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Added Value of Amide Proton Transfer Weighted MRI in the Evaluation of treatment Response to Neoadjuvant Therapy of Locally Advanced Rectal Cancer1Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 2Philips Healthcare, Beijing, China
Synopsis
Keywords: Treatment Response, Tumor, complete response
Motivation: The existing evaluation system remains inadequate for assessing complete response(CR) to neoadjuvant therapy (NAT) for locally advanced rectal cancer (LARC). There is a pressing need for more precise imaging evaluation methods.
Goal(s): To investigate the added value of Amide Proton Transfer weighted (APTw) MRI in the evaluation of CR to NAT in patients with LARC.
Approach: Diagnosis performance of conventional assessment and APTw-added combined assessment was assessed by receiver operating characteristic curve (ROC) analysis.
Results: Diagnostic efficiency in the evaluation of CR was significantly improved when APTw imaging was added to conventional evaluation, with AUC improved from 0.706 to 0.969
Impact: Superimposing the advantage of noninvasiveness, APTw imaging may have great application value in solving the clinical problem of diagnosing CR to NAT and provide additional valuable information for clinical decision making.
Purpose
To investigate the added value of Amide Proton Transfer weighted (APTw) magnetic resonance imaging (MRI) in the evaluation of CR to NAT in patients with LARCMaterials and Methods
In this approved single-center prospective study, patients with LARC (T3-4N0M0 or T1-4N+M0) who underwent NAT and subsequent surgery, with adequate MRI quality were enrolled. All patients underwent conventional MRI and APTw imaging before and after NAT. Conventional evaluation of CR to NAT based on post-NAT T2WI and DWI, tumor segmentation and histogram analysis based on post-NAT APTw images, were performed by two experienced radiologists independently. Pathologic complete response (pCR) served as the reference standard. Feature selection of histogram parameters was according to significant difference between-groups and low Pearson correlation coefficients between variables. Diagnosis performance of conventional assessment and APTw-added combined assessment was assessed by receiver operating characteristic curve (ROC) analysis. The AUCs were compared using the Delong method.Results
64 participants were evaluated: 21 with pCR and 43 with non-pCR. The accuracy, sensitivity, and specificity of the conventional assessment based on T2WI and DWI in discriminating CR to NAT were 0.703 (95% CI: 0.697,0.710), 0.698 (95% CI: 0.560,0.835), and 0.714 (95% CI: 0.521,0.908), respectively. Four variables, namely. 90percentile, totalenergy, range, and entropy, were selected for further multivariate logistic regression analysis and finally totalenergy and entropy entered into the APTw-added combined model (combination of APT histogram parameters, T2WI and DWI). The accuracy, sensitivity, and specificity of the APTw-added combined model in discriminating CR to NAT were 0.953 (95% CI: 0.952,0.954), 0.930 (95% CI: 0.854,1.000), and 1.000 (95% CI: 1.000,1.000), respectively. Diagnostic efficiency in the evaluation of CR was significantly improved when APTw imaging was added to conventional evaluation based on T2WI and DWI, with AUC improved from 0.706 to 0.969. Using the APTw-added combined model, the accuracy, sensitivity, and specificity for evaluation CR in test set were 0.900 (95% CI: 0.882,0.918), 0.857 (95% CI: 0.598,1.000), and 1.000 (95% CI: 1.000,1.000), respectively (Table 3), and the AUC was 0.952 (95% CI: 0.820,1).Conclusion
Use of additional APTw imaging yields significantly better diagnostic accuracy than does use of conventional T2WI and DWI in the evaluation of CR to NAT in patients with LARC. Superimposing the advantage of noninvasiveness, APTw imaging may have great application value in solving the clinical problem of diagnosing CR to NAT and provide additional valuable information for clinical decision making.Acknowledgements
No acknowledgement found.References
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