Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2021; 9(24): 6987-6998
Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.6987
Textural differences based on apparent diffusion coefficient maps for discriminating pT3 subclasses of rectal adenocarcinoma
Zhi-Hua Lu, Kai-Jian Xia, Heng Jiang, Jian-Long Jiang, Mei Wu
Zhi-Hua Lu, Heng Jiang, Department of Radiology, Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China
Kai-Jian Xia, Department of Information, Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China
Jian-Long Jiang, Department of Surgery, Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China
Mei Wu, Department of Pathology, Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China
Author contributions: Lu ZH conceived and coordinated the study, designed, performed, and analyzed the experiments, and wrote the paper; Xia KJ, Jiang H, Jiang JL, and Wu M carried out the data collection and analysis, and revised the paper; all authors reviewed the results and approved the final version of the manuscript.
Supported by Jiangsu Provincial Medical Youth Talent, No. QNRC2016212; Suzhou Clinical Special Disease Diagnosis and Treatment Program, No. LCZX201823; Suzhou GuSu Medical Talent Project, No. GSWS2019077; The Science and Technology Bureau of Changshu, No. CS201624 (to Lu ZH); and Jiangsu Committee of Health, No. H2018071 (to Xia KJ).
Institutional review board statement: This case-control study was approved by the Institutional Review Board of the Changshu Hospital Affiliated to Soochow University (2018 Ethics Audit (Declaration) Batch No. 3).
Informed consent statement: The requirement for individual informed consent was waived because of the retrospective design of the study.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Hua Lu, MD, Doctor, Department of Radiology, Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People's Hospital, No. 1 Shuyuan Street, Changshu 215500, Jiangsu Province, China. luzhihua79@163.com
Received: January 1, 2021
Peer-review started: January 1, 2021
First decision: January 24, 2021
Revised: March 1, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: August 26, 2021
Processing time: 235 Days and 0.4 Hours
Abstract
BACKGROUND

The accuracy of discriminating pT3a from pT3b-c rectal cancer using high-resolution magnetic resonance imaging (MRI) remains unsatisfactory, although texture analysis (TA) could improve such discrimination.

AIM

To investigate the value of TA on apparent diffusion coefficient (ADC) maps in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors.

METHODS

This was a case-control study of 59 patients with pT3 rectal adenocarcinoma, who underwent diffusion-weighted imaging (DWI) between October 2016 and December 2018. The inclusion criteria were: (1) Proven pT3 rectal adenocarcinoma; (2) Primary MRI including high-resolution T2-weighted image (T2WI) and DWI; and (3) Availability of pathological reports for surgical specimens. The exclusion criteria were: (1) Poor image quality; (2) Preoperative chemoradiation therapy; and (3) A different pathological type. First-order (ADC values, skewness, kurtosis, and uniformity) and second-order (energy, entropy, inertia, and correlation) texture features were derived from whole-lesion ADC maps. Receiver operating characteristic curves were used to determine the diagnostic value for pT3b-c tumors.

RESULTS

The final study population consisted of 59 patients (34 men and 25 women), with a median age of 66 years (range, 41-85 years). Thirty patients had pT3a, 24 had pT3b, and five had pT3c. Among the ADC first-order textural differences between pT3a and pT3b-c rectal adenocarcinomas, only skewness was significantly lower in the pT3a tumors than in pT3b-c tumors. Among the ADC second-order textural differences, energy and entropy were significantly different between pT3a and pT3b-c rectal adenocarcinomas. For differentiating pT3a rectal adenocarcinomas from pT3b-c tumors, the areas under the curves (AUCs) of skewness, energy, and entropy were 0.686, 0.657, and 0.747, respectively. Logistic regression analysis of all three features yielded a greater AUC (0.775) in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors (69.0% sensitivity and 83.3% specificity).

CONCLUSION

TA features derived from ADC maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors.

Keywords: Diffusion-weighted imaging; Apparent diffusion coefficient; Rectal cancer; Cancer stage; Texture analysis; case-control study

Core Tip: Texture features derived from apparent diffusion coefficient maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors.