title: Intravoxel Incoherent Motion-derived Histogram Metrics for Assessment of Response after Combined Chemotherapy and Radiation Therapy in Rectal Cancer: Initial Experience and Comparison between Single-Section and Volumetric Analyses.
abstract: Purpose To determine the diagnostic performance of intravoxel incoherent motion (IVIM) parameters and apparent diffusion coefficient (ADC) to assess response to combined chemotherapy and radiation therapy (CRT) in patients with rectal cancer by using histogram analysis derived from whole-tumor volumes and single-section regions of interest (ROIs). Materials and Methods The institutional review board approved this retrospective study of 31 patients with rectal cancer who underwent magnetic resonance (MR) imaging before and after CRT, including diffusion-weighted imaging with 34 b values prior to surgery. Patient consent was not required. ADC, perfusion-related diffusion fraction (f), slow diffusion coefficient (D), and fast diffusion coefficient (D*) were calculated on MR images acquired before and after CRT by using biexponential fitting. ADC and IVIM histogram metrics and median values were obtained by using whole-tumor volume and single-section ROI analyses. All ADC and IVIM parameters obtained before and after CRT were compared with histopathologic findings by using t tests with Holm-Sidak correction. Receiver operating characteristic curves were generated to evaluate the diagnostic performance of IVIM parameters derived from whole-tumor volume and single-section ROIs for prediction of histopathologic response. Results Extreme values aside, results of histogram analysis of ADC and IVIM were equivalent to median values for tumor response assessment (P > .06). Prior to CRT, none of the median ADC and IVIM diffusion metrics correlated with subsequent tumor response (P > .36). Median D and ADC values derived from either whole-volume or single-section analysis increased significantly after CRT (P ≤ .01) and were significantly higher in good versus poor responders (P ≤ .02). Median IVIM f and D* values did not significantly change after CRT and were not associated with tumor response to CRT (P > .36). Interobserver agreement was excellent for whole-tumor volume analysis (range, 0.91-0.95) but was only moderate for single-section ROI analysis (range, 0.50-0.63). Conclusion Median D and ADC values obtained after CRT were useful for discrimination between good and poor responders. Histogram metrics did not add to the median values for assessment of tumor response. Volumetric analysis demonstrated better interobserver reproducibility when compared with single-section ROI analysis. (©) RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nougaret
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Hebert Alberto
authors.initials: HA
authors.lastname: Vargas
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lakhman
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Romain
authors.initials: R
authors.lastname: Sudre
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Richard K G
authors.initials: RK
authors.lastname: Do
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Frederic
authors.initials: F
authors.lastname: Bibeau
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: David
authors.initials: D
authors.lastname: Azria
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Eric
authors.initials: E
authors.lastname: Assenat
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Marie-Ange
authors.initials: MA
authors.lastname: Pierredon
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Philippe
authors.initials: P
authors.lastname: Rouanet
authors.affiliation: From the Department of Abdominal Imaging, Saint Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (S.N., M.A.P., B.G.); Institute of Cancer Research of Montpellier (IRCM-U1194), Montpellier, France (S.N., F.B., D.A., B.G.); INSERM, Unit 896, Montpellier, France (S.N., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (H.A.V., Y.L., R.K.G.D.); Departments of Radiology (R.S.), Histopathology (F.B.), Oncology and Radiation Therapy (D.A., E.A.), and Surgery (P.R.), Montpellier Cancer Institute, Montpellier, France; and Department of Statistics-IMAG, Montpellier University, CHU Montpellier, Montpellier, France (N.M.).
authors.forename: Boris
authors.initials: B
authors.lastname: Guiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009038:Motion; D011878:Radiotherapy; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D012007:Rectum / Q000000981:diagnostic imaging / Q000187:drug effects / Q000528:radiation effects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome