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

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*

*Corresponding author for this work

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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.

Original languageEnglish
Pages (from-to)2945-2954
Number of pages10
JournalEuropean Radiology
Volume30
Issue number5
DOIs
Publication statusPublished - May 2020

Keywords

  • Rectal neoplasms
  • Neoadjuvant therapy
  • Magnetic resonance imaging
  • Positron emission tomography computed tomography
  • Logistic models
  • PATHOLOGICAL COMPLETE RESPONSE
  • COMPLETE CLINICAL-RESPONSE
  • DIFFUSION-WEIGHTED MRI
  • PREDICTING RESPONSE
  • PREOPERATIVE CHEMORADIOTHERAPY
  • RADIATION-THERAPY
  • LOCAL RECURRENCE
  • VOLUMETRY
  • SURGERY
  • WAIT

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