Apparent diffusion coefficient modifications in assessing gastro-oesophageal cancer response to neoadjuvant treatment: Comparison with tumour regression grade at histology

Francesco De Cobelli, Francesco Giganti, Elena Orsenigo, Michaela Cellina, Antonio Esposito, Giulia Agostini, Luca Albarello, Elena Mazza, Alessandro Ambrosi, Carlo Socci, Carlo Staudacher, Alessandro Del Maschio

Research output: Contribution to journalArticle


Objectives: To assess changes in apparent diffusion coefficient (ΔADC) and volume (ΔV) after neoadjuvant treatment (NT), and tumour regression grade (TRG) in gastro-oesophageal cancers (GEC), and to discriminate responders from non-responders. Methods: Thirty-two patients with biopsy-proven locally-advanced GEC underwent diffusion weighted magnetic resonance imaging (DWI) pre- and post-NT. Lesion ADC, volume, ΔADC and ΔV were calculated. TRG 1-2-3 patients were classified as R; TRG 4-5 as non-responders. ΔADC-TRG and ΔV-TRG correlations, pre-NT and post-NT ADC, ΔADC and ΔV cut-off values for responders and non-responders were calculated. Two readers measured mean tumour ADCs and interobserver variability was calculated. (Spearman's and intraclass correlation coefficient [ICC]). Results: The interobserver reproducibility was very good both for pre-NT (Spearman's rho = 0.8160; ICC = 0.8993) and post-NT (Spearman's rho = 0.8357; ICC = 0.8663). Responders showed lower pre-NT ADC (1.32 versus 1.63 × 10-3 mm2/s; P = 0.002) and higher post-NT ADC (2.22 versus 1.51 × 10-3 mm2/s; P = 0.001) than non-responders and ADC increased in responders (ΔADC, 85.45 versus -8.21 %; P = 0.00005). ΔADC inversely correlated with TRG (r = -0.71, P = 0.000004); no difference in ΔV between responders and non-responders (-50.92 % versus -14.12 %; P = 0.068) and no correlation ΔV-TRG (r = 0.02 P = 0.883) were observed. Conclusions: The ADC can be used to assess gastro-oesophageal tumour response to neoadjuvant treatment as a reliable expression of tumour regression. Key Points: • DWI is now being used to assess many cancers. • Change in ADC measurements offer new information about oesophageal tumours. • ADC changes are more reliable than dimensional criteria in assessing neoadjuvant treatment. • Such ADC assessment could optimise management of locally advanced gastro-oesophageal cancers.

Original languageEnglish
Pages (from-to)2165-2174
Number of pages10
JournalEuropean Radiology
Issue number8
Publication statusPublished - Aug 2013



  • Apparent diffusion coefficient
  • Diagnosis
  • Diffusion magnetic resonance imaging
  • Gastroesophageal cancer
  • Response to neoadjuvant therapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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