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Open Access 01-07-2016 | Gastrointestinal

MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy

Authors: Doenja M. J. Lambregts, Max J. Lahaye, Luc A. Heijnen, Milou H. Martens, Monique Maas, Geerard L. Beets, Regina G. H. Beets-Tan

Published in: European Radiology | Issue 7/2016

Abstract

Objectives

To assess the value of MRI and diffusion-weighted imaging (DWI) for diagnosing local tumour regrowth during follow-up of organ preservation treatment after chemoradiotherapy for rectal cancer.

Methods

Seventy-two patients underwent organ preservation treatment (chemoradiotherapy + transanal endoscopic microsurgery or “wait-and-see”) and were followed with MRI including DWI (1.5 T) every 3 -months during the first year and 6 months during following years. Two readers scored each MRI for local regrowth using a confidence level, first on standard MRI, then on standard MRI+DWI. Histology and clinical follow-up were the standard reference. Receiver operating characteristic curves were constructed and areas under the curve (AUC) and corresponding accuracy figures calculated on a per-scan basis.

Results

Four hundred and forty MRIs were assessed. Twelve patients developed local regrowth. AUC/sensitivity/specificity for standard MRI were 0.95/58 %/98 % (R1) and 0.96/58 % /100 % (R2). For standard MRI+DWI, these numbers were 0.86/75 %/97 % (R1) and 0.98/75 %/100 % (R2). After adding DWI, the number of equivocal scores decreased from 22 to 7 (R1) and from 40 to 20 (R2).

Conclusions

Although there was no overall improvement in diagnostic performance in terms of AUC, adding DWI improved the sensitivity of MRI for diagnosing local tumour regrowth and lowered the rate of equivocal MRIs.

Key Points

• DWI improves sensitivity for detecting local tumour regrowth after organ preservation treatment.

• In particular, DWI can aid in detecting small local recurrence.

• DWI reduces the number of equivocal scores.

Maas M, Beets-Tan RG, Lambregts DM et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29:4633–4640CrossRefPubMed

Lezoche G, Baldarelli M, Guerrieri M et al (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22:352–358CrossRefPubMed

Habr-Gama A, Perez RO, Proscurshim I et al (2006) Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 10:1319–1328, discussion 1328–1329CrossRefPubMed

Perez RO, Habr-Gama A, Lynn PB et al (2013) Transanal endoscopic microsurgery for residual rectal cancer (ypT0-2) following neoadjuvant chemoradiation therapy: another word of caution. Dis Colon Rectum 56:6–13CrossRefPubMed

Smith JD, Ruby JA, Goodman KA et al (2012) Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg 256:965–972CrossRefPubMed

Habr-Gama A, Gama-Rodrigues J, Sao Juliao GP et al (2014) Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 88:822–828CrossRefPubMed

Habr-Gama A, Sabbaga J, Gama-Rodrigues J et al (2013) Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum 56:1109–1117CrossRefPubMed

Charles-Edwards EM, deSouza NM (2006) Diffusion-weighted magnetic resonance imaging and its application to cancer. Cancer Imaging 6:135–143CrossRefPubMedPubMedCentral

Lambregts DM, Vandecaveye V, Barbaro B et al (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18:2224–2231CrossRefPubMedPubMedCentral

10.

Dzik-Jurasz A, Domenig C, George M et al (2002) Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet 360:307–308CrossRefPubMed

11.

Kim SH, Lee JM, Hong SH et al (2009) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology 253:116–125CrossRefPubMed

12.

Beets-Tan RG, Lambregts DM, Maas M et al (2013) Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 23:2522–2531CrossRefPubMed

13.

Sun YS, Zhang XP, Tang L et al (2010) Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted MR imaging for early detection of tumor histopathologic downstaging. Radiology 254:170–178CrossRefPubMed

14.

Cai P-Q, Wu Y-P, An X et al (2014) Simple measurements on diffusion-weighted MR imaging for assessment of complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Eur Radiol 24:2962–2970CrossRefPubMed

15.

Nishie A, Stolpen AH, Obuchi M, Kuehn DM, Dagit A, Andresen K (2008) Evaluation of locally recurrent pelvic malignancy: performance of T2- and diffusion-weighted MRI with image fusion. J Magn Reson Imaging 28:705–713CrossRefPubMed

16.

Lambregts DM, Cappendijk VC, Maas M, Beets GL, Beets-Tan RG (2011) Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer. Eur Radiol 21:1250–1258CrossRefPubMedPubMedCentral

17.

Colosio A, Soyer P, Rousset P et al (2014) Value of diffusion-weighted and gadolinium-enhanced MRI for the diagnosis of pelvic recurrence from colorectal cancer. J Magn Reson Imaging 40:306–313CrossRefPubMed

18.

Oussalah A, Laurent V, Bruot O et al (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59:1056–1065CrossRefPubMed

19.

Kiryu S, Dodanuki K, Takao H et al (2009) Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn's disease. J Magn Reson Imaging 29:880–886CrossRefPubMed

Title: MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy
Authors: Doenja M. J. Lambregts
Max J. Lahaye
Luc A. Heijnen
Milou H. Martens
Monique Maas
Geerard L. Beets
Regina G. H. Beets-Tan
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 7/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-4062-z

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MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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