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The application of apparent diffusion coefficients derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer

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

Abstract

Objective

To investigate the diagnostic performance of the apparent diffusion coefficient (ADC) derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer.

Materials and methods

One hundred forty-six patients with rectal cancer who underwent preoperative MRI were prospectively enrolled. Two radiologists independently placed free-hand regions of interest (ROIs) in the largest tumor cross section and three small ROIs on the peritumoral zone adjacent to the tumor contour. Maximum values of tumor ADC (ADCtmax), minimum values of tumor ADC (ADCtmin), mean values of tumor ADC (ADCtmean), mean values of peritumor ADC (ADCpmean), and ADCpmean/ADCtmean (ADC ratio) were obtained on ADC maps and correlated with prognostic factors using uni- and multivariate logistic regression, and receiver operating characteristic curve (ROC) analysis.

Results

Interobserver agreement was excellent for ADCtmax and ADCtmean (intraclass correlation coefficient [ICC], 0.915–0.958), and were good for ADCtmin, ADCpmean, and ADC ratio (ICC, 0.774–0.878). The ADC ratio was significantly higher in the poor differentiation, T3–4 stage, lymph node metastasis (LNM)–positive, extranodal extension (ENE)–positive, tumor deposit (TD)–positive, and lymphovascular invasion (LVI)–positive groups than that in the well–moderate differentiation, T1–2 stage, LNM-negative, ENE-negative, TD-negative, and LVI-negative groups (p = 0.008, < 0.001, < 0.001, 0.001, < 0.001, and < 0.001, respectively). The area under the ROC curve (AUC) of the ADC ratio was the highest for assessing poor differentiation (0.700), T3–4 stage (0.707), LNM-positive (0.776), TD-positive (0.848), and LVI-positive (0.778). Both the ADC ratio (AUC = 0.677) and ADCpmean (AUC = 0.686) showed higher diagnostic performance for assessing ENE.

Conclusion

The ADC ratio could provide better predictive performance for assessing preoperative prognostic factors in resectable rectal cancer.

Key Points

• Both the peritumor/tumor ADC ratio and ADC pmean are correlated with important prognostic factors of resectable rectal cancer.

• Both peritumor ADC and peritumor/tumor ADC ratio had higher diagnostic performance than tumor ADC for assessment of prognostic factors in resectable rectal cancer.

• Peritumor/tumor ADC ratio showed the most capability for the assessment of prognostic factors in resectable rectal cancer.

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Abbreviations

ADC ratio:

ADCpmean/ADCtmean

ADCpmean :

Mean values of peritumor ADC

ADCtmax :

Maximum values of tumor ADC

ADCtmean :

Mean values of tumor ADC

ADCtmin :

Minimum values of tumor ADC

AUCs:

Areas under the receiver operating characteristic curves

CI:

Confidence interval

ENE:

Extranodal extension

ICC:

Intraclass correlation coefficient

LNM:

Lymph node metastasis

LVI:

Lymphovascular invasion

ROC:

Receiver operating characteristic

ROI:

Region of interest

SD:

Standard deviations

TD:

Tumor deposit

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Acknowledgements

The authors acknowledge Siyun Liu from General Electric Healthcare and Zhenlin Li from The West China Hospital for their great support for the statistical analysis. This study was approved by the Sichuan Provincial People’s Hospital institutional review board. Approval from our institutional animal care committee was not applicable because this is a human research.

Funding

This study has received funding from Sichuan Science and Technology Program (grant number, 2020YFH0166) and the Key Research Project of Sichuan Province (grant number, 2022YFS0249).

Author information

Author notes

  1. Hang Li and Hong Pu contributed equally to this study.

Authors and Affiliations

  1. Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Yi Yuan, Guang-wen Chen, Hong Pu & Hang Li

  2. Department of Radiology, Affiliated Cancer Hospital of Medical School, University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Chengdu, 610000, China

    **ao-li Chen

  3. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China

    Zhen-lin Li

  4. Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Hao Liu

  5. Department of Pathology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Yi-Sha Liu

  6. Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Ming-hui Pang

  7. GE Healthcare (China), 1# Tongji South Road, Daxing District, Bei**g, 100176, China

    Si-yun Liu

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  1. Yi Yuan
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  9. Hong Pu
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  10. Hang Li
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Corresponding author

Correspondence to Hang Li.

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Guarantor

The scientific guarantor of this publication is Hang Li.

Conflict of interest

The authors of this manuscript declare that Siyun Liu is a statistician from GE Healthcare and controls of the study data. The other authors declare no competing interests.

Statistics and biometry

Siyun Liu and Zhenlin Li kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Yuan, Y., Chen, Xl., Li, Zl. et al. The application of apparent diffusion coefficients derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer. Eur Radiol 32, 5106–5118 (2022). https://doi.org/10.1007/s00330-022-08717-3

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  • DOI: https://doi.org/10.1007/s00330-022-08717-3

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