were evaluated. The CNR on bThreshold maps was significantly higher than that on DW images (9.807 ± 4.811 vs 7.779 ± 3.508, p = 0.005). Reproducibility was excellent for the ADC (ICC 0.933; CV 8.807%), bThreshold values (ICC 0.958; CV 7.399%), and ROI sizes (ICC 0.934; CV 8.425%). Significant negative correlations were observed between mean ADC values and TB grades and positive correlations were observed between mean bThreshold values and TB grades (p < 0.05). bThreshold maps showed better diagnostic performance than ADC maps (AUC, 0.914 vs 0.726; p = 0.048). CONCLUSIONS In LARC patients, bThreshold values could distinguish different TB grades better than ADC values, and bThreshold maps may be a preoperative, non-invasive approach to evaluate TB grades. KEY POINTS • Compared with diffusion-weighted images, bThreshold maps improved visualization and detection of rectal tumors. • Agreement and diagnostic performance of bThreshold values are superior to apparent diffusion coefficient in assessing tumor budding grades in patients with locally advanced rectal cancer. • bThreshold maps could be used to evaluate tumor budding grades non-invasively before operation.
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Affiliation(s)
- Fangying Chen
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China
| | - Shaoting Zhang
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China
| | - Xiaolu Ma
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China
| | - Yukun Chen
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China
| | - Zhen Wang
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China
| | - Yan Zhu
- Department of Pathology, Changhai Hospital, Shanghai, China
| | - Chenguang Bai
- Department of Pathology, Changhai Hospital, Shanghai, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Robert Grimm
- MR Applications Predevelopment, Siemens Healthineers Ltd., Erlangen, Germany
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China.
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China.
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Whole-tumor amide proton transfer-weighted imaging histogram analysis to predict pathological extramural venous invasion in rectal adenocarcinoma: a preliminary study. Eur Radiol 2023:10.1007/s00330-023-09418-1. [PMID: 36700956 DOI: 10.1007/s00330-023-09418-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/19/2022] [Accepted: 01/01/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate amide proton transfer-weighted (APTw)-derived whole-tumor histogram analysis parameters in predicting pathological extramural venous invasion (pEMVI) positive status of rectal adenocarcinoma (RA). METHODS Preoperative MR including APTw imaging of 125 patients with RA (mean 61.4 ± 11.6 years) were retrospectively analyzed. Two radiologists reviewed each case's EMVI status based on the MR-based modified 5-point scale system with conventional MR images. The APTw histogram parameters of primary tumors were obtained automatically using whole-tumor volume histogram analysis. The independent risk factors markedly correlated with pEMVI-positive status were assessed using univariate and multivariate logistic regression analyses. Diagnosis performance was assessed by receiver operating characteristic curve (ROC) analysis. The AUCs were compared using the Delong method. RESULTS Univariate analysis demonstrated that MR-tumor (T) stage, MR-lymph node (N) stage, APTw-10%, APTw-90%, interquartile range, APTw-minimum, APTw-maximum, APTw-mean, APTw-median, entropy, kurtosis, mean absolute deviation (MAD), and robust MAD were significantly related to pEMVI-positive status (all p < 0.05). Multivariate analysis demonstrated that MR-T stage (OR = 4.864, p = 0.018), MR-N stage (OR = 4.967, p = 0.029), interquartile range (OR = 0.892, p = 0.037), APT-minimum (OR = 1.046, p = 0.031), entropy (OR = 11.604, p = 0.006), and kurtosis (OR = 1.505, p = 0.007) were the independent risk factors enabling prediction of pEMVI-positive status. The AUCs for diagnostic ability of conventional MRI assessment, the APTw histogram model, and the combined model (including APTw histogram and clinical variables) were 0.785, 0.853, and 0.918, respectively. The combined model outperformed the APTw histogram model (p = 0.013) and the conventional MRI assessment (p = 0.006). CONCLUSIONS Whole-tumor histogram analysis of APTw images combined with clinical factors showed better diagnosis efficiency in predicting EMVI involvement in RA. KEY POINTS • Rectal adenocarcinomas with pEMVI-positive status are typically associated with higher APTw-SI values. • APTw-minimum, interquartile range, entropy, kurtosis, MR-T stage, and MR-N stage are the independent risk factors for EMVI involvement. • The best prediction for EMVI involvement was obtained with a combined model of APTw histogram and clinical variables (area under the curve, 0.918).
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Radiomics Approaches for the Prediction of Pathological Complete Response after Neoadjuvant Treatment in Locally Advanced Rectal Cancer: Ready for Prime Time? Cancers (Basel) 2023; 15:cancers15020432. [PMID: 36672381 PMCID: PMC9857080 DOI: 10.3390/cancers15020432] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
In recent years, neoadjuvant therapy of locally advanced rectal cancer has seen tremendous modifications. Adding neoadjuvant chemotherapy before or after chemoradiotherapy significantly increases loco-regional disease-free survival, negative surgical margin rates, and complete response rates. The higher complete rate is particularly clinically meaningful given the possibility of organ preservation in this specific sub-population, without compromising overall survival. However, all locally advanced rectal cancer most likely does not benefit from total neoadjuvant therapy (TNT), but experiences higher toxicity rates. Diagnosis of complete response after neoadjuvant therapy is a real challenge, with a risk of false negatives and possible under-treatment. These new therapeutic approaches thus raise the need for better selection tools, enabling a personalized therapeutic approach for each patient. These tools mostly focus on the prediction of the pathological complete response given the clinical impact. In this article, we review the place of different biomarkers (clinical, biological, genomics, transcriptomics, proteomics, and radiomics) as well as their clinical implementation and discuss the most recent trends for future steps in prediction modeling in patients with locally advanced rectal cancer.
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Li H, Chen XL, Liu H, Lu T, Li ZL. MRI-based multiregional radiomics for predicting lymph nodes status and prognosis in patients with resectable rectal cancer. Front Oncol 2023; 12:1087882. [PMID: 36686763 PMCID: PMC9846353 DOI: 10.3389/fonc.2022.1087882] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose To establish and evaluate multiregional T2-weighted imaging (T2WI)-based clinical-radiomics model for predicting lymph node metastasis (LNM) and prognosis in patients with resectable rectal cancer. Methods A total of 346 patients with pathologically confirmed rectal cancer from two hospitals between January 2019 and December 2021 were prospectively enrolled. Intra- and peritumoral features were extracted separately, and least absolute shrinkage and selection operator regression was applied for feature selection. Radiomics signatures were built using the selected features from different regions. The clinical-radiomic nomogram was developed by combining the intratumoral and peritumoral radiomics signatures score (radscore) and the most predictive clinical parameters. The diagnostic performances of the nomogram and clinical model were evaluated using the area under the receiver operating characteristic curve (AUC). The prognostic model for 3-year recurrence-free survival (RFS) was constructed using univariate and multivariate Cox analysis. Results The intratumoral radscore (radscore 1) included four features, the peritumoral radscore (radscore 2) included five features, and the combined intratumoral and peritumoural radscore (radscore 3) included ten features. The AUCs for radscore 3 were higher than that of radscore 1 in training cohort (0.77 vs. 0.71, P=0.182) and internal validation cohort (0.76 vs. 0.64, P=0.041). The AUCs for radscore 3 were higher than that of radscore 2 in training cohort (0.77 vs. 0.74, P=0.215) and internal validation cohort (0.76 vs. 0.68, P=0.083). A clinical-radiomic nomogram showed a higher AUC compared with the clinical model in training cohort (0.84 vs. 0.67, P<0.001) and internal validation cohort (0.78 vs. 0.64, P=0.038) but not in external validation (0.72 vs. 0.76, P=0.164). Multivariate Cox analysis showed MRI-reported extramural vascular invasion (EMVI) (HR=1.099, 95%CI: 0.462-2.616; P=0.031) and clinical-radiomic nomogram-based LNM (HR=2.232, 95%CI:1.238-7.439; P=0.017) were independent risk factors for assessing 3-year RFS. Combined clinical-radiomic nomogram based LNM and MRI-reported EMVI showed good performance in training cohort (AUC=0.748), internal validation cohort (AUC=0.706) and external validation (AUC=0.688) for predicting 3-year RFS. Conclusion A clinical-radiomics nomogram exhibits good performance for predicting preoperative LNM. Combined clinical-radiomic nomogram based LNM and MRI-reported EMVI showed clinical potential for assessing 3-year RFS.
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Affiliation(s)
- Hang Li
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
| | - Xiao-li Chen
- Department of Radiology, Affiliated Cancer Hospital of Medical School, University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, China
| | | | - Tao Lu
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China,*Correspondence: Tao Lu, ; Zhen-lin Li,
| | - Zhen-lin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Tao Lu, ; Zhen-lin Li,
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Fu C, Shao T, Hou M, Qu J, Li P, Yang Z, Shan K, Wu M, Li W, Wang X, Zhang J, Luo F, Zhou L, Sun J, Zhao F. Preoperative prediction of tumor deposits in rectal cancer with clinical-magnetic resonance deep learning-based radiomic models. Front Oncol 2023; 13:1078863. [PMID: 36890815 PMCID: PMC9986582 DOI: 10.3389/fonc.2023.1078863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Background This study aimed to establish an effective model for preoperative prediction of tumor deposits (TDs) in patients with rectal cancer (RC). Methods In 500 patients, radiomic features were extracted from magnetic resonance imaging (MRI) using modalities such as high-resolution T2-weighted (HRT2) imaging and diffusion-weighted imaging (DWI). Machine learning (ML)-based and deep learning (DL)-based radiomic models were developed and integrated with clinical characteristics for TD prediction. The performance of the models was assessed using the area under the curve (AUC) over five-fold cross-validation. Results A total of 564 radiomic features that quantified the intensity, shape, orientation, and texture of the tumor were extracted for each patient. The HRT2-ML, DWI-ML, Merged-ML, HRT2-DL, DWI-DL, and Merged-DL models demonstrated AUCs of 0.62 ± 0.02, 0.64 ± 0.08, 0.69 ± 0.04, 0.57 ± 0.06, 0.68 ± 0.03, and 0.59 ± 0.04, respectively. The clinical-ML, clinical-HRT2-ML, clinical-DWI-ML, clinical-Merged-ML, clinical-DL, clinical-HRT2-DL, clinical-DWI-DL, and clinical-Merged-DL models demonstrated AUCs of 0.81 ± 0.06, 0.79 ± 0.02, 0.81 ± 0.02, 0.83 ± 0.01, 0.81 ± 0.04, 0.83 ± 0.04, 0.90 ± 0.04, and 0.83 ± 0.05, respectively. The clinical-DWI-DL model achieved the best predictive performance (accuracy 0.84 ± 0.05, sensitivity 0.94 ± 0. 13, specificity 0.79 ± 0.04). Conclusions A comprehensive model combining MRI radiomic features and clinical characteristics achieved promising performance in TD prediction for RC patients. This approach has the potential to assist clinicians in preoperative stage evaluation and personalized treatment of RC patients.
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Affiliation(s)
- Chunlong Fu
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Tingting Shao
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Hou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiali Qu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Li
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Radiology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Zebin Yang
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Kangfei Shan
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Meikang Wu
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Weida Li
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Xuan Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingfeng Zhang
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Fanghong Luo
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Long Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jihong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China.,Cancer Center, Zhejiang University, Hangzhou, China
| | - Fenhua Zhao
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
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Taoum C, Carrier G, Jarlier M, Roche G, Gagniere J, Fiess C, De Forges H, Chevarin C, Colombo PE, Barnich N, Rouanet P, Bonnet M. Determination of biomarkers associated with neoadjuvant treatment response focusing on colibactin-producing Escherichia coli in patients with mid or low rectal cancer: a prospective clinical study protocol (MICARE). BMJ Open 2022; 12:e061527. [PMID: 36460331 PMCID: PMC9723882 DOI: 10.1136/bmjopen-2022-061527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The management of mid and low rectal cancer is based on neoadjuvant chemoradiotherapy (CRT) followed by standardised surgery. There is no biomarker in rectal cancer to aid clinicians in foreseeing treatment response. The determination of factors associated with treatment response might allow the identification of patients who require tailored strategies (eg, therapeutic de-escalation or intensification). Colibactin-producing Escherichia coli (CoPEC) has been associated with aggressive colorectal cancer and could be a poor prognostic factor. Currently, no study has evaluated the potential association between intestinal microbiota composition and tumour response to CRT in mid and low rectal cancer. The aim of this study is to assess the association between response to neoadjuvant CRT and faecal intestinal microbiota composition and/or CoPEC prevalence in patients with mid or low rectal cancer. METHODS AND ANALYSIS This is a non-randomised bicentric prospective clinical study with a recruitment capacity of 200 patients. Three stool samples will be collected from participants with histological-proven adenocarcinome of mid or low rectum who meet eligibility criteria of the study protocol: one before neoadjuvant treatment start, one in the period between CRT end and surgery and one the day before surgery. In each sample, CoPEC will be detected by culture in special media and molecular (PCR) approaches. The global microbiota composition will be also assessed by the bacterial 16S rRNA gene sequencing. Neoadjuvant CRT response and tumour regression grade will be described using the Dworak system at pathological examination. Clinical data and survival outcomes will also be collected and investigated. ETHICS AND DISSEMINATION MICARE was approved by the local ethics committee (Comité de Protection des Personnes Sud-Est II, 18 December 2019. Reference number 2019-A02493-54 and the institutional review board. Patients will be required to provide written informed consent. Results will be published in a peer reviewed journal. TRIAL REGISTRATION NUMBER NCT04103567.
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Affiliation(s)
- Christophe Taoum
- Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Guillaume Carrier
- Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
| | - Marta Jarlier
- Biometrics Unit, Regional Cancer Centre Val d'Aurelle-Paul Lamarque, Montpellier, France
| | - Gwenaelle Roche
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
| | - Johan Gagniere
- Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Fiess
- Clinical Research and Innovation Department, Regional Cancer Centre Val d'Aurelle-Paul Lamarque, Montpellier, France
| | - Helene De Forges
- Clinical Research and Innovation Department, Regional Cancer Centre Val d'Aurelle-Paul Lamarque, Montpellier, France
| | - Caroline Chevarin
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Nicolas Barnich
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
| | - Philippe Rouanet
- Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Mathilde Bonnet
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Clermont Auvergne University, Clermont-Ferrand, France
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Lorenzo Liñán MÁ, García Armengol J, Martín Martín GP, Martínez Sanjuán V, Roig Vila JV. Validation of pelvic magnetic resonance imaging as the method of choice to determine the distance to the anal margin in rectal cancer. Cir Esp 2022; 100:772-779. [PMID: 36064169 DOI: 10.1016/j.cireng.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/06/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Distance from anal verge of rectal tumours and their anatomical relationships contribute to determine the multidisciplinary therapeutic strategy based on the combination of radio-chemotherapy and radical surgery. Our aims are to investigate which is the most accurate method for the preoperative measuring of the distance from the anal verge in rectal tumours and if the pelvic MRI can substitute the classical instrumental methods. METHODS Prospective study of diagnostic precision between flexible colonoscopy (FC), preoperative rigid rectosigmoidoscopy (pRR) and pelvic MRI in patients scheduled to radical surgery. Rigid intraoperative rectoscopy (iRR) was considered the reference test. The correlations between the different techniques and their determination coefficient as well as the intraclass correlation coefficient and the degree of agreement between the different tests were analyzed. RESULTS 96 patients (65% males), mean age (SD): 68 (14.1) years were included. 72% received neoadjuvant treatment. The mean distance to the anal margin measured by FC = 103.5 mm, was significantly greater than others, which had similar values: pRR = 81.1; MRI = 77.4; iRR = 82.9 mm (P < .001). A significant intraclass correlation was observed and there was high agreement between all pre- and intraoperative measurements except for the performed by FC, which overestimated the results. MRI provided more individualized and accurate information. CONCLUSIONS There is variability between the measurement methods, being colonoscopy the least reliable. MRI offers objective, comparable, accurate and individualized values that can replace those obtained by pRR for tumours of any location in the rectum.
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Affiliation(s)
- Miguel Ángel Lorenzo Liñán
- Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - Juan García Armengol
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Gonzalo Pablo Martín Martín
- Cirugía, Centro Médico Teknon, Barcelona, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Vicente Martínez Sanjuán
- Servicio de Radiología y Resonancia Magnética, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - José Vicente Roig Vila
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Lu BL, Chen Y, Wen ZQ, Liu YY, Ma YR, Que YT, Zhang ZW, Wu XH, Yu SP. Quantitative assessment of the microstructure of the mesorectum with different prognostic statuses by intravoxel incoherent motion diffusion-weighed magnetic resonance imaging. BMC Gastroenterol 2022; 22:481. [PMID: 36418952 PMCID: PMC9685901 DOI: 10.1186/s12876-022-02555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The mesorectum surrounding the rectum provides an ideal substrate for tumour spread. However, preoperative risk assessment is still an issue. This study aimed to investigate the microstructural features of mesorectum with different prognostic statuses by intravoxel incoherent motion diffusion-weighted imaging (IVIM DWI). METHODS Patients with pathologically proven rectal adenocarcinoma underwent routine high-resolution rectal magnetic resonance imaging (MRI) and IVIM DWI sequences were acquired. The MRI-detected circumferential resection margin (mrCRM) and extramural vascular invasion (mrEMVI) were evaluated. IVIM parameters of the mesorectum adjacent to (MAT) and distant from (MDT) the tumour were measured and compared between and within the prognostic factor groups. RESULTS The positive mrCRM (pMAT < 0.001; pMDT = 0.013) and mrEMVI (pMAT = 0.001; pMDT < 0.001) groups demonstrated higher D values in the MAT and MDT than the corresponding negative groups. Conversely, the positive mrCRM (p = 0.001) and mrEMVI (p < 0.001) groups both demonstrated lower f values in the MAT. Similarly, in the self-comparison between the MAT and MDT in the above subgroups, D showed a significant difference in all subgroups (p < 0.001 for all), and f showed a significant difference in the positive mrCRM (p = 0.001) and mrEMVI (p = 0.002) groups. Moreover, the MAT displayed a higher D* in the positive mrCRM (p = 0.014), negative mrCRM (p = 0.009) and negative mrEMVI groups (p < 0.001). CONCLUSION The microstructure of the mesorectum in patients with rectal cancer with poor prognostic status shows changes based on IVIM parameters. IVIM parameters might be promising imaging biomarkers for risk assessment of tumour spread in mesorectum preoperatively.
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Affiliation(s)
- Bao-Lan Lu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China
| | - Yan Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China
| | - Zi-Qiang Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China
| | - Yi-Yan Liu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China
| | - Yu-Ru Ma
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China
| | - Yu-Tao Que
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China
| | - Zhi-Wen Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China
| | - Xue-Han Wu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China
| | - Shen-Ping Yu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2nd, 510080, Guangzhou, People's Republic of China.
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Roeder F, Gerum S, Hecht S, Huemer F, Jäger T, Kaufmann R, Klieser E, Koch OO, Neureiter D, Emmanuel K, Sedlmayer F, Greil R, Weiss L. How We Treat Localized Rectal Cancer-An Institutional Paradigm for Total Neoadjuvant Therapy. Cancers (Basel) 2022; 14:cancers14225709. [PMID: 36428801 PMCID: PMC9688120 DOI: 10.3390/cancers14225709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Total neoadjuvant therapy (TNT)-the neoadjuvant employment of radiotherapy (RT) or chemoradiation (CRT) as well as chemotherapy (CHT) before surgery-may lead to increased pathological complete response (pCR) rates as well as a reduction in the risk of distant metastases in locally advanced rectal cancer. Furthermore, increased response rates may allow organ-sparing strategies in a growing number of patients with low rectal cancer and upfront immunotherapy has shown very promising early results in patients with microsatellite instability (MSI)-high/mismatch-repair-deficient (dMMR) tumors. Despite the lack of a generally accepted treatment standard, we strongly believe that existing data is sufficient to adopt the concept of TNT and immunotherapy in clinical practice. The treatment algorithm presented in the following is based on our interpretation of the current data and should serve as a practical guide for treating physicians-without any claim to general validity.
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Affiliation(s)
- Falk Roeder
- Department of Radiation Oncology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Sabine Gerum
- Department of Radiation Oncology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Tarkan Jäger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Reinhard Kaufmann
- Department of Radiology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University Salzburg, Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Oliver Owen Koch
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Klaus Emmanuel
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Felix Sedlmayer
- Department of Radiation Oncology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-57255-25801
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