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Il Giornale Italiano di Radiologia Medica 2018 Luglio-Agosto;5(4):502-14

DOI: 10.23736/S2283-8376.18.00107-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Role of diffusion weighted imaging sequence with 3 tesla magnetic resonance imaging in rectal cancers after neoadjuvant chemo-radiotherapy

Manuela VERRUSIO 1, Francesco SANI 1 , Renata TODARO 2, Maurilio GENOVESE 1, Riccardo SCAGLIONI 1, Valentina FRISULLO 1, Anna R. PECCHI 1, Luca REGGIANI BONETTI 3, Andrea SPALLANZANI 4, Pietro TORRICELLI 1

1 Dipartimento di Radiologia, Università di Modena e Reggio Emilia, Modena, Italia; 2 Unità Operativa Complessa di Radiodiagnostica e Radioterapia, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G. Ingrassia”, Università degli Studi di Catania, Catania, Italia; 3 Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università di Modena e Reggio Emilia, Modena, Italia; 4 Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, Università di Modena e Reggio Emilia, Modena, Italia


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BACKGROUND: The aim of this article was to assess the role of diffusion weighted imaging sequence (DWI) with 3 tesla magnetic resonance imaging (MRI 3T) in predicting the complete response of locally advanced rectal cancer to neoadjuvant chemo-radiotherapy (CRT) and the role of intermediate MR in predicting the complete response of the pathology already after 1 week of CRT.
METHODS: A total of 23 patients were recruited with a new diagnosis of rectal cancer, confirmed histologically after biopsy sampling, in T3-T4 or N1-x stage, all subjected to staging MRI before the onset of CRT, RM intermediate after 1 week from its start and final MRI after 4-6 weeks from the end of the therapy; each MRI examination was completed with a diffusion-weighted imaging (DWI) sequence. We examined the changes in apparent diffusion coefficient (ADC) of the neoplastic tissue after 1 week from the beginning of CRT and 4-6 weeks after its termination and we compared them with the degree of tumor regression (TRG) determined by the anatomopathologist on the surgical finding.
RESULTS: In our study we found a significant increase in the precise value of the ADC of the neoplastic tissue already after 1 week from the beginning of CRT in the group of patients who presented a complete tumor regression compared to the patients with partial or absent tumor response (P=0.0284) at histopathological examination, this variation was statistically more significant after 4-6 weeks from its term (P=0.0005). Similar results were obtained by considering the percentage change in punctual ADC: after 1 week from the beginning of CRT a significantly greater difference was observed between patients with complete tumor regression compared to patients with partial or no response (P=0.0260), equally after 4-6 weeks from its term (P=0.0003).
CONCLUSIONS: The results of our analysis show encouraging elements, to be confirmed by studies with samples of larger patients, to support the baseline MR sequences with the DWI, as an early monitoring parameter of neoadjuvant CRT; these results, if confirmed, could have important prognostic, clinical and therapeutic implications, to be confirmed through studies with larger patient samples, to support the baseline MR sequences with the DWI, as an early monitoring parameter of neoadjuvant CRT; these results, if confirmed, could have important prognostic, clinical and therapeutic implications.


KEY WORDS: Rectal neoplasms - Magnetic resonance imaging - DWI

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