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Prediction of tumor budding in patients with rectal adenocarcinoma using b-value threshold map

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate the feasibility of b-value threshold (bThreshold) map in preoperative evaluation of tumor budding (TB) in patients with locally advanced rectal cancer (LARC).

Methods

Patients with LARC were enrolled and underwent diffusion-weighted imaging (DWI). Contrast-to-noise ratio (CNR) between the lesions and normal tissues was assessed using DWI and bThreshold maps. TB was counted and scored using hematoxylin and eosin staining. Reproducibility for the apparent diffusion coefficient (ADC), bThreshold values, and region-of-interest (ROI) sizes were compared. Differences in ADC and bThreshold values with low-intermediate and high TB grades and the correlations between mean ADC and bThreshold values with TB categories were analyzed. Diagnostic performance of ADC and bThreshold values was assessed using area under the curve (AUC) and decision curve analysis.

Results

Fifty-one patients were evaluated. The CNR on bThreshold maps was significantly higher than that on DW images (9.807 ± 4.811 vs 7.779 ± 3.508, p = 0.005). Reproducibility was excellent for the ADC (ICC 0.933; CV 8.807%), bThreshold values (ICC 0.958; CV 7.399%), and ROI sizes (ICC 0.934; CV 8.425%). Significant negative correlations were observed between mean ADC values and TB grades and positive correlations were observed between mean bThreshold values and TB grades (p < 0.05). bThreshold maps showed better diagnostic performance than ADC maps (AUC, 0.914 vs 0.726; p = 0.048).

Conclusions

In LARC patients, bThreshold values could distinguish different TB grades better than ADC values, and bThreshold maps may be a preoperative, non-invasive approach to evaluate TB grades.

Key Points

• Compared with diffusion-weighted images, b Threshold maps improved visualization and detection of rectal tumors.

• Agreement and diagnostic performance of b Threshold values are superior to apparent diffusion coefficient in assessing tumor budding grades in patients with locally advanced rectal cancer.

• b Threshold maps could be used to evaluate tumor budding grades non-invasively before operation.

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Abbreviations

ADC:

Apparent diffusion coefficient

b Threshold :

b-value threshold

CNR:

Contrast-to-noise ratio

CRC:

Colorectal cancer

DWI:

Diffusion-weighted imaging

LARC:

Locally advanced rectal cancer

MRI:

Magnetic resonance imaging

RC:

Rectal cancer

TB:

Tumor budding

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Funding

This study has received funding by the National Key Clinical Specialist Construction Programs of China (Grant Number N/A); Youth Initiative Fund of Naval Medical University (Grant Number 2018QN05), and Natural Science Foundation of Shanghai (Grant Number 20ZR1456300).

Author information

Author notes

  1. Fangying Chen and Shaoting Zhang contributed equally.

Authors and Affiliations

  1. Department of Radiology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Shanghai, 200433, China

    Fangying Chen, Shaoting Zhang, ** Lu, Fu Shen & Luguang Chen

  2. Department of Pathology, Changhai Hospital, Shanghai, China

    Yan Zhu & Chenguang Bai

  3. MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China

    Caixia Fu

  4. MR Applications Predevelopment, Siemens Healthineers Ltd., Erlangen, Germany

    Robert Grimm

Authors
  1. Fangying Chen
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Corresponding authors

Correspondence to Fu Shen or Luguang Chen.

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Guarantor

The scientific guarantor of this publication is Luguang Chen.

Conflict of interest

Two coauthors (Caixia Fu and Robert Grimm) are employees of Siemens Healthcare, and they declared that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Twenty-nine patients with pathologically proven as T2 or T3, had been partially reported in our previous study, were included and we further enlarged the sample size in the present study. Previous work mainly aimed to investigate the usefulness of b-value threshold (bThreshold) map in the evaluation of rectal adenocarcinoma by comparing it with diffusion-weighted images and ADC maps regarding lesion detection and the prediction of pathological features, which found that compared with DWI, the bThreshold map offers significantly higher CNR, which improves lesion visualization and detection. bThreshold values could differentiate between pathologic differentiation degrees and T stages and have a better diagnostic performance than ADC for N staging, while several reports showed that tumor budding (TB) is an indicator of metastasis and adverse reaction to neoadjuvant therapy in colorectal cancers, which help assess individualized therapeutic strategies. However, a preoperative and non-invasive approach to evaluate TB grades is lacking. Therefore, the purpose of the current study was to investigate the feasibility of bThreshold maps in preoperative evaluations of TB in patients with locally advanced rectal cancer (LARC), which found bThreshold values could distinguish different TB grades better than ADC values in LARC patients, and bThreshold maps may be a preoperative, non-invasive approach to evaluate TB grades.

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Chen, F., Zhang, S., Ma, X. et al. Prediction of tumor budding in patients with rectal adenocarcinoma using b-value threshold map. Eur Radiol 33, 1353–1363 (2023). https://doi.org/10.1007/s00330-022-09087-6

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  • DOI: https://doi.org/10.1007/s00330-022-09087-6

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