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European Radiology
Published in: European Radiology 5/2020

01-05-2020 | Magnetic Resonance Imaging | Gastrointestinal

Value of combined multiparametric MRI and FDG-PET/CT to identify well-responding rectal cancer patients before the start of neoadjuvant chemoradiation

Authors: Niels W. Schurink, Lisa A. Min, Maaike Berbee, Wouter van Elmpt, Joost J. M. van Griethuysen, Frans C. H. Bakers, Sander Roberti, Simon R. van Kranen, Max J. Lahaye, Monique Maas, Geerard L. Beets, Regina G. H. Beets-Tan, Doenja M. J. Lambregts

Published in: European Radiology | Issue 5/2020

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Abstract

Objectives

To explore the value of multiparametric MRI combined with FDG-PET/CT to identify well-responding rectal cancer patients before the start of neoadjuvant chemoradiation.

Methods

Sixty-one locally advanced rectal cancer patients who underwent a baseline FDG-PET/CT and MRI (T2W + DWI) and received long-course neoadjuvant chemoradiotherapy were retrospectively analysed. Tumours were delineated on MRI and PET/CT from which the following quantitative parameters were calculated: T2W volume and entropy, ADC mean and entropy, CT density (mean-HU), SUV maximum and mean, metabolic tumour volume (MTV42%) and total lesion glycolysis (TLG). These features, together with sex, age, mrTN-stage (“baseline parameters”) and the CRT-surgery interval were analysed using multivariable stepwise logistic regression. Outcome was a good (TRG 1–2) versus poor histopathological response. Performance (AUC) to predict response was compared for different combinations of baseline ± quantitative imaging parameters and performance in an ‘independent’ dataset was estimated using bootstrapped leave-one-out cross-validation (LOOCV).

Results

The optimal multivariable prediction model consisted of a combination of baseline + quantitative imaging parameters and included mrT-stage (OR 0.004, p < 0.001), T2W-signal entropy (OR 7.81, p = 0.0079) and T2W volume (OR 1.028, p = 0.0389) as the selected predictors. AUC in the study dataset was 0.88 and 0.83 after LOOCV. No PET/CT features were selected as predictors.

Conclusions

A multivariable model incorporating mrT-stage and quantitative parameters from baseline MRI can aid in identifying well-responding patients before the start of treatment. Addition of FDG-PET/CT is not beneficial.

Key Points

• A multivariable model incorporating the mrT-stage and quantitative features derived from baseline MRI can aid in identifying well-responding patients before the start of neoadjuvant chemoradiotherapy.
• mrT-stage was the strongest predictor in the model and was complemented by the tumour volume and signal entropy calculated from T2W-MRI.
• Adding quantitative features derived from pre-treatment PET/CT or DWI did not contribute to the model’s predictive performance.
Appendix
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Metadata
Title
Value of combined multiparametric MRI and FDG-PET/CT to identify well-responding rectal cancer patients before the start of neoadjuvant chemoradiation
Authors
Niels W. Schurink
Lisa A. Min
Maaike Berbee
Wouter van Elmpt
Joost J. M. van Griethuysen
Frans C. H. Bakers
Sander Roberti
Simon R. van Kranen
Max J. Lahaye
Monique Maas
Geerard L. Beets
Regina G. H. Beets-Tan
Doenja M. J. Lambregts
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06638-2

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