Diffusion kurtosis imaging in the prediction of poor responses of locally advanced gastric cancer to neoadjuvant chemotherapy

• Published in: European journal of radiology Vol. 128; p. 108974
• Main Authors: Fu, Jia, Tang, Lei, Li, Zi-Yu, Li, Xiao-Ting, Zhu, Hai-Feng, Sun, Ying-Shi, Ji, Jia-Fu
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.07.2020
• Subjects: Aged; Apparent diffusion coefficient (ADC); Area Under Curve; Diffusion kurtosis imaging (DKI); Diffusion Magnetic Resonance Imaging - methods; Female; Gastric cancer; Humans; Image Interpretation, Computer-Assisted - methods; Male; Middle Aged; Neoadjuvant Therapy - methods; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Response prediction; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - drug therapy; Treatment Outcome; Apparent diffusion coefficient (ADC); Gastric cancer; Response prediction; Diffusion kurtosis imaging (DKI)
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2020.108974

•The kurtosis values can better predict the poor responders compared to ADC on DWI.•Poor response group of gastric cancer had higher kurtosis values than effective response group.•The parameters from different DWI models may predict poor responders. To assess the efficacy of diffusion kurtosis imaging (DKI) in the prediction of the treatment response to neoadjuvant chemotherapy in patients with locally advanced gastric cancer (LAGC). A total of 31 LAGC patients were enrolled in this prospective study. All patients underwent diffusion-weighted MRI examination (with b = 01, 2001, 5001, 8002, 10004, 15004, 20006 s/mm2, the subscript denotes the number of signal averages) before and after chemotherapy. DKI and mono-exponential (b = 0, 800 s/mm2) models were built. Apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) of the LAGC tumors were measured. The absolute change values (ΔX) and percentage change values (%ΔX) of the above parameters post neoadjuvant chemotherapy (NACT) were calculated. The response was evaluated according to the pathological tumor regression grade scores (effective response group: TRG 0–2, poor response group: TRG 3). Mann–Whitney U test and receiver operating characteristic (ROC) curves were applicated for statistical analysis. There were 17 patients in the effective response group (ERG), and 14 patients in the poor response group (PRG). The MKpre and MKpost values in PRG were significantly higher than those in ERG [(0.671 ± 0.026) and (0.641 ± 0.019) vs. (0.584 ± 0.023) and (0.519 ± 0.018), p < 0.001]. ADCpost and MDpost in PRG were significantly lower than those in ERG (p = 0.005, p =0.001). Significant differences were also observed for % ΔMK, ΔMD and ΔMK between the two groups (p < 0.05). The area under the curve (AUC) for the prediction of PRG was highest for MKpost (AUC = 0.958, cutoff value = 0.614). The MKpre and MKpost had the highest sensitivity (91.70 %) and specificity (93.80 %) in the prediction of PRG, respectively. Both DKI and ADC values show potential for the prediction of the PRG in LAGC patients. The DKI parameters, especially MKpost displayed the best performance.