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{"title":"Arterial Mucosal Linear Enhancement at Contrast-enhanced MRI to Exclude Residual Tumor after Neoadjuvant Chemotherapy and Radiation Therapy for Rectal Cancer.","authors":"Gengyun Miao, Liheng Liu, Jingjing Liu, Mengsu Zeng","doi":"10.1148/radiol.232713","DOIUrl":null,"url":null,"abstract":"<p><p>Background A watch-and-wait regimen for locally advanced rectal cancer after neoadjuvant chemotherapy and radiation therapy (NCRT) relies on identifying complete tumor response. However, the concordance between a complete response at combined T2-weighted and diffusion-weighted MRI (T2DWI) and pathologic complete response (pCR; ie, ypT0N0) in the tumor is unsatisfactory. Purpose To assess whether identification of mucosal linear enhancement (MLE) at arterial-phase contrast-enhanced (CE) T1-weighted MRI is associated with ypT0 status in patients with locally advanced rectal cancer after NCRT and to evaluate whether combining MLE at CE T1-weighted MRI and negative lymph node metastasis (LNM) at T2DWI can improve identification of pCR. Materials and Methods This retrospective study included patients with locally advanced rectal cancer who underwent total mesorectal excision after NCRT between July 2020 and July 2023 at a tertiary referral academic center. Restaging MRI included T2DWI and arterial-phase CE T1-weighted MRI for primary tumor assessment and T2DWI for evaluation of LNM status. Imaging features associated with ypT0 status were identified at multivariable regression analysis. Results In total, 239 patients (mean age, 58 years ± 12 [SD]; 180 male patients) were assessed. MLE was more common in the ypT0 group than in the ypT1-4 group after NCRT (73% vs 4%, respectively; <i>P</i> < .001). MLE was associated with higher odds of ypT0 status in an adjusted analysis (odds ratio, 137; 95% CI: 25, 767; <i>P</i> < .001). The combination of MLE and negative LNM status achieved an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.79, 0.88) for pCR. Conclusion MLE at CE MRI was associated with higher odds of complete tumor response. Combining MLE and negative LNM status showed good performance for identifying complete tumor response and may exclude residual tumors after NCRT in patients with locally advanced rectal cancer. © RSNA, 2024 <i>Supplemental material is available for this article.</i> See also the editorial by Schoellnast in this issue.</p>","PeriodicalId":20896,"journal":{"name":"Radiology","volume":null,"pages":null},"PeriodicalIF":12.1000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1148/radiol.232713","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
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Abstract
Background A watch-and-wait regimen for locally advanced rectal cancer after neoadjuvant chemotherapy and radiation therapy (NCRT) relies on identifying complete tumor response. However, the concordance between a complete response at combined T2-weighted and diffusion-weighted MRI (T2DWI) and pathologic complete response (pCR; ie, ypT0N0) in the tumor is unsatisfactory. Purpose To assess whether identification of mucosal linear enhancement (MLE) at arterial-phase contrast-enhanced (CE) T1-weighted MRI is associated with ypT0 status in patients with locally advanced rectal cancer after NCRT and to evaluate whether combining MLE at CE T1-weighted MRI and negative lymph node metastasis (LNM) at T2DWI can improve identification of pCR. Materials and Methods This retrospective study included patients with locally advanced rectal cancer who underwent total mesorectal excision after NCRT between July 2020 and July 2023 at a tertiary referral academic center. Restaging MRI included T2DWI and arterial-phase CE T1-weighted MRI for primary tumor assessment and T2DWI for evaluation of LNM status. Imaging features associated with ypT0 status were identified at multivariable regression analysis. Results In total, 239 patients (mean age, 58 years ± 12 [SD]; 180 male patients) were assessed. MLE was more common in the ypT0 group than in the ypT1-4 group after NCRT (73% vs 4%, respectively; P < .001). MLE was associated with higher odds of ypT0 status in an adjusted analysis (odds ratio, 137; 95% CI: 25, 767; P < .001). The combination of MLE and negative LNM status achieved an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.79, 0.88) for pCR. Conclusion MLE at CE MRI was associated with higher odds of complete tumor response. Combining MLE and negative LNM status showed good performance for identifying complete tumor response and may exclude residual tumors after NCRT in patients with locally advanced rectal cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Schoellnast in this issue.
在直肠癌新辅助化疗和放疗后,通过对比增强磁共振成像的动脉黏膜线性增强来排除残余肿瘤。
背景 新辅助化疗和放疗(NCRT)后局部晚期直肠癌的观察和等待方案依赖于确定肿瘤完全反应。然而,T2加权和弥散加权磁共振成像(T2DWI)联合检查的完全反应与肿瘤病理完全反应(pCR,即ypT0N0)之间的一致性并不令人满意。目的 评估动脉相对比增强(CE)T1加权MRI的粘膜线性增强(MLE)与NCRT后局部晚期直肠癌患者的ypT0状态是否相关,并评估将CE T1加权MRI的MLE与T2DWI的阴性淋巴结转移(LNM)相结合是否能提高pCR的识别率。材料与方法 这项回顾性研究纳入了 2020 年 7 月至 2023 年 7 月期间在一家三级转诊学术中心接受 NCRT 后全直肠间膜切除术的局部晚期直肠癌患者。重新分期磁共振成像包括用于评估原发肿瘤的T2DWI和动脉相CE T1加权磁共振成像,以及用于评估LNM状态的T2DWI。多变量回归分析确定了与 ypT0 状态相关的影像特征。结果 共评估了 239 名患者(平均年龄为 58 岁 ± 12 [SD];180 名男性患者)。在接受 NCRT 治疗后,ypT0 组的 MLE 发生率高于 ypT1-4 组(分别为 73% 对 4%;P < .001)。在调整分析中,MLE 与较高的 ypT0 状态几率相关(几率比,137;95% CI:25,767;P < .001)。MLE 与 LNM 阴性状态相结合,pCR 的接收者操作特征曲线下面积为 0.84 (95% CI: 0.79, 0.88)。结论 CE MRI检查发现MLE与较高的肿瘤完全反应几率相关。结合 MLE 和阴性 LNM 状态可很好地识别完全肿瘤反应,并可排除局部晚期直肠癌患者 NCRT 后的残留肿瘤。RSNA, 2024 这篇文章有补充材料。另请参阅本期 Schoellnast 的社论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。