title: Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison with T2 weighted and PET/CT imaging.
abstract: OBJECTIVE
  To evaluate the added value of diffusion-weighted imaging (DWI) in combination with T(2) weighted imaging (T2WI) compared with T2WI alone or positron emission tomography (PET)/CT for detecting viable tumour after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer.
  
  
  METHODS
  50 consecutive patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. All patients underwent 3.0 T rectal MRI and PET/CT after completing CRT. For qualitative analysis, two radiologists independently reviewed T2WI alone and DWI with T2WI over a 1-month interval. One nuclear medicine physician reviewed PET/CT images using a five-point scale. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting viable tumour were assessed. For quantitative analysis, the apparent diffusion coefficients (ADCs) of the lesions were measured and compared between the viable tumour group and non-viable tumour groups.
  
  
  RESULTS
  For detecting viable tumours, DWI with T2WI improved diagnostic accuracies (Reviewer 1 detected 90%; Reviewer 2, 86%) over T2WI alone (Reviewer 1 detected 76%, p=0.5; Reviewer 2, 64%, p=0.013) or PET/CT (48%, p<0.001). The sensitivity of DWI with T2WI (Reviewer 1 detected 98%; Reviewer 2, 91%) was significantly higher than those of T2WI alone (Reviewer 1 detected 77%; Reviewer 2, 64%) or PET-CT (43%, p<0.05). Only for Reviewer 2 was the NPV of DWI with T2WI (43%) significantly different from that of PET/CT (17%, p<0.05). The specificities and PPVs of DWI with T2WI were not improved over those of T2WI alone or of PET/CT (both p>0.05). The mean ADC of the viable tumour group (0.93 × 10(-3) mm(2) sc(-1)) was significantly lower than that of the non-viable tumour group (1.55 × 10(-3) mm(2) sc(-1), p<0.0001).
  
  
  CONCLUSIONS
  Adding DWI to T2WI is helpful for detecting viable tumours after neoadjuvant CRT compared with T2WI alone or PET/CT in patients with locally advanced rectal cancer.
authors.affiliation: Department of Radiology, Samsung Medicine Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: I
authors.initials: I
authors.lastname: Song
authors.forename: S H
authors.initials: SH
authors.lastname: Kim
authors.forename: S J
authors.initials: SJ
authors.lastname: Lee
authors.forename: J Y
authors.initials: JY
authors.lastname: Choi
authors.forename: M J
authors.initials: MJ
authors.lastname: Kim
authors.forename: H
authors.initials: H
authors.lastname: Rhim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000379:methods; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18