MR Imaging with Apparent Diffusion Coefficient Histogram Analysis: Evaluation of Locally Advanced Rectal Cancer after Chemotherapy and Radiation Therapy

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Abstract
Our hypothesis in the study is that post–chemotherapy and radiation therapy skewness of the apparent diffusion coefficient histogram and percentage change in apparent diffusion coefficient can help predict a favorable response to neoadjuvant chemotherapy and radiation therapy in patients with locally advanced rectal cancer. PurposeTo determine response to neoadjuvant chemotherapy and radiation therapy in patients with locally advanced rectal cancer (LARC) by using magnetic resonance (MR) apparent diffusion coefficient (ADC) histogram analysis.Materials and MethodsNinety-two patients with LARC underwent MR imaging with rectal barium before and after chemotherapy and radiation therapy (CRT). Rectal expansion with barium expanded the lumen, provided similar imaging geometry before and after CRT, and eliminated fecal matter, air, and residual fluid. T2-weighted images, the percentage change in ADC, and ADC histogram skewness and kurtosis were assessed. The histopathologic tumor regression grade (TRG) ranged from 1a (66%–99% residual tumor cells) to 3 (no residual cells). The Wilcoxon signed-rank test, the Spearman correlation test, multivariable linear regression, and one-way analysis of variance were used to determine post- and pretreatment differences and correlations between tumor size and ADC.ResultsOf the 92 patients, 16 (1...

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