Distinguishing T1-2 and T3a tumors of rectal cancer with texture analysis and functional MRI parameters
Year: 2022
Type: article
Study design: Observational Study
Abstract: We aimed to investigate whether the texture analysis and functional magnetic resonance imaging (fMRI) could differentiate rectal cancer pathological stages T1-2 (pT1-2) and T3a (pT3a). METHODSEighty-two rectal adenocarcinoma patients at stage pT1-2 and pT3a received T2 and fMRI examination before surgery.The latter included apparent diffusion coefficient (ADC) sequence, dynamic contrast enhancement (DCE) MRI, and intravoxel incoherent motion (IVIM) diffusion weighted imaging.Patients were grouped into early stage (pT1-2) and advanced stage (pT3a).The MRI accuracy in diagnosing rectal cancer before surgery was calculated.The differences in clinicopathological variables, quantitative parameters including ADC values, IVIM parameters (perfusion fraction [f], true diffusion coefficient [D], and pseudodiffusion coefficient [D*]), DCE MRI parameters (transfer constant [K trans ], reflux constant [K ep ], and extravascular extracellular fractional volume [V e ]), and texture features were compared between the groups.Receiver operating characteristic (ROC) curves of texture features and fMRI parameters were generated to distinguish pT1-2 and pT3a tumors.The multivariate analysis was used to develop a predictive model and to find independent risk factors.Hosmer-Lemeshow test was used to see the fitness of the model.DeLong test was applied to compare the ROC curves of different features.Correlation of texture features and fMRI parameters with stage were calculated using r (Spearman's rank correlation coefficient). RESULTSThe preoperative accuracy in differentiating pT1-2 from pT3a rectal cancer using MRI was 74.39%.K ep , V e , and ADC showed significant differences between the groups.K ep and ADC showed negative correlation with stage.V e correlated positively with stage.Twenty-five texture features from T2 images showed significant differences between groups, and S(0,2)SumOfSqs and WavEnLH_s_2 among these showed better performance, showing negative correlation with stage.The area under the curve (AUC) values of S(0,2)SumOfSqs, WavEnLH_s_2, ADC, K ep , and V e were 0.721, 0.699, 0.690, 0.666, and 0.653, respectively.The multivariate analysis showed that S(0,2) SumOfSqs, WavEnLH_s_2, and ADC are risk factors for advanced tumors, and the logistic model built by K ep , V e , S(0,2)SumOfSqs, WavEnLH_s_2, and ADC has the AUC, sensitivity, and specificity of 0.833, 88.5%, and 73.3%, respectively.ROC curve of the model showed statistical significance between S(0,2)SumOfSqs, ADC, K ep , and V e .The P value of the Hosmer-Lemeshow test was 0.65.CONCLUSION S(0,2)SumOfSqs, WavEnLH_s_2, and ADC are risk factors for advanced rectal cancer, and the model built by K ep , V e , S(0,2)SumOfSqs, WavEnLH_s_2, and ADC has better performance than using a single method.The application of above combinations could be beneficial to patients' accurate and individualized treatments.P atients with early stages of rectal cancer (T1-2) still have the opportunity to receive organ-preserving surgical treatment.1 According to previous research studies, 2,3 neoadjuvant chemoradiotherapy (NCRT) has become essential treatment strategy of great necessity for patients with advanced rectal cancer (T3-4) to improve disease-free survival.This is because patients with advanced rectal cancer have more probability of local recurrence and distant metastasis than those with the early stage of rectal cancer.Magnetic resonance imaging (MRI) has been used for tumor diagnosis due to its extraordinary soft tissue resolution, and clear observation of in depth and extent of tumor Department of Radiology (J.H.
Institution: First Affiliated Hospital of Soochow University
Language: English
Topic: MRI in cancer diagnosis
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Funder: Soochow University
OpenAlex ID: W4280538890