Ces radiol. 2015, 69(3):165-173 | DOI: 10.55095/CesRadiol2015/026

Evaluation of rectal carcinoma response to neoadjuvant treatment using multiparametric imaging on 3T MRI scannerOriginal article

Eva Korčáková¹, Hynek Mírka¹, Jan Kastner¹, Petr Novák², Tomáš Svoboda³, Ondřej Daum⁴

¹ Klinika zobrazovacích metod LF UK a FN, Plzeň

² Chirurgická klinika LF UK a FN, Plzeň

³ Onkologická a radioterapeutická klinika LF UK a FN, Plzeň

⁴ Šiklův patologicko-anatomický ústav LF UK, Plzeň

Aim: Evaluation of capability of multiparametric MR imaging (MRI) in the prediction and evaluation of response to neoadjuvant chemoradiotherapy in locally advanced rectal carcinoma.


Metod: We performed a retrospective analysis of multiparametric MRI examinations on 3T scanner and histological findings in 22 patients before and after neoadjuvant chemoradiotherapy. In addition to the standard noncontrast and postcontrast MRI, the examinations included dynamic contrast-enhanced scans and diffusion-weighted images.

Results: The assessment of tumor staging using only noncontrast MRI and nondynamic postcontrast scans has a tendency to overestimate the extent of tumors in the group of neoadjuvant treatment responders. If we compared pharmakokinetic parameters and apparent diffusion coefficient (ADC) values from the baseline MRI within the group of responders and nonresponders, we find significantly lower value for the parameter V_e in the group of responders (p = 0,013), differencies in all other parameters were nonsignificant. Comparison of the results of the baseline examination with examination after treatment separately in the group of responders and nonresponders, we found statistically significant changes in values ADC (p < 0,001), K^trans (p < 0,001), K_ep (p = 0,002) and iAUC (p = 0,048) in the group of responders. In the group of non-responders is a statistically significant difference only in the parameter V_e (p = 0,027).

Conclusion: From our research it is noticeable that although MRI is the most sensitive method for evaluation of the advanced stages of rectal cancer, is impossible to use it for prediction of the therapeutic effect in patients before neoadjuvant chemoradiotherapy. It seems, that based of the comparison of results of pharmakokinetic analysis and ADC values from baseline and posttreatment MRI, it is possible to select patients with good response to the treatment, that can be candidates for less radical surgery or application of Watch and Wait protocol.

Keywords: rectal carcinoma, magnetics resonance imaging, neoadjuvant treatment, diffusion weighted imaging, pharmacokinetic analysis

Grants and funding:

Podpořeno projektem Ministerstva zdravotnictví ČR Koncepční rozvoj výzkumné instituce 00669806 - FN Plzeň a Programem rozvoje vědních oborů Karlovy Univerzity (projekt P36).

Accepted: September 9, 2015; Published: September 1, 2015  Show citation