The split scar sign as an indicator of sustained complete response after neoadjuvant therapy in rectal cancer.
Objectives: To measure the diagnostic performance of a new radiologic pattern on restaging magnetic resonance (MR) high-resolution T2-weighted imaging (T2-WI)-the split scar sign-for the identification of sustained complete response (SCR) after neoadjuvant therapy in rectal cancer.Methods: Instituti...
| Publicado en: | European Radiology Vol. 30; no. 1; pp. 224 - 239 |
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| Autores principales: | , , , , , , , , |
| Formato: | diagnostic images pictorial research tables/charts Journal Article |
| Publicado: |
Springer Nature
Jan2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=140064735&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 140064735 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09387994 NPH jtl: European Radiology issn: 09387994 maglogo: N pubinfo: dt: Jan2020 vid: 30 iid: 1 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 140064735 140064735 NLM31350587 140064735 10.1007/s00330-019-06348-9 NLM31350587 140064735 ppf: 224 ppct: 15 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: The split scar sign as an indicator of sustained complete response after neoadjuvant therapy in rectal cancer. aug: au: Santiago, Inês Barata, Maria Figueiredo, Nuno Parés, Oriol Henriques, Vanessa Galzerano, António Carvalho, Carlos Matos, Celso Heald, Richard J. affil: Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal sug: subj: Magnetic Resonance Imaging Methods Rectal Neoplasms Pathology Male Rectal Neoplasms Diagnosis Neoadjuvant Therapy Methods Neoplasm Recurrence, Local Adult Sensitivity and Specificity Aged Middle Age Retrospective Design Cicatrix Pathology Rectal Neoplasms Therapy Female Disease Remission Human Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Male Female ab: Objectives: To measure the diagnostic performance of a new radiologic pattern on restaging magnetic resonance (MR) high-resolution T2-weighted imaging (T2-WI)-the split scar sign-for the identification of sustained complete response (SCR) after neoadjuvant therapy in rectal cancer.Methods: Institutional review board approval was obtained for this retrospective study and the informed consent requirement was waived. Fifty-eight consecutive patients with rectal cancer who underwent neoadjuvant therapy were enrolled. Two radiologists blindly and independently reviewed restaging pelvic MR imaging and recorded the presence/absence of the split scar sign (mrSSS). On a second round, they also assessed the relative proportion of intermediate signal intensity on T2-WI (mrT2) and of high signal intensity on high b-value diffusion-weighted imaging (mrDWI). Endoscopic response grading records were retrieved. Qui-square test was employed in search for associations between SCR, defined as pathologic complete response or long-term recurrence-free clinical follow-up, and mrSSS, mrT2, mrDWI and endoscopy. Interobserver agreement for imaging parameters was estimated using Cohen's kappa (k).Results: mrSSS was significantly associated with SCR, with specificity = 0.97/0.97, sensitivity = 0.52/0.64, PPV = 0.93/0.94, NPV = 0.73/0.78, and AuROC = 0.78/0.83, for observers 1/2, respectively. mrDWI was significantly associated with SCR for observer 2, with specificity = 0.76, sensitivity = 0.60, PPV = 0.65, NPV = 0.71, and AuROC = 0.69. mrT2 and endoscopy were not discriminative. Interobserver agreement was substantial for mrSSS (k = 0.69), moderate for mrDWI (k = 0.46), and poor for mrT2 (k = 0.17).Conclusion: The split scar sign is a simple morphologic pattern visible on restaging T2-WI which, although not sensitive, is very specific for the identification of sustained complete responders after neoadjuvant therapy in rectal cancer.Key Points: • The split scar sign is a morphologic pattern visible on high-resolution T2-weighted MR imaging in rectal cancer patients after neoadjuvant therapy. It therefore does not require any changes to standard protocol. • At first restaging pelvic MR imaging (mean: 9.1 weeks after the end of radiotherapy), the split scar sign identified patients who sustained a complete response with very high specificity (0.97) and positive predictive value (0.93-0.94). • The split scar sign has the potential to improve patient selection for "watch-and-wait" after neoadjuvant therapy in rectal cancer. pubtype: Academic Journal doctype: diagnostic images pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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