Intravoxel Incoherent Motion Model of Diffusion Weighted Imaging and Diffusion Kurtosis Imaging in Differentiating of Local Colorectal Cancer Recurrence from Scar/Fibrosis Tissue by Multivariate Logistic Regression Analysis

Roberta Fusco,Paolo Delrio,Biagio Pecori,Vincenzo Cerciello,Giuseppe Totaro,Nicola Raiano,Fabiana Tatangelo,Robert Grimm,Antonella Petrillo,Mario Sansone,Daniela Rega,Vincenza Granata,Antonio Avallone

doi:10.3390/app10238609

Abstract

Purpose: The aim of the study is to evaluate the potential of Intravoxel incoherent motion model of diffusion weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in the differentiation of local colorectal cancer recurrence (LCR) from scar/fibrosis tissue in patients that underwent chemo-radiation therapy followed by the total mesorectal excision (TME) for locally advanced rectal cancer (LARC). Methods: Fifty-six patients were retrospectively included for the image analysis. Diffusion and perfusion parameters were extracted by DWI data (apparent diffusion coefficient (ADC), pseudo-diffusion coefficient (Dp), perfusion fraction (fp), and tissue diffusivity (Dt)) and DKI data (mean of diffusion coefficient (MD) and mean of diffusional Kurtosis). Wilcoxon-Mann-Whitney U test, receiver operating characteristic (ROC) analyses, and area under ROC curve (AUC) were used in a univariate statistical analysis. Backward stepwise multivariate logistic regression analysis was also performed. Results: LCR was found in 34 patients and treatment related changes such as scar/fibrosis tissue in 22 patients. At univariate analysis, low performance was reached by the mean value of Kurtosis with and AUC of 0.72 and an accuracy of 75%, respectively. Considering a regression model obtained as weighted sum of the ADC, Kurtosis, fp and Dp mean values, reached an AUC of 0.82 with a sensitivity of 72%, a specificity of 93%, and an accuracy of 81%. Conclusions: DWI derived parameters combined with DKI derived metrics in a multivariate model could allow differentiating of local colorectal recurrence from scar/fibrosis tissue after TME of LARC.

Highlights

The third most common cancer and the third leading cause of oncological death in the United States and Europe is the colorectal cancer [1,2]
We searched among the internal surgical database and the radiological information system (Elefante.NET of Agfa Healthcare, Milano, Italy) of our institution from January 2011 to September 2018 an in order to select patients that after chemo-radiation therapy (CRT) followed by total mesolectal excision have suspicious local colorectal cancer recurrence and underwent MR
Low accuracy was reached by the single parameter to differentiate local colorectal cancer recurrence (LCR) by scar/fibrosis, the best results were reached by the mean value of Kurtosis

Summary

Introduction

The third most common cancer and the third leading cause of oncological death in the United States and Europe is the colorectal cancer [1,2]. Total mesorectal excision (TME) following neoadjuvant chemo-radiation therapy (CRT) is the gold standard for locally advanced rectal cancer (LARC). One concern after surgery is the local recurrence rate, which recently improved, is still relevant [4]. Local recurrence in patients with rectal cancer undergoing surgical resection has an incidence of. Total mesorectal excision has standardized the surgical technique in treating primary rectal cancer and has significantly reduced the local colorectal cancer recurrence (LCR) rate from 30%. Sauer et al reported that the rectal cancer local recurrences incidence within five years was 6% and 13%, respectively, for patients who received preoperative CRT and postoperative CRT (p = 0.006) [3]

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