Diagnostic and Interventional Radiology
Abdominal Imaging - Original Article

Can diffusion-weighted MRI determine complete responders after neoadjuvant chemoradiation for locally advanced rectal cancer?


Departments of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey


Departments of Radiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey


Radiation Oncology, Istanbul University Istanbul School of Medicine, İstanbul, Turkey


Oncology Institute, Istanbul University, İstanbul, Turkey


General Surgery, Istanbul University Istanbul School of Medicine, İstanbul, Turkey


Pathology, Istanbul University Istanbul School of Medicine, İstanbul, Turkey


Public Health, Istanbul University Istanbul School of Medicine, İstanbul, Turkey

Diagn Interv Radiol 2012; 18: 574-581
DOI: 10.4261/1305-3825.DIR.5755-12.1
Read: 816 Downloads: 561 Published: 03 September 2019


We aimed to prospectively determine if analyzing pre- and post-chemoradiotheraphy (CRT) changes in the signal intensity (SI) and apperent diffusion coefficient (ADC) values from diffusion-weighted magnetic resonance imaging (DW-MRI) can accurately predict complete responders for locally advanced rectal cancer. 


Thirty patients (mean age, 54.3 years) with locally advanced rectal cancer who underwent neoadjuvant CRT and subsequent surgery were included in this study. All patients were evaluated pre- and post-CRT by standardized turbo spin echo and DW-MRI. Pre- and post-CRT tumor and normal rectal wall SI (which were gradually scored as very high, high, intermediate, low, and no signal) and ADC values were recorded. 


Tumor SIs were decreased in all of the patients that had a therapy response. However, complete tumor SI loss was only seen in two (22.2%) of nine patients with a pathological complete response, while it regressed to low and/or intermediate SI levels in the remaining seven patients (77.8%). Post-CRT ADC values of rectal tumors were significantly higher from the preCRT ADC values (P < 0.0001; Z=-9.39). However, post-CRT ADC values from the complete and partial/no response patient groups were not significantly different (P = 0.071; Z=-1.99). 


In re-staging of rectal tumors by DW-MRI, an increase in ADC values and decrease in SIs can predict therapy response but cannot unequivocally determine a complete response.

EISSN 1305-3612