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Locally advanced rectal cancer: Is diffusion weighted MRI helpful for the identification of complete responders (ypT0N0) after neoadjuvant chemoradiation therapy?

European Radiology, ISSN: 0938-7994, Vol: 23, Issue: 12, Page: 3440-3449
2013
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Article Description

Objectives: To determine retrospectively the additional value of DWI-MRI toT2-MRI for predicting complete response (ypT0N0 = CR) after chemoradiation-therapy (CRT) in locally advanced rectal cancer. Methods: Seventy locally advanced rectal cancer patients underwent CRT followed by restaging MRI and resection. Two readers with different experience levels independently scored T2 images for CR and, in a second reading, combined T2 and DWI. A 5-point confidence-level score was used to generate ROC curves. Areas under the ROC curves (AUC) and interobserver agreement were compared for both readings. Histology served as reference standard. Results: The interobserver agreement increased after addition of DWI from 0.35 to 0.58 but the AUC improved only for the experienced reader (0.77 to 0.89, p = 0.005 vs. 0.74 to 0.70, p > 0.05). Sensitivity and NPV improved from 20-30 % to 40-70 %, respectively 88 % to 91-95 %. Specificity and PPV improved only for the experienced reader (87 to 93 % respectively 27 to 63 %). Conclusion: Adding DWI to T2-MRI improves consistency between readers and has potential to improve readers' accuracy dependent on his/her experience. DWI could be of additional value, particularly in ruling out CR (high NPV), but considering the sub-optimal PPV one should be cautious about relying solely on MRI for the clinical decision to offer a wait-and-see strategy. Key Points: • Diffusion-weighted magnetic resonance imaging is increasingly used to assess rectal tumours • Adding DWI to T2-MRI potentially improves diagnostic accuracy for identifying complete responders • Adding DWI to T2-MRI improves consistency among readers with different experience levels. • This combination can help rule out complete tumour response. • Patients should not be selected for wait-and-see strategies by MRI alone. © 2013 European Society of Radiology.

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