title: Combined value of apparent diffusion coefficient-standardized uptake value max in evaluation of post-treated locally advanced rectal cancer.
abstract: OBJECTIVE
  To assess the clinical diagnostic value of functional imaging, combining quantitative parameters of apparent diffusion coefficient (ADC) and standardized uptake value (SUV)max, before and after chemo-radiation therapy, in prediction of tumor response of patients with rectal cancer, related to tumor regression grade at histology.
  
  
  METHODS
  A total of 31 patients with biopsy proven diagnosis of rectal carcinoma were enrolled in our study. All patients underwent a whole body (18)FDG positron emission tomography (PET)/computed tomography (CT) scan and a pelvic magnetic resonance (MR) examination including diffusion weighted (DW) imaging for staging (PET1, RM1) and after completion (6.6 wk) of neoadjuvant treatment (PET2, RM2). Subsequently all patients underwent total mesorectal excision and the histological results were compared with imaging findings. The MR scanning, performed on 1.5 T magnet (Philips, Achieva), included T2-weighted multiplanar imaging and in addition DW images with b-value of 0 and 1000 mm²/s. On PET/CT the SUVmax of the rectal lesion were calculated in PET1 and PET2. The percentage decrease of SUVmax (ΔSUV) and ADC (ΔADC) values from baseline to presurgical scan were assessed and correlated with pathologic response classified as tumor regression grade (Mandard's criteria; TRG1 = complete regression, TRG5 = no regression).
  
  
  RESULTS
  After completion of therapy, all the patients were submitted to surgery. According to the Mandard's criteria, 22 tumors showed complete (TRG1) or subtotal regression (TRG2) and were classified as responders; 9 tumors were classified as non responders (TRG3, 4 and 5). Considering all patients the mean values of SUVmax in PET 1 was higher than the mean value of SUVmax in PET 2 (P < 0.001), whereas the mean ADC values was lower in RM1 than RM2 (P < 0.001), with a ΔSUV and ΔADC respectively of 60.2% and 66.8%. The best predictors for TRG response were SUV2 (threshold of 4.4) and ADC2 (1.29 × 10(-3) mm(2)/s) with high sensitivity and specificity. Combining in a single analysis both the obtained median value, the positive predictive value, in predicting the different group category response in related to TRG system, presented R(2) of 0.95.
  
  
  CONCLUSIONS
  The functional imaging combining ADC and SUVmax in a single analysis permits to detect changes in cellular tissue structures useful for the assessment of tumour response after the neoadjuvant therapy in rectal cancer, increasing the sensitivity in correct depiction of treatment response than either method alone.
authors.affiliation: Davide Ippolito, Davide Fior, Chiara Trattenero, Elena De Ponti, Silvia Drago, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Ippolito
authors.affiliation: Davide Ippolito, Davide Fior, Chiara Trattenero, Elena De Ponti, Silvia Drago, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Fior
authors.affiliation: Davide Ippolito, Davide Fior, Chiara Trattenero, Elena De Ponti, Silvia Drago, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Trattenero
authors.affiliation: Davide Ippolito, Davide Fior, Chiara Trattenero, Elena De Ponti, Silvia Drago, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy.
authors.forename: Elena De
authors.initials: ED
authors.lastname: Ponti
authors.affiliation: Davide Ippolito, Davide Fior, Chiara Trattenero, Elena De Ponti, Silvia Drago, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Drago
authors.affiliation: Davide Ippolito, Davide Fior, Chiara Trattenero, Elena De Ponti, Silvia Drago, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Guerra
authors.affiliation: Davide Ippolito, Davide Fior, Chiara Trattenero, Elena De Ponti, Silvia Drago, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy.
authors.forename: Cammillo Talei
authors.initials: CT
authors.lastname: Franzesi
authors.affiliation: Davide Ippolito, Davide Fior, Chiara Trattenero, Elena De Ponti, Silvia Drago, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sironi
keywords: Advanced rectal cancer; Apparent diffusion coefficient; FDG-PET/CT; Functional imaging; Magnetic resonance imaging; Neoadjuvant treatment; Tumor regression grade