Evaluation of preoperative chemoradiation therapy for lower rectal carcinoma using DWIBS

We investigated the efficacy of diffusion-weighed whole body imaging with background body signal suppression (DWIBS) in assessing effects of chemoradiation therapy (CRT) on rectal carcinoma. DWIBS was performed in patients (n = 12) with primary rectal carcinoma undergoing preoperative CRT before and 3 weeks after the treatment. Each patient received a total irradiation dose of 45 Gy at a single dose of 1.8 Gy administered once daily. Parallel to this, in the 1 st, 3rd and 5th weeks 350 mg/m² 5-fluorouracil and 35 mg/m² Heucovorin were administered for 5 days. The apparent diffusion coefficient (ADC) was measured by DWIBS and surgical resection of the tumors enabled a correlation of ADC values with the pathological findings. With respect to histopathological grading of regression, two, five and five cases exhibited Grade 3, Grade 2 and Grade 1, respectively. In all patients, ADC values were higher after completion of CRT compared to those before it (1.23±0.26 × 10^-3mm²/s vs 0.75±0.13 × 10^-3mm²/s, p<0.001). After completion of CRT, mean ADC values were 1.71 ±0.38 × 10- ³mm²/s, 1.25±0.10 × 10^-3mm ²/s and 1.02±0.08 × 10^-3mm²/s for Grade 3, Grade 2 and Grade 1, respectively. These preliminary results indicate that DWIBS may be a valuable tool to assess effects of CRT on rectal carcinoma by using appropriate cut-off values.