Evaluating The Stage And The Response Of Esophageal Squamous Cell Carcinoma After Chemoradiotherapy By Using Intravoxel Incoherent Motion Diffusion-weighted Imaging

Part one: Evaluating the Stage of Esophageal Squamous Cell Carcinoma by using Intravoxel Incoherent Motion Diffusion-weighted ImagingObjective: To investigate whether the value of IVIM(intravoxel incoherent motion)could determine esophageal squamous cell carcinoma(ESCC)and evaluate its stage.Methods: Sixty patients with resectable ESCC and 20 healthy individuals underwent esophageal multi-b of diffusion-weighted imaging(DWI)with 3.0-T magnetic resonance system.Pure diffusion coefficient(D),perfusion-related incoherent microcirculation(D*)and microvascular volume fraction(f)were measured on DWI data.The Mann-Whitney U tests with Bonferroni correction for multigroup comparisons were performed to compare D,D*,and f between stages.Receiver operating characteristic(ROC)analysis was performed to determine if any IVIM parameter could be excellent in identifying the tumor and its stage.Results: The Mann-Whitney U tests with Bonferroni correction showed that D and f could discriminate patients with ESCC from normal esophagus wall(all P < 0.01)while D* may could not(P > 0.05),and that the values of D and f could help distinguish T1-stage or stage Ⅰ tumors from normal esophagus(all P < 0.05).By ROC analysis,f could best distinguish patients with ESCC from healthy individuals with areas under ROC(AUC)of 0.964,and T1-stage esophageal cancer from normal esophagus wall with AUC of 0.984 in comparison with the other DWI parameters.Conclusions: IVIM derived parameter can be negatively correlated with the occurrence and stage of ESCC,and f can be a suitable index for detecting ESCC,and differentiating its grouped T stages and its anatomic stages.Part two: Evaluating the Response of Esophageal Squamous Cell Carcinoma after Chemoradiotherapy by using Intravoxel Incoherent Motion Diffusion-weighted ImagingObjective: To investigate whether the value of IVIM(intravoxel incoherent motion)could be related to tumor response after chemoradiotherapy(CRT).Methods: Twenty-one ESCC patients underwent esophageal multi-b of diffusion-weighted imaging(DWI)with 3.0-T magnetic resonance system before and after CRT.Pure diffusion coefficient(D),perfusion-related incoherent microcirculation(D*)and microvascular volume fraction(f)were measured on DWI data.The Mann-Whitney U tests for the two group comparisons were performed to compare D,D*,and f between the two inspections.Receiver operating characteristic(ROC)analysis was performed to determine if any IVIM parameter could be excellent in assessing tumor response after CRT.Results: The Mann-Whitney U tests showed that D and f could discriminate patients with ESCC before and after CRT(both P < 0.01)while D* may could not(P > 0.05),and that the values of D and f could help distinguish the patients who benefiting more from CRT(all P < 0.05).By ROC analysis,f could best distinguish ESCC patients who benefiting more from CRT with areas under ROC(AUC)of 0.898 before the combined treatment,and with AUC of 0.759 after the therapy in comparison with the other IVIM parameters.Conclusions: D and f of ESCC increased after chemoradiotherapy,and f can be a suitable index for predictiving therapeutic effect,and differentiating its remission groups.