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Abstract
PurposeTo assess T2*-weighted imaging (T2*WI) and reduced field-of-view diffusion-weighted Imaging (rDWI) derived parameters and their relationships with histopathological factors in patients with rectal cancer.MethodsFifty-four patients with pathologically-proven rectal cancer underwent preoperative T2*-weighted imaging and rDWI in this retrospective study. R2* values from T2*-weighted imaging and apparent diffusion coefficient (ADC) values from rDWI were compared in terms of different histopathological prognostic factors using student’s t-test or Mann-Whitney U-test. The correlations of R2* and ADC with prognostic factors were assessed by Spearman correlation analysis. The diagnostic performances of R2* and ADC were analyzed by receiver operating characteristic curves (ROC) separately and jointly.ResultsSignificant positive correlation was found between R2* values and T stage, lymph node involvement, histological grades, CEA level, the presence of EMVI and tumor deposit (r = 0.374 ~ 0.673, p = 0.000–0.006), with the exception of CA19-9 level, CRM status and tumor involvement in the circumference lumen (TIL). Meanwhile, ADC values negatively correlated with almost all the prognostic factors (r = −0.588 to −0.299, p = 0.000–0.030), except CA19-9 level. The AUC range was 0.724–0.907 for R2* and 0.674–0.887 for ADC in discrimination of different prognostic factors. While showing the highest AUC of 0.913 (0.803–1.000) in differentiation of T stage, combination of R2* and ADC with reference to different prognostic factors did not significantly improve the diagnostic performance in comparison with individual R2*/ADC parameter.ConclusionsR2* and ADC were associated with important histopathological prognostic factors of rectal cancer. R2* might act as additional quantitative imaging marker for tumor characterization of rectal cancer.
Highlights
Colorectal cancer (CRC) is presently the most common tumor occurring in the digestive system, with high mortality worldwide [1]
The prognosis of rectal cancer is associated with many factors, such as TNM staging, histological differentiation, extramural vascular invasion (EMVI), circumferential margin (CRM) involvement, range of tumor involvement in the circumference lumen (TIL) and tumor markers including carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9) [3,4,5,6,7]
Current MRI techniques of rectal cancer utilized in clinics are comprised of T2 weighted imaging, diffusion-weighted imaging (DWI), dynamic-contrast-enhanced imaging technique (DCE), and other functional techniques
Summary
Colorectal cancer (CRC) is presently the most common tumor occurring in the digestive system, with high mortality worldwide [1]. The choice of treatment including surgery, with or without preoperative and postoperative neoadjuvant chemo-radiotherapy depends on the probability of patients having distant metastasis and local recurrence [8,9,10]. The risk stratification for distant metastasis and tumor recurrence based on the prognostic factors is very important for treatment planning of patients with rectal cancer. Current MRI techniques of rectal cancer utilized in clinics are comprised of T2 weighted imaging, diffusion-weighted imaging (DWI), dynamic-contrast-enhanced imaging technique (DCE), and other functional techniques. The administration of contrast media is required for DCE-MRI by invasive method. As for DWI technique, it is based on single-shot echo-planar imaging (ss-EPI), which is often associated with limited image quality including geometric distortion, ghosting and insufficient image resolution [12, 13]. Optimization of MRI techniques is necessitated for rectal cancer imaging
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