Role of Intravoxel Incoherent Motion and Dynamic-Contrast-Enhanced Perfusion in Response Prediction of Patients with Colorectal Cancer after Neoadjuvant Chemotherapy.

Abstract

Colorectal cancer (CRC) is a complex malignancy requiring multimodal treatment strategies, including neoadjuvant chemoradiation therapy (Neo-CRT), to improve patient outcomes. However, the response to Neo-CRT varies among individuals, which necessitates the development of reliable predictors of treatment response. The present study aimed to investigate the role of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) perfusion in predicting treatment response in CRC patients after Neo-CRT. This study was conducted on patients diagnosed with locally advanced CRC who received Neo-CRT. IVIM and DCE perfusion imaging were performed before and after CRT. Quantitative parameters, including perfusion fraction (f), diffusion coefficient (D), and transfer constant (Ktrans), were calculated from the imaging data. Treatment response was assessed based on the pathological response after surgery. Statistical data were analyzed in SPSS v. 26 using the t-test and the chi-square method. A total of 51 patients (female: male = 22:29, mean age = 58.14±3.49) participated in the study. Among all the patients, 15 (29.4%) cases had good responses, while 36 (70.58%) cases did not respond to treatment. All DCE parameters showed higher sensitivity and specificity than IVIM D*. Ve, Kep, and DCE Ktrans indicated significant predictive power for treatment response. Ktrans was the most accurate parameter for predicting response to treatment. Overall sensitivity and specificity of DCE were 88.8% [95% CI: 80-95.6], and 80 % [95% CI: 65-90], and those of IVIM were 65.5% and 81%, respectively. Sensitivity and specificity for DCE + IVIM were 79.5% and 93.5%, and those of DCE + IVIM + standard magnetic resonance imaging were 80.2% and 86%, respectively. IVIM and DCE perfusion imaging could serve as promising tools for predicting treatment response in CRC patients after Neo-CRT.