Perfusion MRI for the prediction of treatment response after preoperative chemoradiotherapy in locally advanced rectal cancer

To evaluate the utility of perfusion MRI as a potential biomarker for predicting response to chemoradiotherapy (CRT) in locally advanced rectal cancer. Thirty-nine patients with primary rectal carcinoma who were scheduled for preoperative CRT were prospectively recruited. Perfusion MRI was performed with a 3.0-T MRI system in all patients before therapy, at the end of the 2nd week of therapy, and before surgery. The K (trans) (volume transfer constant) and V (e) (extracellular extravascular space fraction) were calculated. Before CRT, the mean tumour K (trans) in the downstaged group was significantly higher than that in the non-downstaged group (P = 0.0178), but there was no significant difference between tumour regression grade (TRG) responders and TRG non-responders (P = 0.1392). Repeated-measures analysis of variance (ANOVA) showed significant differences for evolution of K (trans) values both between downstaged and non-downstaged groups (P = 0.0215) and between TRG responders and TRG non-responders (P = 0.0001). Regarding V (e), no significant differences were observed both between downstaged and non-downstaged groups (P = 0.689) or between TRG responders and TRG non-responders (P = 0.887). Perfusion MRI of rectal cancer can be useful for assessing tumoural K (trans) changes by CRT. Tumours with high pre-CRT K (trans) values tended to respond favourably to CRT, particularly in terms of downstaging criteria. aEuro cent Perfusion MRI can now assess therapeutic response of tumours to therapy. aEuro cent Tumours with high initial K (trans) values responded favourably to chemoradiotherapy. aEuro cent Perfusion MRI of rectal cancer may help with decisions about management.