Diffusion-Weighted Magnetic Resonance Imaging of 103 Patients with Rectal Adenocarcinoma Identifies the Apparent Diffusion Coefficient as an Imaging Marker for Tumor Invasion and Regional Lymph Node Involvement.

BACKGROUND This retrospective study included 103 patients diagnosed with rectal adenocarcinoma at a single center in Poland who underwent preoperative diffusion-weighted magnetic resonance imaging (DWI) and aimed to determine whether the apparent diffusion coefficient (ADC) was an imaging marker for tumor invasion and regional lymph node involvement. MATERIAL AND METHODS We analyzed primary staging magnetic resonance examinations of the rectum of 103 consecutive patients with histologically proven non-mucinous adenocarcinoma who underwent surgical treatment. In 85 patients, surgery was preceded by long-course chemoradiotherapy (n=18) or short-course radiotherapy (n=67). The following DWI parameters were measured: ADC mean, minimum, maximum, and standard deviation in the region of interest (ADC SD-in-ROI). Values were compared between subgroups based on histological parameters from the report: tumor stage, lymph node stage, differentiation grade, the presence of extranodal tumor deposits, angioinvasion, and perineural invasion. Statistical analysis was performed using the Mann-Whitney U test and the unilateral t test. RESULTS ADC mean values were lower for cases in which postoperative histopathological examination lymph node invasion (P=0.04) and tumor deposits were found (P=0.04). Minimal ADC value was higher in cases in which tumor deposits were not found (P=0.009). ADC SD-in-ROI values were lower in cases in which lymph nodes invasion was confirmed (P=0.014). There were no statistically significant differences for other parameters. CONCLUSIONS The ADC values in pre-treatment DWI in patients with rectal adenocarcinoma were correlated with tumor invasion and regional lymph node metastases. Therefore, ADC values from the pre-treatment MRI may help plan adjuvant therapy in patients with rectal adenocarcinoma.