Diffusion-weighted magnetic resonance imaging in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

Abstract
Purpose: To analyze diffusion-weighted magnetic resonance imaging (DW-MRI) for treatment response assessment in locally advanced
rectal cancer (LARC).
Patients and methods: Patients with histologically proven rectal adenocarcinoma, stage IIeIII disease, were enrolled and underwent surgery
following neoadjuvant chemoradiotherapy (nCRT). All patients were referred for a DW-MRI protocol on a 3 Tesla MR-system, consisting
of axial T2-weighted and DWI sequences prior (I), during (II) and after (III) nCRT. Corresponding apparent diffusion coefficient (ADC)
values were calculated.
Results: Between February 2011 and June 2015, 37 patients participated in the study. All patients completed programmed treatment. Overall,
11 patients (29.7%) had pathologic complete response (pCR). No correlation between the mean pre- (ADC-I), during (ADC-II), post-
(ADC-III) ADC and the reduction in tumor size after nCRT was recorded. No substantial difference in the ADC distribution was found
between pCR and no-pCR patients. The ADC-II level significantly increased in the pCR cases (T ¼ 1.675; p < 0.05).
Conclusion: ADC value could be useful for discriminating between the pCR patients and the no-pCR patients. Further studies are necessary
to identify the optimal MRI parameters combination to predict tumor response to nCRT. It is hoped that these data will provide the basis for
a more solid scientific evidence