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T2-weighted signal intensity-selected volumetry for prediction of pathological complete response after preoperative chemoradiotherapy in locally advanced rectal cancer

 Sungwon Kim  ;  Kyunghwa Han  ;  Nieun Seo  ;  Hye Jin Kim  ;  Myeong-Jin Kim  ;  Woong Sub Koom  ;  Joong Bae Ahn  ;  Joon Seok Lim 
 EUROPEAN RADIOLOGY, Vol.28(12) : 5231-5240, 2018 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Chemoradiotherapy ; Colectomy* ; Diffusion Magnetic Resonance Imaging/methods* ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging/methods* ; Postoperative Period ; Predictive Value of Tests ; ROC Curve ; Rectal Neoplasms/diagnosis* ; Rectal Neoplasms/therapy ; Rectum/pathology* ; Reproducibility of Results ; Treatment Outcome
Drug therapy ; Magnetic resonance imaging ; Neoadjuvant therapy ; Rectal neoplasms ; Tumor burden
OBJECTIVES: To evaluate the diagnostic value of signal intensity (SI)-selected volumetry findings in T2-weighted magnetic resonance imaging (MRI) as a potential biomarker for predicting pathological complete response (pCR) to preoperative chemoradiotherapy (CRT) in patients with rectal cancer. METHODS: Forty consecutive patients with pCR after preoperative CRT were compared with 80 age- and sex-matched non-pCR patients in a case-control study. SI-selected tumor volume was measured on post-CRT T2-weighted MRI, which included voxels of the treated tumor exceeding the SI (obturator internus muscle SI + [ischiorectal fossa fat SI - obturator internus muscle SI] × 0.2). Three blinded readers independently rated five-point pCR confidence scores and compared the diagnostic outcome with SI-selected volumetry findings. The SI-selected volumetry protocol was validated in 30 additional rectal cancer patients. RESULTS: The area under the receiver-operating characteristic curve (AUC) of SI-selected volumetry for pCR prediction was 0.831, with an optimal cutoff value of 649.6 mm3 (sensitivity 0.850, specificity 0.725). The AUC of the SI-selected tumor volume was significantly greater than the pooled AUC of readers (0.707, p < 0.001). At this cutoff, the validation trial yielded an accuracy of 0.87. CONCLUSION: SI-selected volumetry in post-CRT T2-weighted MRI can help predict pCR after preoperative CRT in patients with rectal cancer. KEY POINTS: • Fibrosis and viable tumor MRI signal intensities (SIs) are difficult to distinguish. • T2 SI-selected volumetry yields high diagnostic performance for assessing pathological complete response. • T2 SI-selected volumetry is significantly more accurate than readers and non-SI-selected volumetry. • Post-chemoradiation therapy T2-weighted MRI SI-selected volumetry facilitates prediction of pathological complete response.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Sungwon(김성원) ORCID logo https://orcid.org/0000-0001-5455-6926
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
Ahn, Joong Bae(안중배) ORCID logo https://orcid.org/0000-0001-6787-1503
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
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