Pretreatment Dynamic Contrast-Enhanced Magnetic Resonance And DWI Imaging For Response Prediction To Neoadjuvant Chemoradiotherapy In Patients With Esophageal Cancer

Background:According to the global cancer burden data released by the World Health Organization in 2020,esophageal cancer is the 7th most common malignant tumor in the world and the 6th leading cause of cancer death.Due to the atypical early symptoms of esophageal cancer,patients were already in a relatively advanced stage when they visited the doctor.The CSCO Grade IA recommendation in 2022 for patients with advanced local esophageal cancer at initial visit is for esophagectomy after neoadjuvant chemoradiotherapy（n CRT）.About 40%of patients obtained pathological complete response（p CR）after n CRT.On the other hand,the complication rate after resection of esophageal cancer is high which seriously affects the quality of life of patients.Therefore,some researchers have proposed whether active observation measures can be taken for esophageal cancer patients who have obtained p CR after n CRT,so that patients can avoid surgical risks and postoperative complications and obtain better quality of life at the same time.However,relatively few studies have been carried out to evaluate whether p CR has been achieved after n CRT,and there is a lack of accurate and non-invasive evaluation methods.Therefore,this study aims to explore diffusion-weighted MRI（DWI-MRI）,dynamic contrast-enhanced MRI（DCE-MRI）to predict and evaluate the efficacy of n CRT and whether p CR was achieved after n CRT in locally advanced esophageal cancer.Objective:The purpose of this study was to explore the relationship between MRI parameters and p CR in patients with locally advanced esophageal cancer by using two times DWI-MRI and DCE-MRI scanned before and after n CRT.To evaluate the efficacy of n CRT and to enhance the potential value of DWI-MRI and DCE-MRI prediction p CR.Methods:Patients with locally advanced esophageal cancer who met the inclusion criteria were examined with DWI-MRI and DCE-MRI twice,before and after n CRT.Based on histopathological regression of the tumor after resection of esophageal carcinoma,evaluate whether p CR has been achieved.Apparent diffusion coefficient（ADC）of tumor and vascular permeability parameters（Ktrans and Kep）of DCE-MRI were calculated to predict the apparent correlation between these parameters and p CR,and to evaluate the efficacy of n CRT.Result:Among the 36 patients included,13 patients achieved p CR and 23 did not achieved p CR.For DWI-MRI,the Post-ADC_mean of ADC measured after n CRT and the change of ADC(ΔADC_mean)before and after n CRT could predict p CR（P values were0.020,<0.001,respectively）,there was no difference in the accuracy of p CR prediction between the two parameters.For DCE-MRI,the mean value of Ktrans(Post-Ktrans_mean),mean value of Kep(Post-Kep_mean)（P values were 0.004,0.015,respectively）measured after n CRT and the changes ofΔKtrans_mean andΔKep_mean（P values were<0.001）before and after treatment were significant for predicting p CR.ΔKtrans_mean、Post-Kep_mean、ΔKep_mean、Post-Ktrans_mean was no difference in the accuracy of p CR prediction,however,the accuracy ofΔKtrans_meanin predicting p CR was better than that of Post-Ktrans_max.Conclusion:Both DWI-MRI and DCE-MRI have the potential to predict pathological reactions after n CRT in locally advanced esophageal cancer.There was no significant difference between DWI-MRI parametersΔADC_mean and Post-ADC_mean in predicting p CR accuracy.