Jalil, O;
Afaq, A;
Ganeshan, B;
Patel, UB;
Boone, D;
Endozo, R;
Groves, A;
... Arulampalam, T; + view all
(2017)
Magnetic resonance-based texture parameters as potential imaging biomarkers for predicting long term survival in locally advanced rectal cancer treated by chemoradiotherapy.
Colorectal Disease
, 19
(4)
pp. 349-362.
10.1111/codi.13496.
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Abstract
AIM: The study aimed to investigate whether textural features of rectal cancer on magnetic resonance imaging (MRI) can predict long term survival in patients treated with long-course chemoradiotherapy. METHOD: Textural analysis (TA) using a filtration-histogram technique of T2-weighted pre- and six-week post chemoradiotherapy MRI was undertaken using TexRAD, a proprietary software algorithm. Regions of interest enclosing the largest cross-sectional area of the tumour were manually delineated on the axial images and filtration-step extracted features at different anatomical scales (fine, medium, and coarse) followed by quantification of statistical features (mean intensity, standard-deviation, entropy, skewness, kurtosis and mean of positive pixels [MPP]) using histogram analysis. Cox multiple regression analysis determined which univariate features including textural, radiological and histological, independently predicted overall survival (OS), disease free survival (DFS) and recurrence-free survival (RFS). RESULTS: MPP (fine-texture, HR: 6.9, 95% CI [2.43-19.55], p= <0.001), mean (medium-texture, HR: 5.6 [1.4-21.7], p=0.007) and extramural venous invasion (EMVI) on MRI (HR: 2.96, [1.04-8.37], p=0.041) independently predicted OS while mean (medium texture, HR: 4.53, [1.58-12.94], p=0.003), MPP (fine texture, HR: 3.36 [1.36-8.31], p=0.008) and threatened circumferential resection margin (CRM) on MRI (HR: 3.1 [1.01-9.46], p=0.046) predicted DFS. For OS; EMVI on MRI (HR: 4.23 [1.41-12.69], p=0.01) and for DFS; kurtosis (medium-texture, HR: 3.97 [1.44-10.94], p=0.007) and CRM involvement on MRI (HR: 3.36 [1.21-9.32], p=0.02) were the independent post-treatment factors. Only TA independently predicted RFS on pre- or post-treatment analyses. CONCLUSION: MR based TA of rectal cancers can predict outcome before undergoing surgery and could potentially select patients for individualized therapy. This article is protected by copyright. All rights reserved.
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