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Evaluation of peritumoral and intratumoral apparent diffusion coefficient parameters for the diagnosis of pathological factors in resectable rectal cancer
SUN Yancong  XIE Beichen  NIU Jin  DUAN Jinhui  ZHANG Jian  YAN Ruifang 

Cite this article as: SUN Y C, XIE B C, NIU J, et al. Evaluation of peritumoral and intratumoral apparent diffusion coefficient parameters for the diagnosis of pathological factors in resectable rectal cancer[J]. Chin J Magn Reson Imaging, 2023, 14(7): 53-60. DOI:10.12015/issn.1674-8034.2023.07.010.

[Abstract] Objective To investigate the diagnostic value of peritumoral and intratumoral apparent diffusion coefficient (ADC) in the pathological prognostic factors of resectable rectal cancer.Materials and Methods Sixty-eight patients with rectal cancer who received preoperative MRI were retrospectively analyzed. Two radiologists independently placed three circular regions of interest (ROIs) with an area of about 20 mm2 in the largest cross section of the tumor, and three oval ROIs with an area of about 22 mm2 in the peritumoral region adjacent to the tumor contour. The maximum of tumor ADC (ADCtmax), minimum of tumor ADC (ADCtmin), mean of tumor ADC (ADCtmean), maximum of peritumoral ADC (ADCpmax), mean of peritumoral ADC (ADCpmean) and ADCpmean/ADCtmean (ADC ratio) were obtained, and the differences between groups with different prognostic factors were compared. Independent sample t test, Mann-Whitney U test and χ² test were used to compare whether the difference was statistically significant. The variables with statistically significant differences in univariate analysis were included in multivariate logistic regression analysis to screen out independent risk factors and establish a joint prediction model. Receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC), and the diagnostic efficacy of each parameter and the combined prediction model for pathological prognostic factors was analyzed. DeLong test was used to compare whether the AUC of different parameters and a joint prediction model was statistically different.Results The inter-observer agreement of the parameters was good [intraclass correlation coefficient (ICC)>0.75]. The ADC ratio of T3 group was higher than that of T1-T2 group, poorly differentiated group was higher than that of moderately well differentiated group, lymph node metastasis (LNM) positive group was higher than that of LNM negative group, tumor deposition (TD) positive group was higher than TD negative group, lymphovascular infiltration (LVI) positive group was higher than LVI negative group, ADCtmean in T1-T2 group was higher than T3 group, LNM negative group was higher than LNM positive group. ADCpmean in T1-T2 group was lower than that in T3 group, TD positive group was higher than that in TD negative group, and LVI positive group was higher than that in LVI negative group, and the differences were statistically significant (P<0.05). The ROC curve analysis showed that the AUCs of ADC ratio in predicting T3, LNM-positive, high differentiation, TD-positive, and LVI-positive were 0.803 [95% (confidence interval, CI): 0.694-0.911], 0.737 (95% CI: 0.614-0.859), 0.787 (95% CI: 0.628-0.945), 0.706 (95% CI: 0.572-0.841), and 0.802 (95% CI: 0.685-0.919); the AUCs of ADCtmean in predicting T3 and LNM-positive were 0.737 (95% CI: 0.617-0.858) and 0.683 (95% CI: 0.548-0.818); the AUCs of ADCpmean in predicting T3, TD-positive, and LVI-positive were 0.691 (95% CI: 0.566-0.816), 0.702 (95% CI: 0.566-0.838), and 0.763 (95% CI: 0.647-0.880).Conclusions Peritumoral and intratumoral ADC parameters are important for the diagnosis of pathological factors in resectable rectal cancer, the AUC values of ADC ratio in T stage, LNM, TD and LVI of rectal cancer were higher than those of ADCtmean and ADCpmean.
[Keywords] rectal cancer;peritumoral tissue;within the tumor tissue;diffusion weighted imaging;apparent dispersion coefficient;magnetic resonance imaging;diagnosis;prognosis

SUN Yancong   XIE Beichen   NIU Jin   DUAN Jinhui   ZHANG Jian   YAN Ruifang*  

Department of Magnetic Resonance, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China

Corresponding author: Yan RF, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Medical Science and Technology Research Program of Henan Province (No. LHGJ20200519).
Received  2022-11-23
Accepted  2023-06-25
DOI: 10.12015/issn.1674-8034.2023.07.010
Cite this article as: SUN Y C, XIE B C, NIU J, et al. Evaluation of peritumoral and intratumoral apparent diffusion coefficient parameters for the diagnosis of pathological factors in resectable rectal cancer[J]. Chin J Magn Reson Imaging, 2023, 14(7): 53-60. DOI:10.12015/issn.1674-8034.2023.07.010.

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