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Ye YX, Yang L, Kang Z, Wang MQ, Xie XD, Lou KX, Bao J, Du M, Li ZX. Magnetic resonance imaging-based lymph node radiomics for predicting the metastasis of evaluable lymph nodes in rectal cancer. World J Gastrointest Oncol 2024; 16:1849-1860. [PMID: 38764830 PMCID: PMC11099437 DOI: 10.4251/wjgo.v16.i5.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/23/2024] [Accepted: 03/04/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Lymph node (LN) staging in rectal cancer (RC) affects treatment decisions and patient prognosis. For radiologists, the traditional preoperative assessment of LN metastasis (LNM) using magnetic resonance imaging (MRI) poses a challenge. AIM To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable LNs. METHODS In this retrospective study, 270 LNs (158 nonmetastatic, 112 metastatic) were randomly split into training (n = 189) and validation sets (n = 81). LNs were classified based on pathology-MRI matching. Conventional MRI features [size, shape, margin, T2-weighted imaging (T2WI) appearance, and CE-T1-weighted imaging (T1WI) enhancement] were evaluated. Three radiomics models used 3D features from T1WI and T2WI images. Additionally, a nomogram model combining conventional MRI and radiomics features was developed. The model used univariate analysis and multivariable logistic regression. Evaluation employed the receiver operating characteristic curve, with DeLong test for comparing diagnostic performance. Nomogram performance was assessed using calibration and decision curve analysis. RESULTS The nomogram model outperformed conventional MRI and single radiomics models in evaluating LNM. In the training set, the nomogram model achieved an area under the curve (AUC) of 0.92, which was significantly higher than the AUCs of 0.82 (P < 0.001) and 0.89 (P < 0.001) of the conventional MRI and radiomics models, respectively. In the validation set, the nomogram model achieved an AUC of 0.91, significantly surpassing 0.80 (P < 0.001) and 0.86 (P < 0.001), respectively. CONCLUSION The nomogram model showed the best performance in predicting metastasis of evaluable LNs.
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Affiliation(s)
- Yong-Xia Ye
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Liu Yang
- Department of Colorectal Surgery, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
| | - Zheng Kang
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Mei-Qin Wang
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Xiao-Dong Xie
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Ke-Xin Lou
- Department of Pathology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Jun Bao
- Colorectal Center, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Mei Du
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
| | - Zhe-Xuan Li
- Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210011, Jiangsu Province, China
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Li QY, Yang D, Guan Z, Yan XY, Li XT, Sun RJ, Lu QY, Zhang XY, Sun YS. Extranodal Extension at Pretreatment MRI and the Prognostic Value for Patients with Rectal Cancer. Radiology 2024; 310:e232605. [PMID: 38530176 DOI: 10.1148/radiol.232605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background Detection of extranodal extension (ENE) at pathology is a poor prognostic indicator for rectal cancer, but whether ENE can be identified at pretreatment MRI is, to the knowledge of the authors, unknown. Purpose To evaluate the performance of pretreatment MRI in detecting ENE using a matched pathologic reference standard and to assess its prognostic value in patients with rectal cancer. Materials and Methods This single-center study included a prospective development data set consisting of participants with rectal adenocarcinoma who underwent pretreatment MRI and radical surgery (December 2021 to January 2023). MRI characteristics were identified by their association with ENE-positive nodes (χ2 test and multivariable logistic regression) and the performance of these MRI features was assessed (area under the receiver operating characteristic curve [AUC]). Interobserver agreement was assessed by Cohen κ coefficient. The prognostic value of ENE detected with MRI for predicting 3-year disease-free survival was assessed by Cox regression analysis in a retrospective independent validation cohort of patients with locally advanced rectal cancer (December 2019 to July 2020). Results The development data set included 147 participants (mean age, 62 years ± 11 [SD]; 87 male participants). The retrospective cohort included 110 patients (mean age, 60 years ± 9; 79 male participants). Presence of vessel interruption and fusion (both P < .001), heterogeneous internal structure, and the broken-ring and tail signs (odds ratio range, 4.10-23.20; P value range, <.001 to .002) were predictors of ENE at MRI, and together achieved an AUC of 0.91 (95% CI: 0.88, 0.93) in detecting ENE. Interobserver agreement was moderate for the presence of vessel interruption and fusion (κ = 0.46 for both) and substantial for others (κ = 0.61-0.67). The presence of ENE at pretreatment MRI was independently associated with worse 3-year disease-free survival (hazard ratio, 3.00; P = .02). Conclusion ENE can be detected at pretreatment MRI, and its presence was associated with worse prognosis for patients with rectal cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Eberhardt in this issue.
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Affiliation(s)
- Qing-Yang Li
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Ding Yang
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Zhen Guan
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xin-Yue Yan
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xiao-Ting Li
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Rui-Jia Sun
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Qiao-Yuan Lu
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Xiao-Yan Zhang
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
| | - Ying-Shi Sun
- From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China
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Li H, Chai L, Pu H, Yin LL, Li M, Zhang X, Liu YS, Pang MH, Lu T. T2WI-based MRI radiomics for the prediction of preoperative extranodal extension and prognosis in resectable rectal cancer. Insights Imaging 2024; 15:57. [PMID: 38411722 PMCID: PMC10899552 DOI: 10.1186/s13244-024-01625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE To investigate whether T2-weighted imaging (T2WI)-based intratumoral and peritumoral radiomics can predict extranodal extension (ENE) and prognosis in patients with resectable rectal cancer. METHODS One hundred sixty-seven patients with resectable rectal cancer including T3T4N + cases were prospectively included. Radiomics features were extracted from intratumoral, peritumoral 3 mm, and peritumoral-mesorectal fat on T2WI images. Least absolute shrinkage and selection operator regression were used for feature selection. A radiomics signature score (Radscore) was built with logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each Radscore. A clinical-radiomics nomogram was constructed by the most predictive radiomics signature and clinical risk factors. A prognostic model was constructed by Cox regression analysis to identify 3-year recurrence-free survival (RFS). RESULTS Age, cT stage, and lymph node-irregular border and/or adjacent fat invasion were identified as independent clinical risk factors to construct a clinical model. The nomogram incorporating intratumoral and peritumoral 3 mm Radscore and independent clinical risk factors achieved a better AUC than the clinical model in the training (0.799 vs. 0.736) and validation cohorts (0.723 vs. 0.667). Nomogram-based ENE (hazard ratio [HR] = 2.625, 95% CI = 1.233-5.586, p = 0.012) and extramural vascular invasion (EMVI) (HR = 2.523, 95% CI = 1.247-5.106, p = 0.010) were independent risk factors for predicting 3-year RFS. The prognostic model constructed by these two indicators showed good performance for predicting 3-year RFS in the training (AUC = 0.761) and validation cohorts (AUC = 0.710). CONCLUSION The nomogram incorporating intratumoral and peritumoral 3 mm Radscore and clinical risk factors could predict preoperative ENE. Combining nomogram-based ENE and MRI-reported EMVI may be useful in predicting 3-year RFS. CRITICAL RELEVANCE STATEMENT A clinical-radiomics nomogram could help preoperative predict ENE, and a prognostic model constructed by the nomogram-based ENE and MRI-reported EMVI could predict 3-year RFS in patients with resectable rectal cancer. KEY POINTS • Intratumoral and peritumoral 3 mm Radscore showed the most capability for predicting ENE. • Clinical-radiomics nomogram achieved the best predictive performance for predicting ENE. • Combining clinical-radiomics based-ENE and EMVI showed good performance for 3-year RFS.
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Affiliation(s)
- Hang Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# Second Section of First Ring Road, Qingyang District, Chengdu, Sichuan, 610070, China
| | - Li Chai
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Pu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# Second Section of First Ring Road, Qingyang District, Chengdu, Sichuan, 610070, China
| | - Long-Lin Yin
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# Second Section of First Ring Road, Qingyang District, Chengdu, Sichuan, 610070, China
- Institute of Radiation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mou Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# Second Section of First Ring Road, Qingyang District, Chengdu, Sichuan, 610070, China
| | - Xin Zhang
- Pharmaceutical Diagnostic Team, GE Healthcare, Beijing, 100176, China
| | - Yi-Sha Liu
- Department of Pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# Second Section of First Ring Road, Qingyang District, Chengdu, Sichuan, 610070, China
| | - Ming-Hui Pang
- Department of Geriatric Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# Second Section of First Ring Road, Qingyang District, Chengdu, Sichuan, 610070, China
| | - Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# Second Section of First Ring Road, Qingyang District, Chengdu, Sichuan, 610070, China.
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Zhuang Z, Ma X, Zhang Y, Yang X, Wei M, Deng X, Wang Z. Establishment and validation of nomograms for predicting mesorectal lymph node staging and restaging. Int J Colorectal Dis 2022; 37:2069-2083. [PMID: 36028723 DOI: 10.1007/s00384-022-04244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preoperative determination of lymph node (LN) status is crucial in treatment planning for rectal cancer. This study prospectively evaluated the risk factors for lymph node metastasis (LNM) at staging and restaging based on a node-by-node pairing between MRI imaging findings and histopathology and constructed nomograms to evaluate its diagnostic value. METHODS From July 2021 to July 2022, patients with histopathologically verified rectal cancer who underwent MRI before surgery were prospectively enrolled. Histological examination of each LN status in the surgical specimens and anatomical matching with preoperative imaging. Taking histopathological results as the gold standard, federating clinical features from patients and LN imaging features on MRI-T2WI. Risk factors for LN metastasis were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomograms was assessed with calibration plots and bootstrapped-concordance index and validated using validation cohorts. RESULTS A total of 500 target LNs in 120 patients were successfully matched with node-by-node comparisons. A total of 353 LNs did not receive neoadjuvant therapy and 147 LNs received neoadjuvant chemoradiotherapy (neoCRT). Characterization of LNs not receiving neoadjuvant therapy and multivariate regression showed that the short diameter, preoperative CEA level, mrT-stage, border contour, and signal intensity were associated with a high risk of LN metastasis (P < 0.05). The nomogram predicted that the area under the curve was 0.855 (95% CI, 0.794-0.916) and 0.854 (95% CI, 0.727-0.980) in the training and validation cohorts, respectively. In the neoadjuvant therapy group, short diameter, ymrT-stage, internal signal, and MRI-EMVI were associated with LN positivity (P < 0.05), and the area under the curves using the nomogram was 0.912 (95% CI, 0.856-0.968) and 0.915 (95% CI, 0.817-1.000) in two cohorts. The calibration curves demonstrate good agreement between the predicted and actual probabilities for both the training and validation cohorts. CONCLUSION Our nomograms combined with preoperative clinical and imaging biomarkers have the potential to improve the prediction of nodal involvement, which can be used as an essential reference for preoperative N staging and restaging of rectal cancer.
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Affiliation(s)
- Zixuan Zhuang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xueqin Ma
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Zhang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Yang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangbing Deng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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Zhuang Z, Ma X, Zhang Y, Yang X, Wei M, Deng X, Wang Z. Technique to match mesorectal lymph nodes imaging findings to histopathology: node-by-node comparison. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04305-6. [PMID: 36028725 DOI: 10.1007/s00432-022-04305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lymph node status is critical for staging rectal cancer and determining neoadjuvant therapy regimens. Establishing a matching between imaging and histopathological lymph nodes is fundamental for predicting lymph node status. This study reports a technique to achieve node-by-node pairing of mesorectal lymph nodes between imaging findings and histopathology. METHODS Fifty-two patients with histopathologically verified rectal cancer underwent magnetic resonance imaging before surgery. The status of each lymph node in the surgical specimens was analyzed histopathologically and matched with preoperative imaging after the operation. RESULTS A total of 346 mesorectal lymph nodes were located on imaging evaluation, of which 313 were confirmed histopathologically, and 33 were unmatched. The total success rate of the technique was 90.5%. Node-by-node analysis revealed 280 benign and 33 malignant nodal structures. CONCLUSION The technique to match mesorectal lymph node imaging findings to histopathology was feasible and effective. It simplified the technical method and had a reasonable success matching rate, which could provide a standardized approach for obtaining a prospective correlation between imaging and histological findings, supporting all subsequent related studies at the level of mesorectal lymph nodes.
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Affiliation(s)
- Zixuan Zhuang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Xueqin Ma
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Zhang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Xuyang Yang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Mingtian Wei
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Xiangbing Deng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Ziqiang Wang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China.
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Crafa F, Vanella S, Catalano OA, Pomykala KL, Baiamonte M. Role of one-step nucleic acid amplification in colorectal cancer lymph node metastases detection. World J Gastroenterol 2022; 28:4019-4043. [PMID: 36157105 PMCID: PMC9403438 DOI: 10.3748/wjg.v28.i30.4019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/03/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
Current histopathological staging procedures in colorectal cancer (CRC) depend on midline division of the lymph nodes (LNs) with one section of hematoxylin and eosin staining. Cancer cells outside this transection line may be missed, which could lead to understaging of Union for International Cancer Control Stage II high-risk patients. The one-step nucleic acid amplification (OSNA) assay has emerged as a rapid molecular diagnostic tool for LN metastases detection. It is a molecular technique that can analyze the entire LN tissue using a reverse-transcriptase loop-mediated isothermal amplification reaction to detect tumor-specific cytokeratin 19 mRNA. Our findings suggest that the OSNA assay has a high diagnostic accuracy in detecting metastatic LNs in CRC and a high negative predictive value. OSNA is a standardized, observer-independent technique, which may lead to more accurate staging. It has been suggested that in stage II CRC, the upstaging can reach 25% and these patients can access postoperative adjuvant chemotherapy. Moreover, intraoperative OSNA sentinel node evaluation may allow early CRC to be treated with organ-preserving surgery, while in more advanced-stage disease, a tailored lymphadenectomy can be performed considering the presence of aberrant lymphatic drainage and skip metastases.
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Affiliation(s)
- Francesco Crafa
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Serafino Vanella
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Onofrio A Catalano
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Kelsey L Pomykala
- Department of Nuclear Medicine, Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, University Hospital Essen, University of Duisburg-Essen, Essen 45141, Germany
| | - Mario Baiamonte
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
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Borgheresi A, De Muzio F, Agostini A, Ottaviani L, Bruno A, Granata V, Fusco R, Danti G, Flammia F, Grassi R, Grassi F, Bruno F, Palumbo P, Barile A, Miele V, Giovagnoni A. Lymph Nodes Evaluation in Rectal Cancer: Where Do We Stand and Future Perspective. J Clin Med 2022; 11:2599. [PMID: 35566723 PMCID: PMC9104021 DOI: 10.3390/jcm11092599] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/12/2022] Open
Abstract
The assessment of nodal involvement in patients with rectal cancer (RC) is fundamental in disease management. Magnetic Resonance Imaging (MRI) is routinely used for local and nodal staging of RC by using morphological criteria. The actual dimensional and morphological criteria for nodal assessment present several limitations in terms of sensitivity and specificity. For these reasons, several different techniques, such as Diffusion Weighted Imaging (DWI), Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Dynamic Contrast Enhancement (DCE) in MRI have been introduced but still not fully validated. Positron Emission Tomography (PET)/CT plays a pivotal role in the assessment of LNs; more recently PET/MRI has been introduced. The advantages and limitations of these imaging modalities will be provided in this narrative review. The second part of the review includes experimental techniques, such as iron-oxide particles (SPIO), and dual-energy CT (DECT). Radiomics analysis is an active field of research, and the evidence about LNs in RC will be discussed. The review also discusses the different recommendations between the European and North American guidelines for the evaluation of LNs in RC, from anatomical considerations to structured reporting.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
| | - Letizia Ottaviani
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale IRCCS di Napoli, 80131 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Federica Flammia
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Roberta Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Francesca Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Abruzzo Health Unit 1, Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, 67100 L’Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
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Zou Y, Sun S, Liu Q, Liu J, Shi Y, Sun F, Gong Y, Lu X, Zhang X, Xia S. A new prediction model for lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma: Based on dual-energy CT. Eur J Radiol 2021; 145:110060. [PMID: 34839216 DOI: 10.1016/j.ejrad.2021.110060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/26/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The current study aimed to develop and validate a prediction model to estimate the independent risk factors for lateral cervical lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC) patients based on dual-energy computed tomography (DECT). METHOD This study retrospectively conducted 406 consecutive patients from July 2015 to June 2019 to form the derivation cohorts and performed internal validation. 101 consecutive patients from July 2019 to June 2020 were included to create the external validation cohort. Univariable and multivariable logistic regression analyses were used to evaluate independent risk factors for LLNM. A prediction model based on DECT parameters was built and presented on a nomogram. The internal and external validations were performed. RESULTS Iodine concentration (IC) in the arterial phase (OR 2.761, 95% CI 1.028-7.415, P 0.044), IC in venous phase (OR 3.820, 95% CI 1.430-10.209, P 0.008), located in the superior pole (OR 4.181, 95% CI 2.645-6.609, P 0.000), and extrathyroidal extension (OR 4.392, 95% CI 2.142-9.004, P 0.000) were independently associated with LLNM in the derivation cohort. These four predictors were incorporated into the nomogram. The model showed good discrimination in the derivation (AUC, 0.899), internal (AUC, 0.905), and external validation (AUC, 0.912) cohorts. The decision curve revealed that more advantages would be added using the nomogram to estimate LLNM, which implied that the lateral lymph node dissection was recommended. CONCLUSIONS DECT parameters could provide independent indicators of LLNM in PTC patients, and the nomogram based on them may be helpful in treatment decision-making.
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Affiliation(s)
- Ying Zou
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China; Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China; Department of Radiology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China
| | - Shuangyan Sun
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China; Department of Radiology, JiLin Cancer Hospital, No.1066 JinHu Road, ChaoYang District, ChangChun 130000, China
| | - Qian Liu
- Department of Radiology, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, China
| | - Jihua Liu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China; Department of Radiology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China
| | - Yan Shi
- Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, Shandong 256603, China
| | - Fang Sun
- Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, Shandong 256603, China
| | - Yan Gong
- Department of Radiology, Tianjin Hospital of ITCWM Nan Kai Hospital, No.6 Changjiang Road, Nan Kai District, Tianjin 300100, China
| | - Xiudi Lu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China; Department of Radiology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China
| | - Xuening Zhang
- Department of Radiology, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China.
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Zhou Y, Yang R, Wang Y, Zhou M, Zhou X, Xing J, Wang X, Zhang C. Histogram analysis of diffusion-weighted magnetic resonance imaging as a biomarker to predict LNM in T3 stage rectal carcinoma. BMC Med Imaging 2021; 21:176. [PMID: 34809615 PMCID: PMC8609786 DOI: 10.1186/s12880-021-00706-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/08/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Preoperative identification of rectal cancer lymph node status is crucial for patient prognosis and treatment decisions. Rectal magnetic resonance imaging (MRI) plays an essential role in the preoperative staging of rectal cancer, but its ability to predict lymph node metastasis (LNM) is insufficient. This study explored the value of histogram features of primary lesions on multi-parametric MRI for predicting LNM of stage T3 rectal carcinoma. METHODS We retrospectively analyzed 175 patients with stage T3 rectal cancer who underwent preoperative MRI, including diffusion-weighted imaging (DWI) before surgery. 62 patients were included in the LNM group, and 113 patients were included in the non-LNM group. Texture features were calculated from histograms derived from T2 weighted imaging (T2WI), DWI, ADC, and T2 maps. Stepwise logistic regression analysis was used to screen independent predictors of LNM from clinical features, imaging features, and histogram features. Predictive performance was evaluated by receiver operating characteristic (ROC) curve analysis. Finally, a nomogram was established for predicting the risk of LNM. RESULTS The clinical, imaging and histogram features were analyzed by stepwise logistic regression. Preoperative carbohydrate antigen 199 level (p = 0.009), MRN stage (p < 0.001), T2WIKurtosis (p = 0.010), DWIMode (p = 0.038), DWICV (p = 0.038), and T2-mapP5 (p = 0.007) were independent predictors of LNM. These factors were combined to form the best predictive model. The model reached an area under the ROC curve (AUC) of 0.860, with a sensitivity of 72.8% and a specificity of 85.5%. CONCLUSION The histogram features on multi-parametric MRI of the primary tumor in rectal cancer were related to LN status, which is helpful for improving the ability to predict LNM of stage T3 rectal cancer.
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Affiliation(s)
- Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Rui Yang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang Province, China
| | - Yuan Wang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang Province, China
| | - Meng Zhou
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang Province, China
| | - Xueyan Zhou
- School of Technology, Harbin University, Harbin, Heilongjiang Province, China
| | - JiQing Xing
- Department of Physical Education, Harbin Engineering University, Harbin, 150001, Heilongjiang Province, China
| | - Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, Heilongjiang Province, China.
| | - Chunhui Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.
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Grimm P, Loft MK, Dam C, Pedersen MRV, Timm S, Rafaelsen SR. Intra- and Interobserver Variability in Magnetic Resonance Imaging Measurements in Rectal Cancer Patients. Cancers (Basel) 2021; 13:cancers13205120. [PMID: 34680269 PMCID: PMC8534180 DOI: 10.3390/cancers13205120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer is the second most common cancer in Europe, and accurate lymph node staging in rectal cancer patients is essential for the selection of their treatment. MRI lymph node staging is complex, and few studies have been published regarding its reproducibility. This study assesses the inter- and intraobserver variability in lymph node size, apparent diffusion coefficient (ADC) measurements, and morphological characterization among inexperienced and experienced radiologists. Four radiologists with different levels of experience in MRI rectal cancer staging analyzed 36 MRI scans of 36 patients with rectal adenocarcinoma. Inter- and intraobserver variation was calculated using interclass correlation coefficients and Cohens-kappa statistics, respectively. Inter- and intraobserver agreement for the length and width measurements was good to excellent, and for that of ADC it was fair to good. Interobserver agreement for the assessment of irregular border was moderate, heterogeneous signal was fair, round shape was fair to moderate, and extramesorectal lymph node location was moderate to almost perfect. Intraobserver agreement for the assessment of irregular border was fair to substantial, heterogeneous signal was fair to moderate, round shape was fair to moderate, and extramesorectal lymph node location was substantial to almost perfect. Our data indicate that subjective variables such as morphological characteristics are less reproducible than numerical variables, regardless of the level of experience of the observers.
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Affiliation(s)
- Peter Grimm
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
- Correspondence:
| | - Martina Kastrup Loft
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
| | - Claus Dam
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
| | - Malene Roland Vils Pedersen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
| | - Signe Timm
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
- Research Unit, Kolding Hospital, University Hospital of Southern Denmark, 6000 Kolding, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (M.K.L.); (C.D.); (M.R.V.P.); (S.R.R.)
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
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Zhuang Z, Zhang Y, Wei M, Yang X, Wang Z. Magnetic Resonance Imaging Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:709070. [PMID: 34327144 PMCID: PMC8315047 DOI: 10.3389/fonc.2021.709070] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
Background Magnetic resonance imaging (MRI)-based lymph node staging remains a significant challenge in the treatment of rectal cancer. Pretreatment evaluation of lymph node metastasis guides the formulation of treatment plans. This systematic review aimed to evaluate the diagnostic performance of MRI in lymph node staging using various morphological criteria. Methods A systematic search of the EMBASE, Medline, and Cochrane databases was performed. Original articles published between 2000 and January 2021 that used MRI for lymph node staging in rectal cancer were eligible. The included studies were assessed using the QUADAS-2 tool. A bivariate random-effects model was used to conduct a meta-analysis of diagnostic test accuracy. Results Thirty-seven studies were eligible for this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of preoperative MRI for the lymph node stage were 0.73 (95% confidence interval [CI], 0.68–0.77), 0.74 (95% CI, 0.68–0.80), and 7.85 (95% CI, 5.78–10.66), respectively. Criteria for positive mesorectal lymph node metastasis included (A) a short-axis diameter of 5 mm, (B) morphological standard, including an irregular border and mixed-signal intensity within the lymph node, (C) a short-axis diameter of 5 mm with the morphological standard, (D) a short-axis diameter of 8 mm with the morphological standard, and (E) a short-axis diameter of 10 mm with the morphological standard. The pooled sensitivity/specificity for these criteria were 75%/64%, 81%/67%, 74%/79%, 72%/66%, and 62%/91%, respectively. There was no significant difference among the criteria in sensitivity/specificity. The area under the receiver operating characteristic (ROC) curve values of the fitted summary ROC indicated a diagnostic accuracy rate of 0.75–0.81. Conclusion MRI scans have minimal accuracy as a reference index for pretreatment staging of various lymph node staging criteria in rectal cancer. Multiple types of evidence should be used in clinical decision-making.
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Affiliation(s)
- Zixuan Zhuang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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12
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Liu Y, Wan L, Peng W, Zou S, Zheng Z, Ye F, Jiang J, Ouyang H, Zhao X, Zhang H. A magnetic resonance imaging (MRI)-based nomogram for predicting lymph node metastasis in rectal cancer: a node-for-node comparative study of MRI and histopathology. Quant Imaging Med Surg 2021; 11:2586-2597. [PMID: 34079725 PMCID: PMC8107309 DOI: 10.21037/qims-20-1049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/05/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of the present study was to investigate the potential risk factors for lymph node metastasis (LNM) in rectal cancer using magnetic resonance imaging (MRI), and to construct and validate a nomogram to predict its occurrence with node-for-node histopathological validation. METHODS Our prediction model was developed between March 2015 and August 2016 using a prospective primary cohort (32 patients, mean age: 57.3 years) that included 324 lymph nodes (LNs) from MR images with node-for-node histopathological validation. We evaluated multiple MRI variables, and a multivariable logistic regression analysis was used to develop the predictive nomogram. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness. The performance of the nomogram in predicting LNM was validated in an independent clinical validation cohort comprising 182 consecutive patients. RESULTS The predictors included in the individualized prediction nomogram were chemical shift effect (CSE), nodal border, short-axis diameter of nodes, and minimum distance to rectal cancer or rectal wall. The nomogram showed good discrimination (C-index: 0.947; 95% confidence interval: 0.920-0.974) and good calibration in the primary cohort. Decision curve analysis confirmed the clinical usefulness of the nomogram in predicting the status of each LN. For the prediction of LN status in the clinical validation cohort by readers 1 and 2, the areas under the curves using the nomogram were 0.890 and 0.841, and the areas under the curves of readers using their experience were 0.754 and 0.704, respectively. Diagnostic efficiency was significantly improved by using the nomogram (P<0.001). CONCLUSIONS The nomogram, which incorporates CSE, nodal location, short-axis diameter, and minimum distance to rectal cancer or rectal wall, can be conveniently applied in clinical practice to facilitate the prediction of LNM in patients with rectal cancer.
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Affiliation(s)
- Yuan Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijuan Wan
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjing Peng
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuangmei Zou
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaoxu Zheng
- Department of Colorectal Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Ye
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Jiang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Ouyang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhao Q, Wan L, Zou S, Zhang C, E T, Yang Y, Ye F, Zhao X, Ouyang H, Zhang H. Prognostic risk factors and survival models for T3 locally advanced rectal cancer: what can we learn from the baseline MRI? Eur Radiol 2021; 31:4739-4750. [PMID: 34003351 DOI: 10.1007/s00330-021-08045-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/07/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the baseline MRI characteristics for predicting survival outcomes and construct survival models for risk stratification to facilitate personalized treatment and follow-up strategies in patients with MRI-defined T3 (mrT3) locally advanced rectal cancer (LARC). METHODS We retrospectively reviewed 256 mrT3 LARC patients evaluated between 2008 and 2012 in our institution, with an average follow-up period of 6.8 ± 1.2 years. The baseline MRI characteristics, clinical data, and follow-up information were evaluated. The patients were randomized into a training cohort (TC, 186 patients) and validation cohort (VC, 70 patients). The TC dataset was used to develop multivariate nomograms for disease-free survival (DFS) and overall survival (OS), while the VC dataset was used for independent validation of the models. Harrell concordance (C) indices and Hosmer-Lemeshow calibration were used to evaluate the performances of the models. RESULTS Baseline mrT3 substage, extramural venous invasion (EMVI) grading, mucinous adenocarcinoma, mesorectal fascia involvement, elevated pretreatment carcinoembryonic antigen level, and neoadjuvant chemoradiotherapy (NCRT) were independent predictors of DFS. T3 substage, EMVI grading, and NCRT were also independent predictors of OS. The nomograms constructed permitted the individualized prediction of 3-year and 5-year DFS and 5-year OS with high discrimination (C-index range, 0.833-0.892) and good calibration in the TC and VC. CONCLUSIONS We have identified baseline MRI characteristics that help independently predict survival outcomes in patients with mrT3 LARC. The survival models based on these characteristics allow for the individualized pretreatment risk stratification in patients with mrT3 LARC. KEY POINTS • Baseline MRI characteristics can independently stratify risk and predict survival outcomes in patients with mrT3 LARC. • The nomograms built using selected baseline MRI characteristics facilitate the individualized pretreatment risk stratification and help with clinical decision-making in patients with mrT3 LARC. • MR-defined risk factors should, therefore, be carefully reported in the baseline MRI evaluation.
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Affiliation(s)
- Qing Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lijuan Wan
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shuangmei Zou
- Department of Diagnostic Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Chongda Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tuya E
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yang Yang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hongmei Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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14
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Zhao L, Liang M, Shi Z, Xie L, Zhang H, Zhao X. Preoperative volumetric synthetic magnetic resonance imaging of the primary tumor for a more accurate prediction of lymph node metastasis in rectal cancer. Quant Imaging Med Surg 2021; 11:1805-1816. [PMID: 33936966 DOI: 10.21037/qims-20-659] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background An accurate assessment of lymph node (LN) status in patients with rectal cancer is important for treatment planning and an essential factor for predicting local recurrence and overall survival. In this study, we explored the potential value of histogram parameters of synthetic magnetic resonance imaging (SyMRI) in predicting LN metastasis in rectal cancer and compared their predictive performance with traditional morphological characteristics and chemical shift effect (CSE). Methods A total of 70 patients with pathologically proven rectal adenocarcinoma who received direct surgical resection were enrolled in this prospective study. Preoperative rectal MRI, including SyMRI, were performed, and morphological characteristics and CSE of LN were assessed. Histogram parameters were extracted on a T1 map, T2 map, and proton density (PD) map, including mean, variance, maximum, minimum, 10th percentile, median, 90th percentile, energy, kurtosis, entropy, and skewness. Receiver operating characteristic (ROC) curves were used to explore their predictive performance for assessing LN status. Results Significant differences in the energy of the T1, T2, and PD maps were observed between LN-negative and LN-positive groups [all P<0.001; the area under the ROC curve (AUC) was 0.838, 0.858, and 0.823, respectively]. The maximum and kurtosis of the T2 map, maximum, and variance of PD map could also predict LN metastasis with moderate diagnostic power (P=0.032, 0.045, 0.016, and 0.047, respectively). Energy of the T1 map [odds ratio (OR) =1.683, 95% confidence interval (CI): 1.207-2.346, P=0.002] and extramural venous invasion on MRI (mrEMVI) (OR =10.853, 95% CI: 2.339-50.364, P=0.002) were significant predictors of LN metastasis. Moreover, the T1 map energy significantly improved the predictive performance compared to morphological features and CSE (P=0.0002 and 0.0485). Conclusions The histogram parameters derived from SyMRI of the primary tumor were associated with LN metastasis in rectal cancer and could significantly improve the predictive performance compared with morphological features and CSE.
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Affiliation(s)
- Li Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Liang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuo Shi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lizhi Xie
- GE Healthcare, Magnetic Resonance Research China, Beijing, China
| | - Hongmei Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Li J, Zhou Y, Wang X, Yu Y, Zhou X, Luan K. Histogram Analysis of Diffusion-Weighted Magnetic Resonance Imaging as a Biomarker to Predict Lymph Node Metastasis in T3 Stage Rectal Carcinoma. Cancer Manag Res 2021; 13:2983-2993. [PMID: 33833581 PMCID: PMC8021267 DOI: 10.2147/cmar.s298907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose This study investigated the predictive value of apparent diffusion coefficient (ADC) histogram parameters of the primary tumor for regional lymph node metastasis (LNM) in pathological T3 stage rectal cancer. Patients and Methods We retrospectively studied 175 patients with T3 stage rectal cancer who underwent preoperative MRI, including diffusion-weighted imaging, between January 2015 and October 2017. Based on pathological analysis of surgical specimens, 113 patients were classified into the LN− group and 62 in the LN+ group. We analyzed clinical data, radiological characteristics and histogram parameters derived from ADC maps. Then, receiver operating characteristic curve (ROC) analyses were generated to determine the best diagnostic performance. Results The mean (p=0.002, cutoff=1.08×10–3 s/mm2), coefficient of variation (CV) (p=0.040, cutoff=0.249) of the ADC map, carbohydrate antigen 199, and N stage with magnetic resonance (mrN stage) were independent factors for LNM. Combining these factors yielded the best diagnostic performance, with the area under the ROC curve of 0.838, 72.9% sensitivity, 79.1% specificity, 65.2% positive predictive value, and 84.5% negative predictive value. Conclusion With the mean >1.08×10–3 s/mm2 and CV <0.249, the ADC improved the diagnostic performance of LNM in T3 stage rectal cancer, which could assist surgeons with neoadjuvant chemoradiotherapy.
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Affiliation(s)
- Jin Li
- College of Intelligent Systems Science and Engineering, Harbin Engineering University, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Yang Zhou
- College of Intelligent Systems Science and Engineering, Harbin Engineering University, Harbin, 150001, Heilongjiang Province, People's Republic of China.,Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Yanyan Yu
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Xueyan Zhou
- School of Technology, Harbin University, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Kuan Luan
- College of Intelligent Systems Science and Engineering, Harbin Engineering University, Harbin, 150001, Heilongjiang Province, People's Republic of China
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Zou Y, Zheng M, Qi Z, Guo Y, Ji X, Huang L, Gong Y, Lu X, Ma G, Xia S. Dual-energy computed tomography could reliably differentiate metastatic from non-metastatic lymph nodes of less than 0.5 cm in patients with papillary thyroid carcinoma. Quant Imaging Med Surg 2021; 11:1354-1367. [PMID: 33816174 DOI: 10.21037/qims-20-846] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Dual-energy computed tomography (DECT) has been widely applied to detect lymph node (LN) and lymph node metastasis (LNM) in various cancers, including papillary thyroid carcinoma (PTC). This study aimed to quantitatively evaluate metastatic cervical lymph nodes (LNs) <0.5 cm in patients with PTC using DECT, which has not been done in previous studies. Methods Preoperative DECT data of patients with pathologically confirmed PTC were retrospectively collected and analyzed between May 2016 and June 2018. A total of 359 LNs from 52 patients were included. Diameter, iodine concentration (IC), normalized iodine concentration (NIC), and the slope of the energy spectrum curve (λHU) of LNs in the arterial and the venous phases were compared between metastatic and non-metastatic LNs. The optimal parameters were obtained from the receiver operating characteristic (ROC) curves. The generalized estimation equation (GEE) model was used to evaluate independent diagnostic factors for LNM. Results A total of 139 metastatic and 220 non-metastatic LNs were analyzed. There were statistical differences of quantitative parameters between the two groups (P value 0.000-0.007). The optimal parameter for diagnosing LNM was IC in the arterial phase, and its area under the curve (AUC), sensitivity, and specificity were 0.775, 71.9%, and 73.6%, respectively. When the three parameters of diameter, IC in the arterial phase, and NIC in the venous phase were combined, the prediction efficiency was better, and the AUC was 0.819. The GEE results showed that LNs located in level VIa [odds ratio (OR) 2.030, 95% confidence interval (CI): 1.134-3.634, P=0.017], VIb (OR 2.836, 95% CI: 1.597-5.038, P=0.000), diameter (OR 2.023, 95% CI: 1.158-3.532, P=0.013), IC in the arterial phase (OR 4.444, 95% CI: 2.808-7.035, P=0.000), and IC in the venous phase (OR 5.387, 95% CI: 3.449-8.413, P=0.000) were independent risk factors for LNM in patients with PTC. Conclusions DECT had good diagnostic performance in the differentiation of cervical metastatic LNs <0.5 cm in patients with PTC.
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Affiliation(s)
- Ying Zou
- Radiological Department, First Central Clinical College, Tianjin Medical University, Tianjin, China.,Radiological Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Meizhu Zheng
- Radiological Department, Third Central Hospital of Tianjin, Tianjin, China
| | - Ziyu Qi
- Radiological Department, First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Yu Guo
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Xiaodong Ji
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Lixiang Huang
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Yan Gong
- Radiological Department, First Central Clinical College, Tianjin Medical University, Tianjin, China.,Radiological Department, Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China
| | - Xiudi Lu
- Radiological Department, First Central Clinical College, Tianjin Medical University, Tianjin, China.,Radiological Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guolin Ma
- Radiological Department, China-Japan Friendship Hospital, Beijing, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
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17
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Stijns RCH, Philips BWJ, Nagtegaal ID, Polat F, de Wilt JHW, Wauters CAP, Zamecnik P, Fütterer JJ, Scheenen TWJ. USPIO-enhanced MRI of lymph nodes in rectal cancer: A node-to-node comparison with histopathology. Eur J Radiol 2021; 138:109636. [PMID: 33721766 DOI: 10.1016/j.ejrad.2021.109636] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE To evaluate the initial results of predicting lymph node metastasis in rectal cancer patients detected in-vivo with USPIO-enhanced MRI at 3 T compared on a node-to-node basis with histopathology. METHODS Ten rectal cancer patients of all clinical stages were prospectively included for an in-vivo 0.85 mm3 isotropic 3D MRI after infusion of Ferumoxtran-10. The surgical specimens were examined ex-vivo with an 0.29 mm3 isotropic MRI examination. Two radiologists evaluated in-vivo MR images with a classification scheme to predict lymph node status. Ex-vivo MRI was used for MR-guided pathology and served as a key link between in-vivo MRI and final histopathology for the node-to-node analysis. RESULTS 138 lymph nodes were detected by reader 1 and 255 by reader 2 (p = 0.005) on in-vivo MRI with a median size of 2.6 and 2.4 mm, respectively. Lymph nodes were classified with substantial inter-reader agreement (κ = 0.73). Node-to-node comparison was possible for 55 lymph nodes (median size 3.2 mm; range 1.2-12.3), of which 6 were metastatic on pathology. Low true-positive rates (3/26, 11 % for both readers) and high true negative rates were achieved (14/17, 82 %; 19/22, 86 %). Pathological re-evaluations of 20 lymph nodes with high signal intensity on USPIO-enhanced MRI without lymph node metastases (false positives) did not reveal tumor metastasis but showed benign lymph node tissue with reactive follicles. CONCLUSIONS High resolution MRI visualizes a large number of mesorectal lymph nodes. USPIO-enhanced MRI was not accurate for characterizing small benign versus small tumoral lymph nodes in rectal cancer patients. Suspicious nodes on in-vivo MRI occur as inflammatory as well as metastatic nodes.
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Affiliation(s)
- Rutger C H Stijns
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Bart W J Philips
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carla A P Wauters
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Patrik Zamecnik
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tom W J Scheenen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, 45141, Germany
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18
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Ge YX, Hu SD, Wang Z, Guan RP, Zhou XY, Gao QZ, Yan G. Feasibility and reproducibility of T2 mapping and DWI for identifying malignant lymph nodes in rectal cancer. Eur Radiol 2020; 31:3347-3354. [PMID: 33185752 DOI: 10.1007/s00330-020-07359-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/27/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value and reproducibility of T2 mapping versus apparent diffusion coefficients (ADC) for identifying malignant lymph nodes in patients with non-mucinous rectal adenocarcinoma. METHODS High-resolution magnetic resonance imaging, diffusion-weighted imaging, and T2 mapping were performed on patients with suspected metastatic lymph nodes in the mesorectum or around the superior rectal artery with a short-axis diameter of 4-10 mm. The T2 and ADC values of pathology-confirmed metastatic versus non-metastatic lymph nodes were compared using the independent-samples t test and receiver operating characteristic curves. Intra- and inter-observer reproducibility were tested. The cutoff value for T2 relaxation time was determined. RESULTS In total, 67 lymph nodes underwent histological analysis, with 24 in the non-metastatic and 43 in the metastatic groups. Intra- and inter-observer agreements for T2 values were 0.999 and 0.998, respectively, which were higher than the ADC values of 0.924 and 0.844, respectively. The mean T2 and ADC values for metastatic lymph nodes (65 ± 7.8 ms and 1.17 ± 0.16 × 10-3 mm2/s, respectively) were significantly lower than for benign lymph nodes(83 ± 5.7 ms and 1.29 ± 0.15 × 10-3 mm2/s, respectively). T2 values had a higher AUC value of 0.990 than the AUC value for ADC of 0.729. With a cutoff value of 77 ms, sensitivity and specificity for T2 values were 95% and 96%, respectively. CONCLUSIONS T2 mapping had higher diagnostic efficacy and reproducibility than ADC and may be useful in differentiating metastatic from non-metastatic lymph nodes in rectal cancer. KEY POINTS • Mean T2 values were significantly shorter for malignant versus benign LNs in patients with non-mucinous rectal adenocarcinoma. • The diagnostic efficacy and reproducibility of T2 values were excellent and superior to ADC values.
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Affiliation(s)
- Yu-Xi Ge
- Department of Radiology, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, Jiangsu, China
| | - Shu-Dong Hu
- Department of Radiology, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, Jiangsu, China
| | - Zi Wang
- Department of Radiology, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, Jiangsu, China
| | - Rong-Ping Guan
- Department of Radiology, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, Jiangsu, China
| | - Xin-Yi Zhou
- Department of Pathology, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, Jiangsu, China
| | - Qi-Zhong Gao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, 214000, Jiangsu, China.
| | - Gen Yan
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, 556 Shengguang Road, Xiamen, 361021, Fujian, China.
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19
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Santiago I, Figueiredo N, Parés O, Matos C. MRI of rectal cancer-relevant anatomy and staging key points. Insights Imaging 2020; 11:100. [PMID: 32880782 PMCID: PMC7471246 DOI: 10.1186/s13244-020-00890-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/26/2020] [Indexed: 02/14/2023] Open
Abstract
Rectal cancer has the eighth highest cancer incidence worldwide, and it is increasing in young individuals. However, in countries with a high human development index, mortality is decreasing, which may reflect better patient management, imaging being key. We rely on imaging to establish the great majority of clinical tumour features for therapeutic decision-making, namely tumour location, depth of invasion, lymph node involvement, circumferential resection margin status and extramural venous invasion. Despite major improvements in technique resulting in better image quality, and notwithstanding the dissemination of guidelines and examples of standardised reports, rectal cancer staging is still challenging on the day-to-day practice, and we believe there are three reasons. First, the normal posterior pelvic compartment anatomy and variants are not common knowledge to radiologists; second, not all rectal cancers fit in review paper models, namely the very early, the very low and the mucinous; and third, the key clinical tumour features may be tricky to analyse. In this review, we discuss the normal anatomy of the rectum and posterior compartment of the pelvis, systematise all rectal cancer staging key points and elaborate on the particularities of early, low and mucinous tumours. We also include our suggested reporting templates and a discussion of its comparison to the reporting templates provided by ESGAR and SAR.
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Affiliation(s)
- Inês Santiago
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal. .,Nova Medical School, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal. .,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Oriol Parés
- Radiation Oncology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
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20
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Žilinskas J, Jokubauskas M, Smailytė G, Gineikienė I, Tamelis A. Comparison of Changes in Disease-Free and Overall Survival of Resectable Rectal Adenocarcinoma between 2010 and 2015. Visc Med 2020; 36:144-149. [PMID: 32355671 DOI: 10.1159/000500730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/02/2019] [Indexed: 11/19/2022] Open
Abstract
Background Management of rectal cancer (RC) has undergone many changes in recent decades. A multidisciplinary approach to this complex disease is essential, ensuring high-quality diagnostic, treatment, and outcomes. We aimed to compare treatment results of RC in a single-centre setting between 2010 and 2015. Methods A retrospective comparative study included patients with newly diagnosed and operated resectable RC. Patients' diagnostic and treatment data were analysed. Postoperative morbidity was measured according to the Clavien-Dindo classification. Survival data were received from the Lithuanian Cancer Registry. Continuous variables were expressed as mean and SD. Student t test and one-way ANOVA were used for parametric data and the Mann-Whitney test for non-parametric. A multivariate logistic regression analysis was used to identify independent factors for increased survival. Association between categorical variables was verified using Pearson χ<sup>2</sup>. Results The study included 179 patients: 80 from 2010 and 99 from 2015. Mean sample age was 67.1 ± 10.7 years. There was no significant difference regarding age, gender, median ASA (3 in both groups), but mean hospital stay was 2 days shorter (8 vs. 10 days) in 2015 (p = 0.002). There were only 8 patients (4%) admitted to the hospital on an emergency basis. Pelvis MRI and abdominal CT were performed more often in 2015: from 37.5 to 77.8% (p < 0.001) and from 52.5 to 97% in 2015, respectively. Circumferential margin evaluation increased from 13.8 to 36.4% (p = 0.001). Neoadjuvant therapy increased from 20% in 2010 to 44.9% in 2015 (p = 0.01). The overall postoperative Clavien-Dindo complication rate was higher in 2015 (13.8 vs. 20.2%, p = 0.596), but in-hospital mortality was lower (1 vs. 0 patients). Comparison of radiological TNM and pathological TNM with one-way ANOVA showed a significant difference staging between 2010 (p = 0.002) and 2015 (p = 0.001). The 2-year overall survival (OS) increased from 76.3 to 86.9% (p = 0.046) and the median disease-free survival from 27 (range 0-35) months to 28 (range 0-35) months (72.5-83.5%, p = 0.077). Multivariate logistic regression analysis determined that availability and performance of MRI were associated with an increased OS (OR = 1.529, 95% CI 0.916-2.554, p = 0.020). Conclusions The expanded quantity of preoperative imaging, an improved radiological staging, and compulsory multidisciplinary team board discussions have led to selective neoadjuvant treatment decision followed by surgery which can positively affect the 2-year OS rate.
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Affiliation(s)
- Justas Žilinskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Mantas Jokubauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Giedrė Smailytė
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
| | - Irina Gineikienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Algimantas Tamelis
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
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21
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Can Ex Vivo Magnetic Resonance Imaging of Rectal Cancer Specimens Improve the Mesorectal Lymph Node Yield for Pathological Examination? Invest Radiol 2020; 54:645-652. [PMID: 31219996 PMCID: PMC6738635 DOI: 10.1097/rli.0000000000000581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental digital content is available in the text. The aim of this study was to use 7 T ex vivo magnetic resonance imaging (MRI) scans to determine the size of lymph nodes (LNs) in total mesorectal excision (TME) specimens and to increase the pathological yield of LNs with MR-guided pathology.
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22
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Saifuddin A, Siddiqui S, Pressney I, Khoo M. The incidence and diagnostic relevance of chemical shift artefact in the magnetic resonance imaging characterisation of superficial soft tissue masses. Br J Radiol 2019; 93:20190828. [PMID: 31834812 DOI: 10.1259/bjr.20190828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Chemical shift artefact (CSA) is often encountered during MRI evaluation of superficial soft tissue masses. The study aim was to determine the incidence and diagnostic relevance of CSA in a consecutive series of superficial soft tissue masses referred to a specialist musculoskeletal sarcoma service. METHODS All patients referred over a 6 month period with a non-lipomatous superficial soft tissue mass were prospectively analysed. Patients characteristics (age, gender), lesion features (anatomical location, size, relationship to the skin and deep fascia), presence of CSA and final histopathological diagnosis were collected. The presence of CSA was statistically analysed against these clinical, imaging and histopathological variables. RESULTS 128 patients fulfilled the inclusion criteria [63 males, 65 females; mean age = 50.6 years (7-96 years)]. CSA was present in 50 cases (39.1%) overall, but in 39 (41.5%) of 94 cases with histological diagnosis. There was no statistically significant relationship to any assessed variable apart from relationship to the deep fascia, CSA being more frequent in lesions contacting the fascia compared to lesions contacting both skin and fascia (p-value 0.02). In particular, the presence of CSA did not allow differentiation between non-malignant and malignant lesions. CONCLUSION The presence of CSA is a not infrequent finding in the MRI assessment of superficial soft tissue masses but does not appear to be of any significance in differentiating between non-malignant and malignant lesions. ADVANCES IN KNOWLEDGE CSA is a relatively common finding in association with superficial soft tissue masses, but does not indicate a particular histological diagnosis or help in the differentiation of non-malignant from malignant lesions.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Shuaib Siddiqui
- Department of Accident & Emergency, East Surrey Hospital, Redhill, UK
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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23
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Sun RJ, Wang L, Li XT, Lu QY, Zhang XY, Guan Z, Sun YS. Baseline MRI detected lateral lymph node as a prognostic factor: a cohort study in pN0 low-risk rectal cancer. J Cancer Res Clin Oncol 2019; 146:739-748. [PMID: 31832762 DOI: 10.1007/s00432-019-03100-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is highly controversial that how to deal with the lateral lymph-node metastasis in patients with rectal cancer. Although lateral lymph node can be detected by preoperative MRI, the metastasis status cannot be accurately determined following standard total mesorectal excision (TME) in low-risk patients. This study was to assess the correlation between preoperative MRI detected lateral lymph-node (LLN) features and prognosis in patients with non-preradiated low recurrence risk rectal cancers. MATERIALS AND METHODS This retrospective study included 593 low-risk rectal cancers underwent TME without neoadjuvant chemo-radiotherapy from January 2013 to December 2015. The features of the largest LLN were retrospectively reviewed on preoperative MRI. The relationship of MR-LLN features with overall survival, metastasis-free survival, and local relapse-free survival was analyzed. RESULTS A total of 593 patients including 415 cases of pN0, 86 cases of pN1, and 92 cases of pN2 were enrolled in this study. In pN0 patients, at least one visible LLN was detected in 104 patients on primary MRI. The MR-T staging, postoperative therapy status, the presence of MR-LLN, and short axis (SA) of MR-LLN were significantly correlated with the recurrence in pN0 patients (all p < 0.05). The OS and MFS were significantly lower in patients with MR-LLN SA ≥ 8 mm than SA < 8 mm (p < 0.01, HR = 4.35, 95% CI = 1.48-12.77). The OS and MFS of patients with pN0-LLN(+) and SA ≥ 8 mm were similar to pN2-LLN(-) patients. The location of MR-LLN showed no significant impact on prognosis. CONCLUSION For low-risk rectal cancers without neoadjuvant chemo-radiotherapy, the presence of MR-LLN is associated with poor prognosis. The pN0-LLN(+) SA ≥ 8 mm patients might be concerned as pN2 patients and receive more intensive neoadjuvant or adjuvant treatment.
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Affiliation(s)
- Rui-Jia Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road Hai Dian District, Beijing, 100142, China
| | - Lin Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Hai Dian District, Beijing, 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road Hai Dian District, Beijing, 100142, China
| | - Qiao-Yuan Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road Hai Dian District, Beijing, 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road Hai Dian District, Beijing, 100142, China
| | - Zhen Guan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road Hai Dian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road Hai Dian District, Beijing, 100142, China.
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Yang X, Chen Y, Wen Z, Liu Y, Xiao X, Liang W, Yu S. Non-invasive MR assessment of the microstructure and microcirculation in regional lymph nodes for rectal cancer: a study of intravoxel incoherent motion imaging. Cancer Imaging 2019; 19:70. [PMID: 31685035 PMCID: PMC6829929 DOI: 10.1186/s40644-019-0255-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/20/2019] [Indexed: 01/02/2023] Open
Abstract
Background The aim of this study is to evaluate the microstructure and microcirculation of regional lymph nodes (LNs) in rectal cancer by using non-invasive intravoxel incoherent motion MRI (IVIM-MRI), and to distinguish metastatic from non-metastatic LNs by quantitative parameters. Methods All recruited patients underwent IVIM-MRI (b = 0, 5, 10, 20, 30, 40, 60, 80, 100, 150, 200, 400, 600, 1000, 1500 and 2000 s/mm2) on a 3.0 T MRI system. One hundred sixty-eight regional LNs with a short-axis diameter equal to or greater than 5 mm from 116 patients were evaluated by two radiologists independently, including 78 malignant LNs and 90 benign LNs. The following parameters were assessed: the short-axis diameter (S), long-axis diameter (L), short- to long-axis diameter ratio (S/L), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion factor (f). Intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement between two readers. Receiver operating characteristic curves were applied for analyzing statistically significant parameters. Results Interobserver agreement of IVIM-MRI parameters between two readers was excellent (ICCs> 0.75). The metastatic group exhibited higher S, L and D (P < 0.001), but lower f (P < 0.001) than the non-metastatic group. The area under the curve (95% CI, sensitivity, specificity) of the multi-parameter combined equation for D, f and S was 0.811 (0.744~0.868, 62.82%, 87.78%). The diagnostic performance of the multi-parameter model was better than that of an individual parameter (P < 0.05). Conclusion IVIM-MRI parameters provided information about the microstructure and microcirculation of regional LNs in rectal cancer, also improved diagnostic performance in identifying metastatic LNs.
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Affiliation(s)
- Xinyue Yang
- Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China, 510280
| | - Yan Chen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, 510080
| | - Ziqiang Wen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, 510080
| | - Yiyan Liu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, 510080
| | - Xiaojuan Xiao
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China, 518033
| | - Wen Liang
- Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China, 510280.
| | - Shenping Yu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China, 510080.
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MRI morphologic and clinicopathologic characteristics for predicting outcomes in patients with locally advanced rectal cancer. Abdom Radiol (NY) 2019; 44:3652-3663. [PMID: 30456561 DOI: 10.1007/s00261-018-1828-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to investigate the value of MRI morphologic and clinicopathologic factors for predicting 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC). METHOD In this retrospective study, pre- and post-neoadjuvant chemoradiotherapy (nCRT) MRI morphologic (e.g., pre-nCRT MRI-detected extramural venous invasion) and clinicopathologic variabilities (e.g., pathological complete response) were evaluated in all patients. Three-year DFS was estimated using Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between morphologic or clinicopathologic variabilities and survival outcomes. RESULTS A total of 115 patients (39 females and 76 males; median age, 54 years; age range, 28-82 years) with LARC treated with nCRT were enrolled. With a median follow-up of 48.0 months, the 3-year DFS was 79.0% for all patients. During follow-up, 18 patients died, 28 patients experienced relapse (26 distant, one local, and one both), and 69 patients were censored. MRI-detected extramural venous invasion (mrEMVI) was the only significantly independent factor of long-term survival, while HR was 2.308 (95% CI 1.151-4.629, P = 0.018) on univariate and 2.495 (95% CI 1.243-5.012, P = 0.010) on multivariate analysis. The 3-year cumulative survival rate in patients with mrEMVI negativity compared with positivity were 86.6% versus 65.0% (P = 0.015), respectively. CONCLUSION In conclusion, pre-nCRT mrEMVI status was the independent significant risk factor for long-term outcomes in LARC patients treated with nCRT, while the other morphologic and clinicopathologic characteristics were not related to the patient survival.
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Juchems MS, Wessling J. [Rational staging and follow-up of colorectal cancer : Do guidelines provide further help?]. Radiologe 2019; 59:820-827. [PMID: 31455978 DOI: 10.1007/s00117-019-0578-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CLINICAL/METHODICAL ISSUE Colorectal cancer is one of the most common malignant tumors. Preoperative imaging is crucial in rectal cancer as patients can only receive optimal treatment when accurate staging is performed. The N‑staging is often difficult with the available options and must be called into question as a staging parameter. STANDARD RADIOLOGICAL METHODS Endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) are particularly suitable for local staging. Multiparametric MRI with diffusion imaging is indispensable for tumor follow-up. METHODICAL INNOVATIONS The assessment of infiltration of the mesorectal fascia is best accomplished using high-resolution MRI. In addition, extramural vascular infiltration (EMVI) has become established as another important prognostic factor. After neoadjuvant therapy and restaging of locally advanced rectal cancer, the identification and validation of prognostically relevant image parameters are prioritized. Multiparametric MRI of the rectum including diffusion imaging as well as the application of radiological and pathological scores (MR-TRG) are becoming increasingly more important in this context. ASSESSMENT For the radiologist it is important to become familiar with indicators of the resectability of rectal cancer and to be able to reliably read prognostically relevant imaging parameters in the tumor follow-up. PRACTICAL RECOMMENDATIONS For the practical application, the establishment of a fixed MRI protocol is essential. In addition to a guideline-compliant TNM classification, the radiologist must provide the clinician with information on infiltration of the mesorectal fascia and extramural vascular infiltration. The MR-TRGs are becoming increasingly more important in tumor follow-up.
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Affiliation(s)
- M S Juchems
- Diagnostische und Interventionelle Radiologie, Klinikum Konstanz, Mainaustr. 35, 78464, Konstanz, Deutschland.
| | - J Wessling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenshospital Münster, Münster, Deutschland
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Rectal cancer: can T2WI histogram of the primary tumor help predict the existence of lymph node metastasis? Eur Radiol 2019; 29:6469-6476. [PMID: 31278581 DOI: 10.1007/s00330-019-06328-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore if there is a correlation between T2WI histogram features of the primary tumor and the existence of regional lymph node (LN) metastasis in rectal cancer. METHODS Eighty-eight patients with pathologically proven rectal adenocarcinoma, who received direct surgical resection and underwent preoperative rectal MRIs, were enrolled retrospectively. Based on pathological analysis of surgical specimen, patients were classified into negative LN (LN-) and positive LN (LN+) groups. The degree of differentiation and pathological T stage were recorded. Clinical T stage, tumor location, and maximum diameter of tumor were evaluated of each patient. Whole-tumor texture analysis was independently performed by two radiologists on axial T2WI, including skewness, kurtosis, energy, and entropy. RESULTS The interobserver agreement was overall good for texture analysis between two radiologists, with intraclass correlation coefficients (ICCs) ranging from 0.626 to 0.826. The LN- group had a significantly higher skewness (p < 0.001), kurtosis (p < 0.001), and energy (p = 0.004) than the LN+ group, and a lower entropy (p = 0.028). These four parameters showed moderate to good diagnostic power in predicting LN metastasis with respective AUC of 0.750, 0.733, 0.669, and 0.648. In addition, they were both correlated with LN metastasis (rs = - 0.413, - 0.385, - 0.28, and 0.245, respectively). The multivariate analysis showed that lower skewness was an independent risk factor of LN metastasis (odds ratio, OR = 9.832; 95%CI, 1.171-56.295; p = 0.01). CONCLUSIONS Signal intensity histogram parameters of primary tumor on T2WI were associated with regional LN status in rectal cancer, which may help improve the prediction of nodal stage. KEY POINTS • Histogram parameters of tumor on T2WI may help to reduce uncertainty when assessing LN status in rectal cancer. • Histogram parameters of tumor on T2WI showed a significant difference between different regional LN status groups in rectal cancer. • Skewness was an independent risk factor of regional LN metastasis in rectal cancer.
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Role of Quantitative Dynamic Contrast-Enhanced MRI in Evaluating Regional Lymph Nodes With a Short-Axis Diameter of Less Than 5 mm in Rectal Cancer. AJR Am J Roentgenol 2018; 212:77-83. [PMID: 30354269 DOI: 10.2214/ajr.18.19866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to discriminate metastatic from nonmetastatic regional lymph nodes (LNs) with short-axis diameters of less than 5 mm in rectal cancer using quantitative parameters derived from dynamic contrast-enhanced (DCE) MRI. SUBJECTS AND METHODS Sixty-five LNs from 122 patients were evaluated, including malignant LNs (n = 27) and benign LNs (n = 38). The following parameters were assessed: the forward volume transfer constant (Ktrans), reverse volume transfer constant (kep), fractional extravascular extracellular space volume (Ve), short-axis diameter, long-axis diameter, and short- to long-axis diameter ratio. ROC curves were used to analyze statistically significant parameters. RESULTS Metastatic LNs exhibited a lower Ktrans than did nonmetastatic LNs (p < 0.001), but the other parameters were not significantly different between the two groups. The AUC of the Ktrans was 0.732, with a 95% CI of 0.610-0.854, and the diagnostic cutoff value was 0.088 min-1 (sensitivity, 60.5%; specificity, 81.5%). CONCLUSION Ktrans had moderate diagnostic performance in assessing small regional LNs in rectal cancer and appears to be a useful predictor when distinguishing malignant LNs from benign LNs only by morphology is difficult.
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Chen Y, Yang X, Wen Z, Lu B, Xiao X, Shen B, Yu S. Fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI for predicting small node metastases in patients with rectal cancer. Cancer Imaging 2018; 18:21. [PMID: 29784058 PMCID: PMC5963161 DOI: 10.1186/s40644-018-0153-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
Abstract
Background To investigate the application value of fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI in regional nodes with different short-axis diameter ranges in rectal cancer, especially in nodes ≤5 mm. Methods Patients with rectal adenocarcinoma confirmed by postoperative histopathology were included, and all the patients underwent preoperative 3.0 T rectal magnetic resonance imaging (MRI) and total mesorectal excision (TME) within 2 weeks after an MR scan. The harvested nodes from specimens were matched with nodes in the field of view (FOV) of images for a node-by-node evaluation. The maximum short-axis diameters of all the visible nodes in the FOV of images were measured by a radiologist; the morphological and enhancement characteristics of these nodes were also independently evaluated by two radiologists. The χ2 test was used to evaluate differences in morphological and enhancement characteristics between benign and malignant nodes. The enhancement characteristics were further compared between benign and malignant nodes with different short-axis diameter ranges using the χ2 test. Kappa statistics were used to describe interobserver agreement. Results A total of 441 nodes from 70 enrolled patients were included in the evaluation, of which 111 nodes were metastatic. Approximately 85.5 and 95.6% of benign nodes were found to have obvious enhancement and homogeneous or mild-heterogeneous enhancement, respectively, whereas approximately 89.2 and 85.1% of malignant nodes showed moderate or mild enhancement and obvious-heterogeneous or rim-like enhancement, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) values of the enhancement degree for identifying the overall nodal status, nodes ≤5 mm and nodes > 5 mm and ≤ 10 mm were 0.887, 0.859 and 0.766 for radiologist 1 and 0.892, 0.823 and 0.774 for radiologist 2, respectively. The AUCs of enhancement homogeneity were 0.940, 0.928 and 0.864 for radiologist 1 and 0.944, 0.938 and 0.842 for radiologist 2, respectively. Nodal border and signal homogeneity were also of certain value in distinguishing metastatic nodes. Conclusions Enhancement characteristics based on fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI were helpful for diagnosing metastatic nodes in rectal cancer and were a reliable indicator for nodes ≤5 mm.
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Affiliation(s)
- Yan Chen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Xinyue Yang
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Ziqiang Wen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Baolan Lu
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Xiaojuan Xiao
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Bingqi Shen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Shenping Yu
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China.
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Zhang C, Ye F, Liu Y, Ouyang H, Zhao X, Zhang H. Morphologic predictors of pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Oncotarget 2017; 9:4862-4874. [PMID: 29435147 PMCID: PMC5797018 DOI: 10.18632/oncotarget.23419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/02/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the value of morphological parameters that can be obtained conveniently by MRI for predicting pathologically complete response (pCR) in patients with rectal cancer. Materials and Methods A cohort of 101 patients was examined using MRI before and after Neoadjuvant chemoradiotherapy (nCRT). Morphological parameters including maximum tumor area (MTA), maximum tumor length (MTL) and maximum tumor thickness (MTT), as well as cylindrical approximated tumor volume (CATV), distance to anal verge (DTA), and the reduction rates were evaluated by two experienced readers independently. Results Post-nCRT MTA and MTL, reduction rates and pre-nCRT DTA were proved to be significantly different between pCR and non-pCR with the AUCs of 0.672-0.853. The sensitivity and specificity for assessing pCR were 61.1-89.9% and 59.0-80.7% respectively. No significant correlation between pre-nCRT size measurements and pCR was obtained. Conclusion The convenient morphological measurements may be useful for predicting pCR with moderate sensitivity and specificity. Combining these predictors with the aim of building diagnostic model should be explored.
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Affiliation(s)
- Chongda Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Yuan Liu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Hongmei Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
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