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
ARTICLE HIGHLIGHTS
Research background

The accuracy of discriminating pT3a from pT3b-c rectal cancer using high-resolution magnetic resonance imaging remains unsatisfactory. Indeed, the mean and median apparent diffusion coefficient (ADC) values are not always significantly sensitive to small changes or precise status of the tumor owing to the intrinsic chaotic environment of tumors.

Research motivation

Texture analysis (TA) could improve the discrimination of pT3a rectal adenocarcinomas from pT3b-c tumors, but pT3 subclasses of rectal cancer have not been previously determined by ADC maps.

Research objectives

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

Research methods

This case-control study assessed patients with pT3 rectal adenocarcinoma, who underwent DWI between October 2016 and December 2018. 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 (ROC) curves were used to determine the diagnostic value for pT3b-c tumors.

Research results

Totally 59 patients (34 men and 25 women) were included, with a median age of 66 years (range, 41-85 years). Thirty patients had pT3a, 24 had pT3b, and five had pT3c. Skewness was significantly lower in the pT3a stage than in pT3b-c tumors. In addition, energy and entropy were significantly different between pT3a rectal adenocarcinomas and pT3b-c tumors. 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).

Research conclusions

TA features derived from ADC maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors, especially skewness, energy, and entropy and their combination.

Research perspectives

Future studies should include T2WI-based TA, since high-resolution T2WI plays a pivotal role in the preoperative staging of rectal cancer, and b-values should also be taken into account. In addition, features with long-term clinical applicability should be assessed. Finally, large multicenter studies are needed to confirm and increase the generalizability of the above findings.