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      Are ADC values of readout-segmented echo-planar diffusion-weighted imaging (RESOLVE) correlated with pathological prognostic factors in rectal adenocarcinoma?

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          Abstract

          Background

          Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values as imaging biomarkers of rectal cancer are currently a hot research spot. The use of ADC values for preoperative judgment of pathological features in rectal cancer has been generally accepted. The image quality evaluation of conventional diffusion is severe deformation, and the measurement of ADC values can easily lead to bias. Readout-segmented echo-planar diffusion-weighted imaging (RESOLVE) provides high signal-to-noise ratio images and significantly reduces distortions caused by magnetosensitive effects. The purpose of this study was to explore the correlations between ADC values of RESOLVE and pathological prognostic factors in rectal adenocarcinoma.

          Methods

          We collected pathological data of 89 patients with pathologically confirmed rectal adenocarcinoma who directly underwent surgical resection without receiving adjuvant therapy. The patients were grouped according to the pathologic type, gross classification, degree of differentiation, TN stage, and immunohistochemical expression of epidermal growth factor receptor (EGFR).

          Results

          RESOLVE ADC values of rectal cancer were measured at b = 800, and correlations between the RESOLVE ADC values obtained in different groups were analysed. We found that RESOLVE ADC values in the ulcer-type group were significantly higher than those in the eminence-type group.

          Conclusion

          RESOLVE ADC values in different pathologic types of rectal cancer were significantly different. RESOLVE ADC values in the EGFR-positive group were significantly lower than those in the EGFR-negative group. There was no significant difference in RESOLVE ADC values between different degrees of pathologic differentiation, TN stages, and positive or negative lymph nodes. The quantitative description of RESOLVE ADC values could be used to assess the biological behaviour of rectal adenocarcinoma.

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          Most cited references27

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          High resolution diffusion-weighted imaging using readout-segmented echo-planar imaging, parallel imaging and a two-dimensional navigator-based reacquisition.

          Single-shot echo-planar imaging (EPI) is well established as the method of choice for clinical, diffusion-weighted imaging with MRI because of its low sensitivity to the motion-induced phase errors that occur during diffusion sensitization of the MR signal. However, the method is prone to artifacts due to susceptibility changes at tissue interfaces and has a limited spatial resolution. The introduction of parallel imaging techniques, such as GRAPPA (GeneRalized Autocalibrating Partially Parallel Acquisitions), has reduced these problems, but there are still significant limitations, particularly at higher field strengths, such as 3 Tesla (T), which are increasingly being used for routine clinical imaging. This study describes how the combination of readout-segmented EPI and parallel imaging can be used to address these issues by generating high-resolution, diffusion-weighted images at 1.5T and 3T with a significant reduction in susceptibility artifact compared with the single-shot case. The technique uses data from a 2D navigator acquisition to perform a nonlinear phase correction and to control the real-time reacquisition of unusable data that cannot be corrected. Measurements on healthy volunteers demonstrate that this approach provides a robust correction for motion-induced phase artifact and allows scan times that are suitable for routine clinical application. (c) 2009 Wiley-Liss, Inc.
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            Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity.

            On diffusion-weighted imaging (DWI), metastatic tumors of the brain may exhibit different signal intensities (SI) depending on their histology and cellularity. The purpose of our study was to verify the hypotheses (1) that SI on DWI predict the histology of metastases and (2) that apparent diffusion coefficient (ADC) values reflect tumor cellularity. We assessed conventional MR images, DWI, and ADC maps of 26 metastatic brain lesions from 26 patients, 13 of whom underwent surgery after the MR examination. Two radiologists performed qualitative assessment by consensus of the SI on DWI in areas corresponding to their enhancing portions. We measured the contrast-to-noise ratio (CNR) on T2-weighted images and normalized ADC (nADC) values, and compared them with tumor cellularity. The mean SI on DWI and the CNR on T2-weighted images were significantly lower in well differentiated than in poorly differentiated adenocarcinomas and lesions other than adenocarcinoma. The mean nADC value was significantly higher in well differentiated than poorly differentiated adenocarcinomas and lesions other than adenocarcinoma. All 3 small-cell carcinomas and 1 large-cell neuroendocrine carcinoma exhibited high SI on DWI. The nADC value showed a significant inverse correlation with tumor cellularity. There was no significant correlation between the CNR and tumor cellularity. The SI on DWI may predict the histology of metastases; well differentiated adenocarcinomas tended to be hypointense, and small- and large-cell neuroendocrine carcinomas showed hyperintensity. Their ADC values reflect tumor cellularity.
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              EGFR FISH assay predicts for response to cetuximab in chemotherapy refractory colorectal cancer patients.

              Standardized conditions to distinguish subpopulations of colorectal cancer (CRC) patients more and less sensitive to cetuximab therapy remain undefined. We retrospectively analyzed epidermal growth factor receptor (EGFR) copy number by fluorescence in situ hybridization (FISH) in paraffin-embedded tumor blocks from 85 chemorefractory CRC patients treated with cetuximab. Results were analyzed according to different score systems previously reported in colorectal and lung cancers. The primary end point of the study was identification of the EGFR FISH score that best associates with response rate (RR). Using receiver operating characteristic (ROC) analysis, the cut-off that best discriminated responders versus nonresponders to cetuximab was a mean of 2.92 EGFR gene copies per cell. This model showed sensitivity of 58.6% [95% confidence interval (CI) = 47.1-70.1) and specificity of 93.3% (95% CI = 80.6-100). EGFR FISH-positive patients (N = 43, 50.6%) had significantly higher RR (P = 0.0001) and significantly longer time to disease progression (P = 0.02) than EGFR FISH negative (N = 42, 49.4%). Other scoring systems resulted less accurate in discriminating patients with the highest likelihood of response to cetuximab therapy. CRC patients with high EGFR gene copy number have an increased likelihood to respond to cetuximab therapy. Prospective clinical trials with a careful standardization of assay conditions and pattern interpretation are urgently needed.
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                Author and article information

                Contributors
                tangcui82@163.com
                lmb_tjyy14@163.com
                xujl_521@163.com
                zhanglh_876@163.com
                zxming_888@163.com
                zhang@siemens.com
                liu@siemens-healthineers.com
                +86-021-65690520 , xululu450@163.com
                Journal
                World J Surg Oncol
                World J Surg Oncol
                World Journal of Surgical Oncology
                BioMed Central (London )
                1477-7819
                12 July 2018
                12 July 2018
                2018
                : 16
                : 138
                Affiliations
                [1 ]ISNI 0000000123704535, GRID grid.24516.34, Department of Radiology, , Tongji University Affiliated Yangpu Hospital, ; No. 450 Tengyue Road, Shanghai, 200090 China
                [2 ]ISNI 0000000123704535, GRID grid.24516.34, Department of General Surgery, , Tongji University Affiliated Yangpu Hospital, ; Shanghai, 200090 China
                [3 ]ISNI 0000000123704535, GRID grid.24516.34, Department of Pathology, , Tongji University Affiliated Yangpu Hospital, ; Shanghai, 200090 China
                [4 ]SIEMENS Healthineers Ltd., Shanghai, China
                Author information
                http://orcid.org/0000-0003-4033-1851
                Article
                1445
                10.1186/s12957-018-1445-z
                6043992
                30001205
                74c16d1c-bd18-4088-b16a-d3925c43cd7b
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 6 February 2018
                : 5 July 2018
                Funding
                Funded by: Project of Science and Technology Commission and National Health and Family Planning Commission in Yanpu District of Shanghai
                Award ID: YP15Q07
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Surgery
                rectal cancer,mri,apparent diffusion coefficient,pathology,prognosis
                Surgery
                rectal cancer, mri, apparent diffusion coefficient, pathology, prognosis

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