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- Title
Value of combined multiparametric MRI and FDG-PET/CT to identify well-responding rectal cancer patients before the start of neoadjuvant chemoradiation.
- Authors
Schurink, Niels W.; Min, Lisa A.; Berbee, Maaike; van Elmpt, Wouter; van Griethuysen, Joost J. M.; Bakers, Frans C. H.; Roberti, Sander; van Kranen, Simon R.; Lahaye, Max J.; Maas, Monique; Beets, Geerard L.; Beets-Tan, Regina G. H.; Lambregts, Doenja M. J.
- Abstract
<bold>Objectives: </bold>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.<bold>Methods: </bold>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).<bold>Results: </bold>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.<bold>Conclusions: </bold>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.<bold>Key Points: </bold>• 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.
- Subjects
RECTAL cancer; CANCER patients; CHEMORADIOTHERAPY; POSITRON emission tomography computed tomography; LOGISTIC regression analysis; RECTUM tumors; RETROSPECTIVE studies; TUMOR classification; RADIOPHARMACEUTICALS; RESEARCH funding; DEOXY sugars; COMBINED modality therapy
- Publication
European Radiology, 2020, Vol 30, Issue 5, p2945
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-019-06638-2