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MRI Assessment of Complete Response to Preoperative Chemoradiation Therapy for Rectal Cancer: 2020 Guide for Practice from the Korean Society of Abdominal Radiology

 Seong Ho Park  ;  Seung Hyun Cho  ;  Sang Hyun Choi  ;  Jong Keon Jang  ;  Min Ju Kim  ;  Seung Ho Kim  ;  Joon Seok Lim  ;  Sung Kyoung Moon  ;  Ji Hoon Park  ;  Nieun Seo  ;  Korean Society of Abdominal Radiology Study Group for Rectal Cancer 
 KOREAN JOURNAL OF RADIOLOGY, Vol.21(7) : 812-828, 2020-07 
Journal Title
Issue Date
Adenocarcinoma ; CR ; Chemoradiation ; Chemoradiotherapy ; Evidence ; Guideline ; Magnetic resonance imaging ; Organ preservation ; Recommendation ; Rectal cancer ; Regression ; Remission ; Response ; Surveillance ; Wait and see ; Watch and wait
Objective: To provide an evidence-based guide for the MRI interpretation of complete tumor response after neoadjuvant chemoradiation therapy (CRT) for rectal cancer using visual assessment on T2-weighted imaging (T2) and diffusion-weighted imaging (DWI).

Materials and methods: PubMed MEDLINE, EMBASE, and Cochrane Library were searched on November 28, 2019 to identify articles on the following issues: 1) sensitivity and specificity of T2 or DWI for diagnosing pathologic complete response (pCR) and the criteria for MRI diagnosis; 2) MRI alone vs. MRI combined with other test(s) in sensitivity and specificity for pCR; and 3) tests to select patients for the watch-and-wait management. Eligible articles were selected according to meticulous criteria and were synthesized.

Results: Of 1615 article candidates, 55 eligible articles (for all three issues combined) were identified. Combined T2 and DWI performed better than T2 alone, with a meta-analytic summary sensitivity of 0.62 (95% confidence interval [CI], 0.43-0.77; I² = 80.60) and summary specificity of 0.89 (95% CI, 0.80-0.94; I² = 92.61) for diagnosing pCR. The criteria for the complete response on T2 in most studies had the commonality of remarkable tumor decrease to the absence of mass-like or nodular intermediate signal, although somewhat varied, as follows: (near) normalization of the wall; regular, thin, hypointense scar in the luminal side with (near) normal-appearance or homogeneous intermediate signal in the underlying wall; and hypointense thickening of the wall. The criteria on DWI were the absence of a hyperintense signal at high b-value (≥ 800 sec/mm²) in most studies. The specific algorithm to combine T2 and DWI was obscure in half of the studies. MRI combined with endoscopy was the most utilized means to select patients for the watch-and-wait management despite a lack of strong evidence to guide and support a multi-test approach.

Conclusion: This systematic review and meta-analysis provide an evidence-based practical guide for MRI assessment of complete tumor response after CRT for rectal cancer.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
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