Perfusion MRI for the prediction of treatment response after preoperative chemoradiotherapy in locally advanced rectal cancer
Authors
Joon Seok Lim ; Daehong Kim ; Song-Ee Baek ; Sungmin Myoung ; Junjeong Choi ; Sang Joon Shin ; Myeong-Jin Kim ; Nam Kyu Kim ; Jinsuk Suh ; Ki Whang Kim ; Ki Chang Keum
Magnetic resonance imaging (MRI) ; Perfusion imaging ; Dynamic contrast-enhanced MRI ; Rectal cancer ; Chemoradiotherapy (CRT)
Abstract
OBJECTIVES: To evaluate the utility of perfusion MRI as a potential biomarker for predicting response to chemoradiotherapy (CRT) in locally advanced rectal cancer.
METHODS: Thirty-nine patients with primary rectal carcinoma who were scheduled for preoperative CRT were prospectively recruited. Perfusion MRI was performed with a 3.0-T MRI system in all patients before therapy, at the end of the 2nd week of therapy, and before surgery. The K (trans) (volume transfer constant) and V (e) (extracellular extravascular space fraction) were calculated.
RESULTS: Before CRT, the mean tumour K (trans) in the downstaged group was significantly higher than that in the non-downstaged group (P = 0.0178), but there was no significant difference between tumour regression grade (TRG) responders and TRG non-responders (P = 0.1392). Repeated-measures analysis of variance (ANOVA) showed significant differences for evolution of K (trans) values both between downstaged and non-downstaged groups (P = 0.0215) and between TRG responders and TRG non-responders (P = 0.0001). Regarding V (e), no significant differences were observed both between downstaged and non-downstaged groups (P = 0.689) or between TRG responders and TRG non-responders (P = 0.887).
CONCLUSION: Perfusion MRI of rectal cancer can be useful for assessing tumoural K (trans) changes by CRT. Tumours with high pre-CRT K (trans) values tended to respond favourably to CRT, particularly in terms of downstaging criteria.
KEY POINTS: • Perfusion MRI can now assess therapeutic response of tumours to therapy. • Tumours with high initial K ( trans ) values responded favourably to chemoradiotherapy. • Perfusion MRI of rectal cancer may help with decisions about management.