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Park S, Park HS, Jang S, Cho J, Kim JH, Yu MH, Jung SI, Kim YJ, Hwang DY. Utility of abbreviated MRI in the post-treatment evaluation of rectal cancer. Acta Radiol 2024; 65:689-699. [PMID: 38778748 DOI: 10.1177/02841851241253936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Post-treatment evaluation of patients with rectal cancer (RC) using magnetic resonance imaging (MRI) burdens medical resources, necessitating an exploration of abbreviated protocols. PURPOSE To evaluate the diagnostic performance of abbreviated MRI (A-MRI) for the post-treatment evaluation of RC patients. MATERIAL AND METHODS This retrospective study included RC patients who underwent non-contrast rectal MRI and standard liver MRI, as well as abdominal contrast-enhanced computed tomography (CECT) for post-treatment evaluation. A-MRI comprised diffusion-weighted imaging (DWI) and T2-weighted imaging of the upper abdomen and the pelvic cavity. Three radiologists independently reviewed A-MRI, CECT, and standard liver MRI in the detection of viable disease. The diagnostic performances were compared using a reference standard considering all available information, including pathology, FDG-PET, endoscopic results, and clinical follow-up. RESULTS We included 78 patients (50 men, 28 women; mean age=60.9 ± 10.2 years) and observed viable disease in 34 (43.6%). On a per-patient-basis analysis, A-MRI showed significantly higher sensitivity (95% vs. 81%, P = 0.04) and higher accuracy (93% vs. 82%, P < 0.01), compared to those of CECT, while A-MRI showed comparable sensitivity (91% vs. 91%, P = 0.42) and accuracy (97% vs. 98%, P = 0.06) to that of standard liver MRI. On a per-lesion-based analysis, A-MRI exhibited significantly superior lesion detectability than that of CECT (figure of merit 0.91 vs. 0.77, P < 0.01) and comparable to that of standard liver MRI (figure of merit 0.91 vs. 0.92, P = 0.75). CONCLUSION A-MRI exhibited higher sensitivity and diagnostic accuracy than those of CECT in the post-treatment evaluation of RC, while it showed comparable performances with standard liver MRI. A-MRI provides diagnostic added value in the follow-up of RC patients.
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Affiliation(s)
- Sungeun Park
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Siwon Jang
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dae-Yong Hwang
- Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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2
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Torri GB, Wiethan CP, Langer FW, de Oliveira GS, Meirelles AVB, Horvat N, Tse JR, Dias AB, Altmayer S. Split scar sign to predict complete response in rectal cancer after neoadjuvant chemoradiotherapy: systematic review and meta-analysis. Eur Radiol 2024; 34:3874-3881. [PMID: 37979009 PMCID: PMC11166750 DOI: 10.1007/s00330-023-10447-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) is the modality of choice for rectal cancer initial staging and restaging after neoadjuvant chemoradiation. Our objective was to perform a meta-analysis of the diagnostic performance of the split scar sign (SSS) on rectal MRI in predicting complete response after neoadjuvant therapy. METHODS MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through June 2023. Primary studies met eligibility criteria if they evaluated the diagnostic performance of the SSS to predict complete response on pathology or clinical follow-up in patients undergoing neoadjuvant chemoradiation. A meta-analysis with a random-effects model was used to estimate pooled sensitivity and specificity, area under the curve (AUC), and diagnostic odds ratio (DOR) of the SSS. RESULTS A total of 4 studies comprising 377 patients met the inclusion criteria. The prevalence of complete response in the studies was 21.7-52.5%. The pooled sensitivity and specificity of the SSS to predict complete response were 62.0% (95% CI, 43.5-78.5%) and 91.9% (95% CI, 78.9-97.2%), respectively. The estimated AUC for SSS was 0.83 (95% CI, 0.56-0.94) with a DOR of 18.8 (95% CI, 3.65-96.5). CONCLUSION The presence of SSS on rectal MRI demonstrated high specificity for complete response in patients with rectal cancer after neoadjuvant chemoradiation. This imaging pattern can be a valuable tool to identify potential candidates for organ-sparing treatment and surveillance. CLINICAL RELEVANCE STATEMENT SSS presents high specificity for complete response post-neoadjuvant. This MRI finding enhances rectal cancer treatment assessment and aids clinicians and patients in choosing watch-and-wait over immediate surgery, which can potentially reduce costs and associated morbidity. KEY POINTS •Fifteen to 50% of rectal cancer patients achieve complete response after neoadjuvant chemoradiation and may be eligible for a watch-and-wait strategy. •The split scar sign has high specificity for a complete response. •This imaging finding is valuable to select candidates for organ-sparing management.
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Affiliation(s)
- Giovanni Brondani Torri
- Department of Radiology and Diagnostic Imaging, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | - Camila Piovesan Wiethan
- Department of Radiology and Diagnostic Imaging, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | - Felipe Welter Langer
- Department of Radiology and Diagnostic Imaging, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | | | - Alice Villa Bella Meirelles
- Clinics Hospital, Federal University of Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, 30130-100, Brazil
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Justin Ruey Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
| | - Adriano Basso Dias
- Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4Th Floor, Toronto, ON, M5T 1W7, Canada
| | - Stephan Altmayer
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA.
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3
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Rafaelsen SR. Enhancement of image quality in rectal cancer imaging through MRI supplemented with rectal micro-enema. Acta Radiol 2024:2841851241256326. [PMID: 38772557 DOI: 10.1177/02841851241256326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
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4
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Miranda J, Causa Andrieu P, Nincevic J, Gomes de Farias LDP, Khasawneh H, Arita Y, Stanietzky N, Fernandes MC, De Castria TB, Horvat N. Advances in MRI-Based Assessment of Rectal Cancer Post-Neoadjuvant Therapy: A Comprehensive Review. J Clin Med 2023; 13:172. [PMID: 38202179 PMCID: PMC10780006 DOI: 10.3390/jcm13010172] [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: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Rectal cancer presents significant diagnostic and therapeutic challenges, with neoadjuvant therapy playing a pivotal role in improving resectability and patient outcomes. MRI serves as a critical tool in assessing treatment response. However, differentiating viable tumor tissue from therapy-induced changes on MRI remains a complex task. In this comprehensive review, we explore treatment options for rectal cancer based on resectability status, focusing on the role of MRI in guiding therapeutic decisions. We delve into the nuances of MRI-based evaluation of treatment response following neoadjuvant therapy, paying particular attention to emerging techniques like radiomics. Drawing from our insights based on the literature, we provide essential recommendations for post-neoadjuvant therapy management of rectal cancer, all within the context of MRI-based findings.
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Affiliation(s)
- Joao Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
- Department of Radiology, University of Sao Paulo, R. Dr. Ovidio Pires de Campos, 75 Cerqueira Cesar, Sao Paulo 05403-010, Brazil
| | - Pamela Causa Andrieu
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Josip Nincevic
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
| | - Lucas de Padua Gomes de Farias
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91—Bela Vista, Sao Paulo 01308-050, Brazil;
- Department of Radiology, Allianca Saude, Av. Pres. Juscelino Kubitschek, 1830, Sao Paulo 01308-050, Brazil
| | - Hala Khasawneh
- Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA;
| | - Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Nir Stanietzky
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
| | - Tiago Biachi De Castria
- Department of Gastrointestinal Oncology, Moffit Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
- Morsani College of Medicine, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
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5
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Kovacs B, Netzer N, Baumgartner M, Schrader A, Isensee F, Weißer C, Wolf I, Görtz M, Jaeger PF, Schütz V, Floca R, Gnirs R, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D, Maier-Hein KH. Addressing image misalignments in multi-parametric prostate MRI for enhanced computer-aided diagnosis of prostate cancer. Sci Rep 2023; 13:19805. [PMID: 37957250 PMCID: PMC10643562 DOI: 10.1038/s41598-023-46747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
Prostate cancer (PCa) diagnosis on multi-parametric magnetic resonance images (MRI) requires radiologists with a high level of expertise. Misalignments between the MRI sequences can be caused by patient movement, elastic soft-tissue deformations, and imaging artifacts. They further increase the complexity of the task prompting radiologists to interpret the images. Recently, computer-aided diagnosis (CAD) tools have demonstrated potential for PCa diagnosis typically relying on complex co-registration of the input modalities. However, there is no consensus among research groups on whether CAD systems profit from using registration. Furthermore, alternative strategies to handle multi-modal misalignments have not been explored so far. Our study introduces and compares different strategies to cope with image misalignments and evaluates them regarding to their direct effect on diagnostic accuracy of PCa. In addition to established registration algorithms, we propose 'misalignment augmentation' as a concept to increase CAD robustness. As the results demonstrate, misalignment augmentations can not only compensate for a complete lack of registration, but if used in conjunction with registration, also improve the overall performance on an independent test set.
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Affiliation(s)
- Balint Kovacs
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany.
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany.
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
| | - Nils Netzer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Baumgartner
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
| | - Adrian Schrader
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Fabian Isensee
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Cedric Weißer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Ivo Wolf
- Mannheim University of Applied Sciences, Mannheim, Germany
| | - Magdalena Görtz
- Junior Clinical Cooperation Unit 'Multiparametric Methods for Early Detection of Prostate Cancer', German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Paul F Jaeger
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Interactive Machine Learning Group, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Victoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Ralf Floca
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| | - Regula Gnirs
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
| | - Klaus H Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
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6
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Prezzi D, Muthuswamy K, Amlani A, Owczarczyk K, Elowaidy A, Mistry T, Bassett P, Goh V. Diffusion-weighted imaging complements T2-weighted MRI for tumour response assessment in squamous anal carcinoma. Eur Radiol 2023; 33:7575-7584. [PMID: 37462820 PMCID: PMC10598114 DOI: 10.1007/s00330-023-09942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVES A published tumour regression grade (TRG) score for squamous anal carcinoma treated with definitive chemoradiotherapy based on T2-weighted MRI yields a high proportion of indeterminate responses (TRG-3). We investigate whether the addition of diffusion-weighted imaging (DWI) improves tumour response assessment in the early post treatment period. MATERIALS AND METHODS This retrospective observational study included squamous anal carcinoma patients undergoing MRI before and within 3 months of completing chemoradiotherapy from 2009 to 2020. Four independent radiologists (1-20 years' experience) scored MRI studies using a 5-point TRG system (1 = complete response; 5 = no response) based on T2-weighted sequences alone, and then after a 12-week washout period, using a 5-point DWI-TRG system based on T2-weighted and DWI. Scoring confidence was recorded on a 5-point scale (1 = low; 5 = high) for each reading and compared using the Wilcoxon test. Indeterminate scores (TRG-3) from each reading session were compared using the McNemar test. Interobserver agreement was assessed using kappa statistics. RESULTS Eighty-five patients were included (mean age, 59 years ± 12 [SD]; 55 women). T2-weighted TRG-3 scores from all readers combined halved from 24% (82/340) to 12% (41/340) with DWI (p < 0.001). TRG-3 scores changed most frequently (41%, 34/82) to DWI-TRG-2 (excellent response). Complete tumour response was recorded clinically in 77/85 patients (91%). Scoring confidence increased using DWI (p < 0.001), with scores of 4 or 5 in 84% (287/340). Interobserver agreement remained fair to moderate (kappa range, 0.28-0.58). CONCLUSION DWI complements T2-weighted MRI by reducing the number of indeterminate tumour responses (TRG-3). DWI increases radiologist's scoring confidence. CLINICAL RELEVANCE STATEMENT Diffusion-weighted imaging improves T2-weighted tumour response assessment in squamous anal cancer, halving the number of indeterminate responses in the early post treatment period, and increases radiologists' confidence. KEY POINTS Tumour response based on T2-weighted MRI is often indeterminate in squamous anal carcinoma. Diffusion-weighted imaging alongside T2-weighted MRI halved indeterminate tumour regression grade scores assigned by four radiologists from 24 to 12%. Scoring confidence of expert and non-expert radiologists increased with the inclusion of diffusion-weighted imaging.
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Affiliation(s)
- Davide Prezzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK.
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | - Ashik Amlani
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kasia Owczarczyk
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ahmed Elowaidy
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tina Mistry
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Vicky Goh
- School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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7
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Gormly KL. Anal cancer MRI: DWI assists response assessment for squamous cell carcinoma, but achieving widespread high-quality scans remains challenging. Eur Radiol 2023; 33:7573-7574. [PMID: 37581667 DOI: 10.1007/s00330-023-09970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Kirsten L Gormly
- Jones Radiology, 226 Greenhill Road, Eastwood, South Australia, 5063, Australia.
- The University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.
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8
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Ou X, van der Reijd DJ, Lambregts DMJ, Grotenhuis BA, van Triest B, Beets GL, Beets-Tan RGH, Maas M. Sense and non-sense of imaging in the era of organ preservation for rectal cancer. Br J Radiol 2023; 96:20230318. [PMID: 37750870 PMCID: PMC10607404 DOI: 10.1259/bjr.20230318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 09/27/2023] Open
Abstract
This review summarizes the current applications and benefits of imaging modalities for organ preservation in the treatment of rectal cancer. The concept of organ preservation in the treatment of rectal cancer has revolutionized the way rectal cancer is managed. Initially, organ preservation was limited to patients with locally advanced rectal cancer who needed neoadjuvant therapy to reduce tumor size before surgery and achieved complete response. However, neoadjuvant therapy is now increasingly utilized for smaller and less aggressive tumors to achieve primary organ preservation. Additionally, more intensive neoadjuvant strategies are employed to improve complete response rates and increase the chances of successful organ preservation. The selection of patients for organ preservation is a critical component of treatment, and imaging techniques such as digital rectal exam, endoscopy, and MRI are commonly used for this purpose. In this review, we provide an overview of what imaging modalities should be chosen and how they can aid in the selection and follow-up of patients undergoing organ-preserving strategies.
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Affiliation(s)
| | | | | | | | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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9
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El Homsi M, Sheedy SP, Rauch GM, Ganeshan DM, Ernst RD, Golia Pernicka JS. Follow-up imaging of anal cancer after treatment. Abdom Radiol (NY) 2023; 48:2888-2897. [PMID: 37024606 DOI: 10.1007/s00261-023-03895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023]
Abstract
Anal cancer treatment response assessment can be challenging with both magnetic resonance imaging (MRI) and clinical evaluation considered essential. MRI, in particular, has shown to be useful for the assessment of treatment response, the detection of recurrent disease in follow up and surveillance, and the evaluation of possible post-treatment complications as well as complications from the tumor itself. In this review, we focus on the role of imaging, mainly MRI, in anal cancer treatment response assessment. We also describe the treatment complications that can occur, and the imaging findings associated with those complications.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | | | - Gaiane M Rauch
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dhakshina M Ganeshan
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randy D Ernst
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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10
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Fraum TJ, Ma J, Jhaveri K, Nepal P, Lall C, Costello J, Harisinghani M. The optimized rectal cancer MRI protocol: choosing the right sequences, sequence parameters, and preparatory strategies. Abdom Radiol (NY) 2023; 48:2771-2791. [PMID: 36899281 DOI: 10.1007/s00261-023-03850-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 03/12/2023]
Abstract
Pelvic MRI plays a critical role in rectal cancer staging and treatment response assessment. Despite a consensus regarding the essential protocol components of a rectal cancer MRI, substantial differences in image quality persist across institutions and vendor software/hardware platforms. In this review, we present image optimization strategies for rectal cancer MRI examinations, including but not limited to preparation strategies, high-resolution T2-weighted imaging, and diffusion-weighted imaging. Our specific recommendations are supported by case studies from multiple institutions. Finally, we describe an ongoing initiative by the Society of Abdominal Radiology's Disease-Focused Panel (DFP) on Rectal and Anal Cancer to create standardized rectal cancer MRI protocols across scanner platforms.
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Affiliation(s)
- Tyler J Fraum
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus, Box 8131, St. Louis, MO, 63110, USA.
| | - Jingfei Ma
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kartik Jhaveri
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Pankaj Nepal
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chandana Lall
- Department of Radiology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - James Costello
- Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Mukesh Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Santini D, Danti G, Bicci E, Galluzzo A, Bettarini S, Busoni S, Innocenti T, Galli A, Miele V. Radiomic Features Are Predictive of Response in Rectal Cancer Undergoing Therapy. Diagnostics (Basel) 2023; 13:2573. [PMID: 37568936 PMCID: PMC10417449 DOI: 10.3390/diagnostics13152573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Rectal cancer is a major mortality cause in the United States (US), and its treatment is based on individual risk factors for recurrence in each patient. In patients with rectal cancer, accurate assessment of response to chemoradiotherapy has increased in importance as the variety of treatment options has grown. In this scenario, a controversial non-operative approach may be considered in some patients for whom complete tumor regression is believed to have occurred. The recommended treatment for locally advanced rectal cancer (LARC, T3-4 ± N+) is total mesorectal excision (TME) after neoadjuvant chemoradiotherapy (nCRT). Magnetic resonance imaging (MRI) has become a standard technique for local staging of rectal cancer (tumor, lymph node, and circumferential resection margin [CRM] staging), in both the US and Europe, and it is getting widely used for restaging purposes. AIM In our study, we aimed to use an MRI radiomic model to identify features linked to the different responses of chemoradiotherapy of rectal cancer before surgery, and whether these features are helpful to understand the effectiveness of the treatments. METHODS We retrospectively evaluated adult patients diagnosed with LARC who were subjected to at least 2 MRI examinations in 10-12 weeks at our hospital, before and after nCRT. The MRI acquisition protocol for the 2 exams included T2 sequence and apparent diffusion coefficient (ADC) map. The patients were divided into 2 groups according to the treatment response: complete or good responders (Group 1) and incomplete or poor responders (Group 2). MRI images were segmented, and quantitative features were extracted and compared between the two groups. Features that showed significant differences (SF) were then included in a LASSO regression method to build a radiomic-based predictive model. RESULTS We included 38 patients (26 males and 12 females), who are classified from T2 and T4 stages in the rectal cancer TNM. After the nCRT, the patients were divided into Group 1 (13 patients), complete or good responders, and Group 2 (25 patients), incomplete or poor responders. Analysis at baseline generated the following significant features for the Mann-Whitney test (out of a total of 107) for each sequence. Also, the analysis at the end of the follow-up yielded a high number of significant features for the Mann-Whitney test (out of a total of 107) for each image. Features selected by the LASSO regression method for each image analyzed; ROC curves relative to each model are represented. CONCLUSION We developed an MRI-based radiomic model that is able to differentiate and predict between responders and non-responders who went through nCRT for rectal cancer. This approach might identify early lesions with high surgical potential from lesions potentially resolving after medical treatment.
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Affiliation(s)
- Diletta Santini
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (D.S.)
| | - Ginevra Danti
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (D.S.)
| | - Eleonora Bicci
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (D.S.)
| | - Antonio Galluzzo
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (D.S.)
| | - Silvia Bettarini
- Department of Health Physics, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Simone Busoni
- Department of Health Physics, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Tommaso Innocenti
- Clinical Gastroenterology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Andrea Galli
- Clinical Gastroenterology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (D.S.)
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Nougaret S, Rousset P, Lambregts DMJ, Maas M, Gormly K, Lucidarme O, Brunelle S, Milot L, Arrivé L, Salut C, Pilleul F, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Cotte E, Rouanet P, Catalano O, Denost Q, Tan RB, Frulio N, Hoeffel C. MRI restaging of rectal cancer: The RAC (Response-Anal canal-CRM) analysis joint consensus guidelines of the GRERCAR and GRECCAR groups. Diagn Interv Imaging 2023; 104:311-322. [PMID: 36949002 DOI: 10.1016/j.diii.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To develop guidelines by international experts to standardize data acquisition, image interpretation, and reporting in rectal cancer restaging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and experts' opinions were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts provided recommendations for reporting template and protocol for data acquisition were collected; responses were analysed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (if ≥ 80% consensus among experts) or uncertain (if < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer restaging with MRI.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology IRCM, Montpellier Cancer Research Institute, 34000 Montpellier, France; INSERM, U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, CHU Lyon-Sud, EMR 3738 CICLY, Université Claude-Bernard Lyon 1, 69495 Pierre-Benite, France
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Kirsten Gormly
- Jones Radiology, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne Université, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Sorbonne Université, 75013 Paris, France
| | - Celine Salut
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | | | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean-Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06000 Nice, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Onofrio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Quentin Denost
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33000 Bordeaux, France
| | - Regina Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Nora Frulio
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
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Seo N, Lim JS. [Interpretation of Rectal MRI after Neoadjuvant Treatment in Patients with Rectal Cancer]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:550-564. [PMID: 37325000 PMCID: PMC10265231 DOI: 10.3348/jksr.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 06/17/2023]
Abstract
MRI is currently the imaging modality of choice to evaluate rectal cancer after neoadjuvant treatment. The purposes of restaging MRI are to assess the resectability of rectal cancer and to decide whether organ preservation strategies can be applied in patients with a complete clinical response. This review article indicates the key MRI features needed to evaluate rectal cancer after neoadjuvant treatment using a systematic approach. Assessment of primary tumor response including MRI findings to predict a complete response is discussed. Additionally, MRI evaluation of the relationship between the primary tumor and adjacent structures, lymph node response, extramural venous invasion, and tumor deposits after neoadjuvant treatment is presented. Knowledge of these imaging features and their clinical relevance may help radiologists provide an accurate and clinically valuable interpretation of restaging rectal MRI.
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14
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Jayaprakasam VS, Alvarez J, Omer DM, Gollub MJ, Smith JJ, Petkovska I. Watch-and-Wait Approach to Rectal Cancer: The Role of Imaging. Radiology 2023; 307:e221529. [PMID: 36880951 PMCID: PMC10068893 DOI: 10.1148/radiol.221529] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 03/08/2023]
Abstract
The diagnosis and treatment of rectal cancer have evolved dramatically over the past several decades. At the same time, its incidence has increased in younger populations. This review will inform the reader of advances in both diagnosis and treatment. These advances have led to the watch-and-wait approach, otherwise known as nonsurgical management. This review briefly outlines changes in medical and surgical treatment, advances in MRI technology and interpretation, and landmark studies or trials that have led to this exciting juncture. Herein, the authors delve into current state-of-the-art methods to assess response to treatment with MRI and endoscopy. Currently, these methods for avoiding surgery can be used to detect a complete clinical response in as many as 50% of patients with rectal cancer. Finally, the limitations of imaging and endoscopy and future challenges will be discussed.
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Affiliation(s)
- Vetri Sudar Jayaprakasam
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Janet Alvarez
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Dana M. Omer
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Marc J. Gollub
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - J. Joshua Smith
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Iva Petkovska
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
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15
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Awiwi MO, Kaur H, Ernst R, Rauch GM, Morani AC, Stanietzky N, Palmquist SM, Salem UI. Restaging MRI of Rectal Adenocarcinoma after Neoadjuvant Chemoradiotherapy: Imaging Findings and Potential Pitfalls. Radiographics 2023; 43:e220135. [PMID: 36927125 DOI: 10.1148/rg.220135] [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: 03/18/2023]
Abstract
Rectal adenocarcinoma constitutes about one-third of all colorectal adenocarcinoma cases. Rectal MRI has become mandatory for evaluation of patients newly diagnosed with rectal cancer because it can help accurately stage the disease, impact the choice to give neoadjuvant therapy or proceed with up-front surgery, and even direct surgical dissection planes. Better understanding of neoadjuvant chemoradiotherapy effects on rectal tumors and recognition that up to 30% of patients can have a pathologic complete response have opened the door for the nonsurgical "watch-and-wait" management approach for rectal adenocarcinoma. Candidates for this organ-preserving approach should have no evidence of malignancy on all three components of response assessment after neoadjuvant therapy (ie, digital rectal examination, endoscopy, and rectal MRI). Hence, rectal MRI again has a major role in directing patient management and possibly sparing patients from unnecessary surgical morbidity. In this article, the authors discuss the indications for neoadjuvant therapy in management of patients with rectal adenocarcinoma, describe expected imaging appearances of rectal adenocarcinoma after completion of neoadjuvant therapy, and outline the MRI tumor regression grading system. Since pelvic sidewall lymph node dissection is associated with a high risk of permanent genitourinary dysfunction, it is performed for only selected patients who have radiologic evidence of sidewall lymph node involvement. Therefore, the authors review the relevant lymphatic compartments of the pelvis and describe lymph node criteria for determining locoregional nodal spread. Finally, the authors discuss limitations of rectal MRI, describe several potential interpretation pitfalls after neoadjuvant therapy, and emphasize how these pitfalls may be avoided. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Muhammad O Awiwi
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Harmeet Kaur
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Randy Ernst
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Gaiane M Rauch
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Ajaykumar C Morani
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Nir Stanietzky
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Sarah M Palmquist
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Usama I Salem
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
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16
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Foley RW, Komber H, Charters P, Ali N, Burns-Cox N, Burn PR. The Effect of Oral Laxatives on Rectal Distension and Image Quality in Magnetic Resonance Imaging of the Prostate. Cureus 2023; 15:e35539. [PMID: 37007417 PMCID: PMC10055861 DOI: 10.7759/cureus.35539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction Increasing rectal size is associated with increased artefacts on magnetic resonance imaging (MRI) of the prostate and has the potential to degrade image quality. The objective of this study was to analyse the effect of oral laxative medication on rectal distension and image quality in prostate MRI. Methods Eighty patients prospectively received either 15 mg of oral senna (laxative group) or no medication (control group). Patients underwent prostate MRI according to standard local protocol and seven rectal dimensions on axial and sagittal images were measured. A subjective assessment of rectal distension was also made using a five-point Likert scale. Finally, artefacts on diffusion-weighted sequences were assessed using a four-point Likert scale. Results There was a small reduction in rectal diameter on sagittal images in the laxative group compared to the control group, with mean diameters of 27.1 mm and 30.0 mm respectively, p=0.02. There was no significant difference in rectal measurements of anteroposterior diameter, transverse diameter, or rectal circumference on axial imaging. Subjective scoring also demonstrated no significant difference in diffusion-weighted imaging quality between the laxative group and control group, p=0.82. Conclusion Bowel preparation with the oral laxative, senna, provided only a marginal decrease in rectal distension on one measure and no reduction in artefacts on diffusion-weighted sequences. The findings of this study do not support the routine use of this medication in patients undergoing prostate MRI.
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17
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Horvat N, El Homsi M, Miranda J, Mazaheri Y, Gollub MJ, Paroder V. Rectal MRI Interpretation After Neoadjuvant Therapy. J Magn Reson Imaging 2023; 57:353-369. [PMID: 36073323 PMCID: PMC9851947 DOI: 10.1002/jmri.28426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, several key advances in the management of locally advanced rectal cancer have been made, including the implementation of total mesorectal excision as the standard surgical approach; use of neoadjuvant chemoradiotherapy in selected patients with a high risk of local recurrence, and finally, adoption of organ preservation strategies, through either local excision or nonoperative management in selected patients with clinical complete response following neoadjuvant chemoradiotherapy. This review aims to shed light on the role of rectal MRI in the assessment of treatment response after neoadjuvant therapy, which is especially important given the growing feasibility of nonoperative management. First, an overview of current neoadjuvant therapies and response assessment based on digital rectal examination, endoscopy, and MRI will be provided. Second, the use of a high-quality restaging rectal MRI protocol will be presented. Third, a step-by-step approach to assessing treatment response on restaging rectal MRI following neoadjuvant treatment will be outlined, acknowledging challenges faced by radiologists during MRI interpretation. Finally, research related to response assessment will be discussed. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joao Miranda
- Department of Radiology, University of Sao Paulo, Sao Paulo, Brazil
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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18
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El Khababi N, Beets-Tan RGH, Tissier R, Lahaye MJ, Maas M, Curvo-Semedo L, Dresen RC, Nougaret S, Beets GL, Lambregts DMJ. Comparison of MRI response evaluation methods in rectal cancer: a multicentre and multireader validation study. Eur Radiol 2022; 33:4367-4377. [PMID: 36576549 DOI: 10.1007/s00330-022-09342-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/30/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare four previously published methods for rectal tumor response evaluation after chemoradiotherapy on MRI. METHODS Twenty-two radiologists (5 rectal MRI experts, 17 general/abdominal radiologists) retrospectively reviewed the post-chemoradiotherapy MRIs of 90 patients, scanned at 10 centers (with non-standardized protocols). They applied four response methods; two based on T2W-MRI only (MRI tumor regression grade (mrTRG); split-scar sign), and two based on T2W-MRI+DWI (modified-mrTRG; DWI-patterns). Image quality was graded using a 0-6-point score (including slice thickness and in-plane resolution; sequence angulation; DWI b-values, signal-to-noise, and artefacts); scores < 4 were classified below average. Mixed model linear regression was used to calculate average sensitivity/specificity/accuracy to predict a complete response (versus residual tumor) and assess the impact of reader experience and image quality. Group interobserver agreement (IOA) was calculated using Krippendorff's alpha. Readers were asked to indicate their preferred scoring method(s). RESULTS Average sensitivity/specificity/accuracy was 57%/64%/62% (mrTRG), 36%/79%/66% (split-scar), 40%/79%/67% (modified-mrTRG), and 37%/82%/68% (DWI-patterns); mrTRG showed higher sensitivity but lower specificity and accuracy (p < 0.001) compared to the other methods. IOA was lower for the split scar method (0.18 vs. 0.39-0.43). Higher reader experience had a significant positive effect on diagnostic performance and IOA (except for the split scar sign); below-average imaging quality had a significant negative effect on diagnostic performance. DWI pattern was selected as the preferred method by 73% of readers. CONCLUSIONS Methods incorporating DWI showed the most favorable results when combining diagnostic performance, IOA, and reader preference. Reader experience and image quality clearly impacted diagnostic performance emphasizing the need for state-of-the-art imaging and dedicated radiologist training. KEY POINTS • In a multireader study comparing 4 MRI methods for rectal tumor response evaluation, those incorporating DWI showed the best results when combining diagnostic performance, IOA, and reader preference. • The most preferred method (by 73% of readers) was the "DWI patterns" approach with an accuracy of 68%, high specificity of 82%, and group IOA of 0.43. • Reader experience level and MRI quality had an evident effect on diagnostic performance and IOA.
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Affiliation(s)
- Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands.,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands.,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Renaud Tissier
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands.,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands.,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar e Universitario de Coimbra EPE, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raphaëla C Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Nougaret
- Medical Imaging Department, Montpellier Cancer Institute, Montpellier Cancer Research Institute (U1194), University of Montpellier, Montpellier, France
| | - Geerard L Beets
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands.,Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands. .,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
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Impact of enema prep on the false-negative rate of a PI-RADS 1 MRI of the prostate for clinically significant prostate cancer. Abdom Radiol (NY) 2022; 47:2494-2499. [PMID: 35583821 DOI: 10.1007/s00261-022-03547-9] [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: 01/11/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To investigate whether use of an enema prep reduces the false-negative (FN) rate of PI-RADS 1 MRI of the prostate for clinically significant prostate cancer (csPCa). MATERIALS AND METHODS 1108 consecutive patients with a PI-RADS 1 MRI performed 01/2016-09/2021 were retrospectively collected. Patient charts were examined for subsequent systematic prostate biopsy performed within 1 year if positive or anytime thereafter if negative. Patients without biopsy were excluded. Use of an enema prep 1-2 h before MRI, which was implemented in 03/2019, was recorded. FN rate of MRI for detection of csPCa, defined as Gleason score ≥ 7, using systematic biopsy was assessed per patient and compared between those with and without an enema prep. Χ2 test and logistic regression were performed. RESULTS 255 patients (median age 64, IQR 58-69) with median PSA 5.6 (IQR 4.2-8.1), PI-RADS 1 MRI, and subsequent biopsy were included in the analysis. 66 patients (26%) had an enema prep and 189 patients (74%) did not. 7 (11%) patients with and 21 (11%) patients without enema prep had a FN biopsy. There was no significant association between enema prep and FN biopsy (OR 0.95, 95% CI 0.38-2.35, p = 0.91). CONCLUSIONS Use of an enema prep prior to prostate MRI did not decrease the FN rate of PI-RADS 1 MRI of the prostate for clinically significant prostate cancer.
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Arnoldner MA, Polanec SH, Lazar M, Kadhjavi S, Clauser P, Pötsch N, Schwarz-Nemec U, Korn S, Hübner N, Shariat SF, Helbich TH, Baltzer PAT. Rectal preparation significantly improves prostate imaging quality: Assessment of the PI-QUAL score with visual grading characteristics. Eur J Radiol 2022; 147:110145. [PMID: 35007983 DOI: 10.1016/j.ejrad.2021.110145] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the effects of a rectal preparation regimen, that consisted of a rectal cleansing enema and an endorectal gel filling protocol, on prostate imaging quality (PI-QUAL). METHODS Multiparametric MRI (mpMRI) was performed in 150 consecutive patients divided into two groups of 75 patients. One group received a rectal preparation with a cleansing enema and endorectal gel filling (median age 65.3 years, median PSA level 6 ng/ml). The other patient group did not receive such a preparation (median age 64 years, median PSA level 6 ng/ml). Two uroradiologists independently rated general image quality and lesion visibility on diffusion-weighted imaging (DWI), T2-weighted (T2w), and dynamic contrast-enhanced (DCE) images using a five-point ordinal scale. In addition, two uroradiologists assigned PI-QUAL scores, using the dedicated scoring sheet. Data sets were compared using visual grading characteristics (VGC) and receiver operating characteristics (ROC)/ area under the curve (AUC) analysis. RESULTS VGC revealed significantly better general image quality for DWI (AUC R1 0.708 (0.628-0.779 CI, p < 0.001; AUC R2 0.687 (0.606-0.760 CI, p < 0.001) and lesion visibility for both readers (AUC R1 0.729 (0.607-0.831 CI, p < 0.001); AUC R2 0.714 (0.590-0.818CI, p < 0.001) in the preparation group. For T2w imaging, rectal preparation resulted in significantly better lesion visibility for both readers (R1 0.663 (0.537-0.774 CI, p = 0.014; R2 0.663 (0.537-0.774 CI, p = 0.014)). Averaged PI-QUAL scores were significantly improved with rectal preparation (AUC R3/R4 0.667, CI 0.581-0.754, p < 0.001). CONCLUSION Rectal preparation significantly improved prostate imaging quality (PI-QUAL) and lesion visibility. Hence, a rectal preparation regimen consisting of a rectal cleansing enema and an endorectal gel filling could be considered.
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Affiliation(s)
- Michael A Arnoldner
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | | | | | - Sam Kadhjavi
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | - Nina Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | - Ursula Schwarz-Nemec
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Austria
| | - Stephan Korn
- Department of Urology, Medical University of Vienna, Austria
| | - Nicolai Hübner
- Department of Urology, Medical University of Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Austria; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria.
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Williams C, Khondakar N, Pinto P, Turkbey B. The Importance of Quality in Prostate MRI. Semin Roentgenol 2021; 56:384-390. [PMID: 34688341 DOI: 10.1053/j.ro.2021.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Cheyenne Williams
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nabila Khondakar
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
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22
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Czyzewska D, Sushentsev N, Latoch E, Slough RA, Barrett T. T2-PROPELLER Compared to T2-FRFSE for Image Quality and Lesion Detection at Prostate MRI. Can Assoc Radiol J 2021; 73:355-361. [PMID: 34423672 DOI: 10.1177/08465371211030206] [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] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The primary objective was to compare T2-FRFSE and T2-PROPELLER sequences for image quality. The secondary objective was to compare the ability to detect prostate lesions at MRI in the presence and absence of motion artefact using the 2 sequences. METHODS 99 patients underwent 3 T MRI examination of the prostate, including T2-FRFSE and T2-PROPELLER sequences. All patients underwent prostate biopsy. Two independent readers rated overall image quality, presence of motion artefact, and blurring for both sequences using a 5-point Likert scale. Scores were compared for the whole group and for subgroups with and without significant motion artefact. Outcome for lesion detection at an MRI threshold of PI-RADS score ≥3 was compared between T2-FRFSE and T2-PROPELLER. RESULTS The overall image quality was not significantly different between T2-FRFSE and T2-PROPELLER sequences (3.74 vs. 3.93, p = 0.275). T2-PROPELLER recorded a lesser degree of motion artefact (score 4.53 vs. 3.78, p <0.0001), but demonstrated greater image blurring (score 3.29 vs. 3.73, p <0.001). However, in a subgroup of patients with significant motion artefact on T2-FRFSE, the T2-PROPELLER sequence demonstrated significantly higher image quality (3.46 vs. 2.49, p <0.001). T2-FRFSE and T2-PROPELLER showed comparable positive predictive values for lesion detection at 93.2% and 97.7%, respectively. CONCLUSIONS T2-PROPELLER provides higher quality imaging in the presence of motion artefact, but T2-FRFSE is preferred in the absence of motion. T2-PROPELLER is therefore recommended as a secondary T2 sequence when imaging requires repeat acquisition due to motion artefact.
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Affiliation(s)
- Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Eryk Latoch
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Poland
| | - Rhys A Slough
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
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Sathiadoss P, Haroon M, Osman H, Ahmad F, Papadatos P, Schieda N. Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality. Can Assoc Radiol J 2021; 73:346-354. [PMID: 34404240 DOI: 10.1177/08465371211033753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To compare 5 different rectal preparation strategies for prostate MRI. METHODS This 5-arm quality-assurance study evaluated 56 patients per arm (280 patients) including: no preparation, clear-fluids diet (CFD) beginning at 00:00 hours on the day of MRI, Fleet®-enema, enema + CFD, enema + CFD + IV-antispasmodic agent. The study was powered to 0.80 with alpha-error of 0.05. Three blinded radiologists independently evaluated T2-Weighted (T2W) and Diffusion Weighed Imaging (DWI) for: rectal diameter (maximal AP diameter), rectal content (stool, fluid, gas), rectal motion, T2W/DWI image quality, T2W image sharpness and DWI susceptibility artifact using 5-point Likert scales. Overall comparisons were performed using analysis of variance (ANOVA) and Kruskal-Wallis, with pair-wise comparisons using paired t-tests and Wilcoxon sign-rank tests. RESULTS Rectal diameter and amount of gas were lower in enema compared to non-enema groups (p < 0.001), with smallest diameter and least gas in the enema + CFD + IV-antispasmodic group (p = 0.022-<0.001). T2W image quality and sharpness were highest in the enema + CFD groups (p < 0.001) with no difference comparing enema + CFD with/without IV-antispasmodic (p = 0.064, 0.084). Motion artifact was least in enema + CFD + IV-antispasmodic group compared to all other groups (p < 0.001), followed by the enema + CFD group (p = 0.008-<0.001). DWI image quality was highest (p < 0.001) and DWI susceptibility artifact lowest (p < 0.001) in the enema + CFD groups (p < 0.001) and did not differ comparing enema + CFD with/without anti-spasmodic (p = 0.058-0.202). CONCLUSIONS Use of enema + clear-fluids diet before prostate MRI yields the highest T2W and DWI image quality with the least DWI artifact. IV-antispasmodic use reduces motion on T2W but does not improve image quality on T2W or DWI, or lessen DWI artifact compared to enema + clear-fluids diet.
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Affiliation(s)
- Paul Sathiadoss
- Department of Medical Imaging, The Ottawa Hospital, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Mohammad Haroon
- Department of Medical Imaging, The Ottawa Hospital, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Heba Osman
- Department of Medical Imaging, The Ottawa Hospital, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Faraz Ahmad
- Faculty of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Philip Papadatos
- Department of Medical Imaging, The Ottawa Hospital, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, 6363University of Ottawa, Ottawa, Ontario, Canada
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Santiago I, Rodrigues B, Barata M, Figueiredo N, Fernandez L, Galzerano A, Parés O, Matos C. Re-staging and follow-up of rectal cancer patients with MR imaging when "Watch-and-Wait" is an option: a practical guide. Insights Imaging 2021; 12:114. [PMID: 34373961 PMCID: PMC8353037 DOI: 10.1186/s13244-021-01055-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022] Open
Abstract
In the past nearly 20 years, organ-sparing when no apparent viable tumour is present after neoadjuvant therapy has taken an increasingly relevant role in the therapeutic management of locally-advanced rectal cancer patients. The decision to include a patient or not in a “Watch-and-Wait” program relies mainly on endoscopic assessment by skilled surgeons, and MR imaging by experienced radiologists. Strict surveillance using the same modalities is required, given the chance of a local regrowth is of approximately 25–30%, almost always surgically salvageable if caught early. Local regrowths occur at the endoluminal aspect of the primary tumour bed in almost 90% of patients, but the rest are deep within it or outside the rectal wall, in which case detection relies solely on MR Imaging. In this educational review, we provide a practical guide for radiologists who are, or intend to be, involved in the re-staging and follow-up of rectal cancer patients in institutions with an established “Watch-and-Wait” program. First, we discuss patient preparation and MR imaging acquisition technique. Second, we focus on the re-staging MR imaging examination and review the imaging findings that allow us to assess response. Third, we focus on follow-up assessments of patients who defer surgery and confer about the early signs that may indicate a sustained/non-sustained complete response, a rectal/extra-rectal regrowth, and the particular prognosis of the “near-complete” responders. Finally, we discuss our proposed report template.
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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.
| | - Bernardete Rodrigues
- Centro Hospitalar de Tondela-Viseu, EPE, Av. Rei Duarte, 3504-509, Viseu, Portugal
| | - Maria Barata
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Laura Fernandez
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Antonio Galzerano
- Pathology Department, 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
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25
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Value of bowel preparation techniques for prostate MRI: a preliminary study. Abdom Radiol (NY) 2021; 46:4002-4013. [PMID: 33770222 PMCID: PMC8286932 DOI: 10.1007/s00261-021-03046-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022]
Abstract
Background Bowel preparation before multiparametric MRI (mpMRI) of the prostate is performed widely, despite contradictory or no evidence for efficacy. Purpose To investigate the value of hyoscine N-butylbromide (HBB), microenema (ME) and ‘dietary restrictions’ (DR) for artifact reduction and image quality (IQ) in mpMRI of the prostate. Study type Retrospective. Population Between 10/2018 and 02/2020 treatment-naïve men (median age, 64.9; range 39.8–87.3) who underwent mpMRI of the prostate were included. The total patient sample comprised of n = 180 patients, who received either HBB, ME, were instructed to adhere to DR, or received a combination of those measures prior to the MR scan. Field strength/sequence T2-weighted imaging (T2w), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) scanned on two 3T systems. Assessment A radiologist specialized in urogenital imaging (R1) and a senior radiology resident (R2) visually assessed IQ parameters on transversal T2w, DWI and ADC maps on a 5-point Likert-like scale. Statistical tests Group comparison between IQ parameters was performed on reader level using Kruskal–Wallis and Mann–Whitney U tests. Binary univariate logistic regression analysis was used to assess independent predictors of IQ. Interrater agreement was assessed using Intraclass Correlation Coefficient (ICC). Results ‘DWI geometric distortion’ was significantly more pronounced in the HBB+/ME−/DR− (R1, 3.6 and R2, 4.0) as compared to the HBB−/ME+/DR− (R1, 4.2 and R2, 4.6) and HBB+/ME+/DR− (R1, 4.3 and R2, 4.7) cohort, respectively. Parameters ‘DWI IQ’ and ‘Whole MRI IQ’ were rated similarly by both readers. ME was a significant independent predictor of ‘good IQ’ for the whole MRI for R1 [b = 1.09, OR 2.98 (95% CI 1.29, 6.87)] and R2 [b = 1.01, OR 2.73 (95% CI 1.24, 6.04)], respectively. Data conclusion ME seems to significantly improve image quality of DWI and the whole mpMRI image set of the prostate. HBB and DR did not have any benefit.
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Chen Y, Wen Z, Ma Y, Liu Y, Que Y, Yang X, Wu Y, Yu S. Metastatic lymph node calcification in rectal cancer: comparison of CT and high-resolution MRI. Jpn J Radiol 2021; 39:642-651. [PMID: 33686499 DOI: 10.1007/s11604-021-01108-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
Calcification causes mixed signal intensity in the lymph node (LN) on high-resolution magnetic resonance imaging (MRI), which is a strong indicator of regional LN metastasis in rectal cancer. Calcified metastatic LNs in rectal cancer commonly display scattered fine punctate calcifications to varying degrees on computed tomography (CT). On high-resolution MRI, the calcifications manifest a patchy area of signal loss in corresponding calcified area that is larger than on CT. It is necessary to recognize the appearance of metastatic LN calcifications on high-resolution MRI in rectal cancer because it is the primary imaging method for local staging in rectal cancer. This pictorial essay aims to introduce an important imaging finding that can contribute to the diagnosis of LN metastasis by illustrating features and differences between CT and high-resolution MRI of metastatic LN calcifications in rectal cancer.
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Affiliation(s)
- Yan Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Ziqiang Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yuru Ma
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yiyan Liu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yutao Que
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xinyue Yang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Yunzhu Wu
- MR Scientific Marketing, SIEMENS Healthineers Ltd., Guangzhou, 510620, China
| | - Shenping Yu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
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Jayaprakasam VS, Javed-Tayyab S, Gangai N, Zheng J, Capanu M, Bates DDB, Fuqua JL, Paroder V, Golia-Pernicka J, Gollub MJ, Petkovska I. Does microenema administration improve the quality of DWI sequences in rectal MRI? Abdom Radiol (NY) 2021; 46:858-866. [PMID: 32926212 DOI: 10.1007/s00261-020-02718-w] [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: 07/01/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine whether the administration of a microenema immediately prior to rectal magnetic resonance imaging (MRI) decreases the level of gas-related artifacts on diffusion-weighted imaging (DWI) sequences. METHODS This retrospective analysis included 492 (183 baseline and 309 post-total neoadjuvant treatment [TNT]) consecutive MRI scans for rectal cancer from January 2019 to January 2020. Scan-related factors were identified including microenema use (yes or no), field of view (FOV) in DWI (b = 800 or b = 1500), and magnet strength (1.5 T or 3 T). Two readers scored DWI studies for gas-related artifacts and T2-weighted sequences for the amount of intraluminal gas on a 5-point scale. Fisher's exact test and the Rao-Scott Chi-squared test were used to examine associations between microenema use and other factors. Generalized estimating equation and multivariable regression models were performed to examine the effect of microenema use in subgroups of scans for each reader. Cohen's κ was used to assess inter-reader agreement. RESULTS Gas-related artifact levels decreased in scans with microenema overall (P < 0.001) as well as when scans were stratified by FOV (P ≤ 0.003). For both readers, post-TNT scans with microenema showed lower artifact levels overall (P < 0.014 and P < 0.001) and in post-TNT subgroups of axial DWI scans (P ≤ 0.006 and P < 0.001) and scans acquired with a 3 T magnet (P ≤ 0.001 for both FOV). No evidence of decreased artifact level was found for baseline studies. Decreased gas was seen with microenema use (P < 0.001 for both readers). Inter-reader agreement on artifact-level and gas-level assessments ranged from slight to substantial (κ = 0.273-0.685). CONCLUSION Microenema use prior to rectal MRI reduces gas-related artifacts on DWI, including both large and small FOV sequences and particularly on post-TNT scans performed at 3 T, and offers a viable solution to improve DWI quality.
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Rectal cancer with complete endoscopic response after neoadjuvant therapy: what is the meaning of a positive MRI? Eur Radiol 2021; 31:4731-4738. [PMID: 33449186 DOI: 10.1007/s00330-020-07657-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/30/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine the short-term outcomes of discordant tumor assessments between DWI-MRI and endoscopy in patients with treated rectal cancer when tumor-bed diffusion restriction is present ("+DWI"). METHODS In this HIPPA-compliant, IRB-approved retrospective study, rectal MRI and endoscopic reports were reviewed for patients with locally advanced primary rectal adenocarcinoma (LARC) treated with chemoradiotherapy or total neoadjuvant therapy and imaged between January 2016 and December 2019. Eligible patients had a +DWI and endoscopy within 2 weeks of each other. True positive MRI were those with tumor on endoscopy and/or biopsy (TPa) or in whom endoscopy was negative for tumor, but subsequent 3-month follow-up endoscopy and DWI were both positive (TPb). The positive predictive value of DWI-MRI was calculated on a per-scan and per-patient basis. DWI-negative MRI exams were not explored in this study. RESULTS In total, 397 patients with nonmetastatic primary LARC were analyzed. After exclusions, 90 patients had 98 follow-up rectal MRI studies with +DWI. Seventy-six patients underwent 80 MRI scans and had concordant findings at endoscopy (TPa). Seventeen patients underwent 18 MRI scans and had discordant findings at endoscopy (FP); among these, 4 scans in 4 patients were initially false positive (FP) but follow-up MRI remained +DWI and the endoscopy turned concordantly positive (TPb). PPV was 0.86 per scan and per patient. In 4/18 (22%) scans and 4/17 (24%) patients with discordances, MRI detected tumor regrowth before endoscopy. CONCLUSIONS Although most +DWI exams discordant with endoscopy are false positive, 22% will reveal that DWI-MRI detects tumor recurrence before endoscopy. KEY POINTS • Most often, in post-treatment assessment for rectal cancer when DWI-MRI shows restriction in the tumor bed and endoscopy shows no tumor, +DWI MRI will be proven false positive. • Conversely, our study demonstrated that, allowing for sequential follow-up at a 3-month maximum interval, DWI-MRI may detect tumor presence in the treated tumor bed before endoscopy in 22% of discordant findings between DWI-MRI and endoscopy. • Our results showed that a majority of DWI-MRI-positive scans in treated rectal cancer concur with the presence of tumor on endoscopy performed within 2 weeks.
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29
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Ullrich T, Kohli MD, Ohliger MA, Magudia K, Arora SS, Barrett T, Bittencourt LK, Margolis DJ, Schimmöller L, Turkbey B, Westphalen AC. Quality Comparison of 3 Tesla multiparametric MRI of the prostate using a flexible surface receiver coil versus conventional surface coil plus endorectal coil setup. Abdom Radiol (NY) 2020; 45:4260-4270. [PMID: 32696213 PMCID: PMC7716937 DOI: 10.1007/s00261-020-02641-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/21/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To subjectively and quantitatively compare the quality of 3 Tesla magnetic resonance imaging of the prostate acquired with a novel flexible surface coil (FSC) and with a conventional endorectal coil (ERC). METHODS Six radiologists independently reviewed 200 pairs of axial, high-resolution T2-weighted and diffusion-weighted image data sets, each containing one examination acquired with the FSC and one with the ERC, respectively. Readers selected their preferred examination from each pair and assessed every single examination using six quality criteria on 4-point scales. Signal-to-noise ratios were measured and compared. RESULTS Two readers preferred FSC acquisition (36.5-45%) over ERC acquisition (13.5-15%) for both sequences combined, and four readers preferred ERC acquisition (41-46%). Analysis of pooled responses for both sequences from all readers shows no significant preference for FSC or ERC. Analysis of the individual sequences revealed a pooled preference for the FSC in T2WI (38.7% vs 17.8%) and for the ERC in DWI (50.9% vs 19.6%). Patients' weight was the only weak predictor of a preference for the ERC acquisition (p = 0.04). SNR and CNR were significantly higher in the ERC acquisitions (p<0.001) except CNR differentiating tumor lesions from benign prostate (p=0.1). CONCLUSION Although readers have strong individual preferences, comparable subjective image quality can be obtained for prostate MRI with an ERC and the novel FSC. ERC imaging might be particularly valuable for sequences with inherently lower SNR as DWI and larger patients whereas the FSC is generally preferred in T2WI. FSC imaging generates a lower SNR than with an ERC.
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Affiliation(s)
- T Ullrich
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany.
| | - M D Kohli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - M A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - K Magudia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - S S Arora
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T Barrett
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - L K Bittencourt
- DASA Company, São Paulo, Brazil
- Department of Radiology, Fluminense Federal University (UFF), Niterói, Rio De Janeiro, Brazil
| | - D J Margolis
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - L Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - B Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A C Westphalen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, CA, USA
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Plodeck V, Radosa CG, Hübner HM, Baldus C, Borkowetz A, Thomas C, Kühn JP, Laniado M, Hoffmann RT, Platzek I. Rectal gas-induced susceptibility artefacts on prostate diffusion-weighted MRI with epi read-out at 3.0 T: does a preparatory micro-enema improve image quality? Abdom Radiol (NY) 2020; 45:4244-4251. [PMID: 32500236 PMCID: PMC8260527 DOI: 10.1007/s00261-020-02600-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess whether the application of a preparatory micro-enema reduces gas-induced susceptibility artefacts on diffusion-weighted MRI of the prostate. METHODS 114 consecutive patients who received multiparametric 3 T MRI of the prostate at our institution were retrospectively enrolled. 63 patients self-administered a preparatory micro-enema prior to imaging, and 51 patients underwent MRI without bowel preparation. Two blinded readers independently reviewed the diffusion-weighted sequences regarding gas-induced artefacts. The presence/severity of artefacts was scored ranging from 0 (no artefact) to 3 (severe artefact). A score ≥ 2 was considered a clinically relevant artefact. Maximum rectal width at the level of the prostate was correlated with the administration of a micro-enema. Scores were compared between the scans performed with and without bowel preparation using univariable and multivariable logistic regression, taking into account potential confounding factors (age and prostate volume). RESULTS Significantly less artefacts were found on diffusion-weighted sequences after the administration of a micro-enema shortly prior to MR imaging. Clinically relevant artefacts were found in 10% in the patient group after enema, in 41% without enema. If present, artefacts were also significantly less severe. Mean severity score was 0.3 (enema administered) and 1.2 (no enema), and odds ratio was 0.137 (p < 0.0001) in univariable ordinal logistic regression. Inter-observer agreement was excellent (κ 0.801). CONCLUSION The use of a preparatory micro-enema prior to 3 T multiparametric prostate MRI significantly reduces both the incidence and severity of gas-induced artefacts on diffusion-weighted sequences and thus improves image quality.
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Affiliation(s)
- Verena Plodeck
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland.
| | - Christoph Georg Radosa
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - Hans-Martin Hübner
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - Christian Baldus
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - Angelika Borkowetz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - Christian Thomas
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - Jens-Peter Kühn
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - Michael Laniado
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - Ralf-Thorsten Hoffmann
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
| | - Ivan Platzek
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland
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Value of High-resolution MRI in Detecting Lymph Node Calcifications in Patients with Rectal Cancer. Acad Radiol 2020; 27:1709-1717. [PMID: 32035757 DOI: 10.1016/j.acra.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/31/2019] [Accepted: 01/01/2020] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES To analyze CT and high-resolution MRI findings of nodal metastasis calcifications and determine the value of high-resolution MRI in detecting nodal calcifications in rectal cancer patients. MATERIALS AND METHODS In total, 229 rectal cancer patients were included. The CT was reviewed for the presence of nodal calcifications by two radiologists. High-resolution two-dimensional turbo spin-echo T2-weighted imaging (2D-TSE-T2WI) and fat-suppressed gadolinium-enhanced isotropic high-resolution three-dimensional gradient-echo T1-weighted imaging (3D-GRE-T1WI) were independently reviewed for nodal calcifications by the two radiologists at one-month and two-month intervals, respectively. The sensitivities, specificities and accuracies of the two high-resolution MRI in detecting nodal calcifications were calculated using CT results as a reference. RESULTS Regional calcified metastatic lymph nodes were found in 28 patients. The node-to-node evaluation revealed that 55 (98.2%) of the 56 calcified lymph nodes were metastatic. Fifty-one (92.7%) calcified metastatic lymph nodes displayed scattered fine punctate calcifications to different degrees on CT. In both types of high-resolution MRI, the calcifications demonstrated a patchy area of markedly reduced signal intensity in corresponding areas that were larger than those on CT. The sensitivity and accuracy of fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI were significantly higher than those of high-resolution 2D-TSE-T2WI (76.8% vs 58.9%, P = 0.013; 98.3% vs 97.9%, P = 0.007; respectively). CONCLUSION Metastatic nodal calcifications are characteristic imaging findings in rectal cancer. Calcifications are indicated by markedly reduced signal on high-resolution MRI, which will alert radiologists to scrutinize CT for nodal calcifications and aid in the accurate diagnosis of metastatic lymph nodes.
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Muglia VF, Vargas HA. Doctor, a patient is on the phone asking about the endorectal coil! Abdom Radiol (NY) 2020; 45:4003-4011. [PMID: 32300836 DOI: 10.1007/s00261-020-02528-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The question referred to in the title of this article is a relatively common situation when performing prostate MRI in some healthcare settings. Moreover, the answer is not always straightforward. The decisions on type of receiver coil for prostate MRI and whether or not an endorectal coil (ERC) should be used is based on several factors. These relate to the patient (e.g., body habitus, presence of metallic devices in the pelvis), the focus of the exam (diagnosis, staging, recurrence), and characteristics of the MRI system (e.g., magnetic field strength and hardware components including coil design and number of elements/channels available in the surface coil). Historically, the combined use of an ERC and a surface coil was the optimal combination for maximizing the signal-to-noise ratio (SNR), particularly for low-strength magnetic fields (1.5T). However, there are several disadvantages associated with the use of an ERC, and several studies have advocated equivalent clinical performance of modern MRI systems for diagnosis and staging of prostate cancer (PCa), either with ERC or surface alone. Accordingly, there is a wide variation in the precise imaging technique across institutions. This article focuses on the most relevant aspects of the decision of whether to use an ERC for PCa MR imaging.
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Affiliation(s)
- Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Av. Bandeirantes 3900, Campus Monte Alegre, Ribeirão Prêto, 14049-900, Brazil.
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Salib MY, Russell JHB, Stewart VR, Sudderuddin SA, Barwick TD, Rockall AG, Bharwani N. 2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging. Radiographics 2020; 40:1807-1822. [PMID: 32946322 DOI: 10.1148/rg.2020200013] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cervical cancer is the fourth most common cancer in women of all ages worldwide. The disease is staged using the International Federation of Gynecology and Obstetrics (FIGO) system, which was updated in 2018. The authors explain the key changes from the 2009 version and the rationale behind them. The changes have been made to reflect common clinical practice, differentiate prognostic outcomes, and guide treatment stratification. Treatment options are dependent on the stage of disease and include fertility-sparing and non-fertility-sparing surgical options as well as chemoradiotherapy for locally advanced disease. The updated FIGO staging gives added importance to MRI as a method of accurately measuring tumor size and depicting the presence of parametrial involvement. With the inclusion of lymph node involvement in the updated 2018 FIGO staging, cross-sectional imaging-and in particular, fluorodeoxyglucose PET/CT-has an increasing role in the depiction of nodal disease. Understanding the radiologic techniques used, the literature supporting them, and common imaging pitfalls ensures accurate staging of disease and optimization of treatment. ©RSNA, 2020 See discussion on this article by Javitt (pp 1823-1824).
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Affiliation(s)
- Miriam Y Salib
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.Y.S., J.H.B.R., V.R.S., S.A.S., T.D.B., A.G.R., N.B.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (T.D.B., A.G.R., N.B.)
| | - James H B Russell
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.Y.S., J.H.B.R., V.R.S., S.A.S., T.D.B., A.G.R., N.B.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (T.D.B., A.G.R., N.B.)
| | - Victoria R Stewart
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.Y.S., J.H.B.R., V.R.S., S.A.S., T.D.B., A.G.R., N.B.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (T.D.B., A.G.R., N.B.)
| | - Siham A Sudderuddin
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.Y.S., J.H.B.R., V.R.S., S.A.S., T.D.B., A.G.R., N.B.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (T.D.B., A.G.R., N.B.)
| | - Tara D Barwick
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.Y.S., J.H.B.R., V.R.S., S.A.S., T.D.B., A.G.R., N.B.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (T.D.B., A.G.R., N.B.)
| | - Andrea G Rockall
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.Y.S., J.H.B.R., V.R.S., S.A.S., T.D.B., A.G.R., N.B.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (T.D.B., A.G.R., N.B.)
| | - Nishat Bharwani
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.Y.S., J.H.B.R., V.R.S., S.A.S., T.D.B., A.G.R., N.B.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (T.D.B., A.G.R., N.B.)
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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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Cianci R, Cristel G, Agostini A, Ambrosini R, Calistri L, Petralia G, Colagrande S. MRI for Rectal Cancer Primary Staging and Restaging After Neoadjuvant Chemoradiation Therapy: How to Do It During Daily Clinical Practice. Eur J Radiol 2020; 131:109238. [PMID: 32905955 DOI: 10.1016/j.ejrad.2020.109238] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/04/2020] [Accepted: 08/12/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To provide a practical overview regarding the state-of-the-art of the magnetic resonance imaging (MRI) protocol for rectal cancer imaging and interpretation during primary staging and restaging after neoadjuvant chemoradiation therapy (CRT), pointing out technical skills and findings that radiologists should consider for their reports during everyday clinical activity. METHOD Both 1.5T and 3.0T scanners can be used for rectal cancer evaluation, using pelvic phased array external coils. The standard MR protocol includes T2-weighted imaging of the pelvis, high-resolution T2-weighted sequences focused on the tumor and diffusion-weighted imaging (DWI). The mnemonic DISTANCE is helpful for the interpretation of MR images: DIS, for distance from the inferior part of the tumor to the anorectal-junction; T, for T staging; A, for anal sphincter complex status; N, for nodal staging; C, for circumferential resection margin status; and E, for extramural venous invasion. RESULTS Primary staging with MRI is a cornerstone in the preoperative workup of patients with rectal cancer, because it provides clue information for decisions on the administration of CRT and surgical treatment. Restaging after CRT is crucial for treatment planning, and findings on post-CRT MRI correlate with the patient's prognosis and survival. It may be useful to remember the mnemonic word "DISTANCE" to check and describe all the relevant MRI findings necessary for an accurate radiological definition of tumor stage and response to CRT. CONCLUSIONS "DISTANCE" assessment for rectal cancer staging and treatment response estimation after CRT may be helpful as a checklist for a structured reporting.
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Affiliation(s)
- Roberta Cianci
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Via dei Vestini, 66100 Chieti, Italy
| | - Giulia Cristel
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Department of Radiology, University Hospital "Umberto I - G.M. Lancisi - G. Salesi", Via Conca 71, 60126 Ancona, AN, Italy
| | - Roberta Ambrosini
- Radiology Unit Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, P. le Spedali Civili 1, 25123 Brescia, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
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Shaikh F, Dupont-Roettger D, Dehmeshki J, Kubassova O, Quraishi MI. Advanced Imaging of Biochemical Recurrent Prostate Cancer With PET, MRI, and Radiomics. Front Oncol 2020; 10:1359. [PMID: 32974134 PMCID: PMC7466650 DOI: 10.3389/fonc.2020.01359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Faiq Shaikh
- Image Analysis Group, Philadelphia, PA, United States
| | | | - Jamshid Dehmeshki
- Image Analysis Group, Philadelphia, PA, United States
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-upon-Thames, United Kingdom
| | | | - Mohammed I. Quraishi
- Department of Radiology, University of Tennessee Medical Center, Knoxville, TN, United States
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Min LA, Vacher YJL, Dewit L, Donker M, Sofia C, van Triest B, Bos P, van Griethuysen JJW, Maas M, Beets-Tan RGH, Lambregts DMJ. Gross tumour volume delineation in anal cancer on T2-weighted and diffusion-weighted MRI - Reproducibility between radiologists and radiation oncologists and impact of reader experience level and DWI image quality. Radiother Oncol 2020; 150:81-88. [PMID: 32540336 DOI: 10.1016/j.radonc.2020.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/06/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess how gross tumour volume (GTV) delineation in anal cancer is affected by interobserver variations between radiologists and radiation oncologists, expertise level, and use of T2-weighted MRI (T2W-MRI) vs. diffusion-weighted imaging (DWI), and to explore effects of DWI quality. METHODS AND MATERIALS We retrospectively analyzed the MRIs (T2W-MRI and b800-DWI) of 25 anal cancer patients. Four readers (Senior and Junior Radiologist; Senior and Junior Radiation Oncologist) independently delineated GTVs, first on T2W-MRI only and then on DWI (with reference to T2W-MRI). Maximum Tumour Diameter (MTD) was calculated from each GTV. Mean GTVs/MTDs were compared between readers and between T2W-MRI vs. DWI. Interobserver agreement was calculated as Intraclass Correlation Coefficient (ICC), Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD). DWI image quality was assessed using a 5-point artefact scale. RESULTS Interobserver agreement between radiologists vs. radiation oncologists and between junior vs. senior readers was good-excellent, with similar agreement for T2W-MRI and DWI (e.g. ICCs 0.72-0.94 for T2W-MRI and 0.68-0.89 for DWI). There was a trend towards smaller GTVs on DWI, but only for the radiologists (P = 0.03-0.07). Moderate-severe DWI-artefacts were observed in 11/25 (44%) cases. Agreement tended to be lower in these cases. CONCLUSION Overall interobserver agreement for anal cancer GTV delineation on MRI is good for both radiologists and radiation oncologists, regardless of experience level. Use of DWI did not improve agreement. DWI artefacts affecting GTV delineation occurred in almost half of the patients, which may severely limit the use of DWI for radiotherapy planning if no steps are undertaken to avoid them.
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Affiliation(s)
- Lisa A Min
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, The Netherlands.
| | - Younan J L Vacher
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Dewit
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mila Donker
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paula Bos
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, The Netherlands; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J W van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Wu M, Mulder HT, Baron P, Coello E, Menzel MI, van Rhoon GC, Haase A. Correction of motion-induced susceptibility artifacts and B 0 drift during proton resonance frequency shift-based MR thermometry in the pelvis with background field removal methods. Magn Reson Med 2020; 84:2495-2511. [PMID: 32367530 PMCID: PMC7402020 DOI: 10.1002/mrm.28302] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
Purpose The linear change of the water proton resonance frequency shift (PRFS) with temperature is used to monitor temperature change based on the temporal difference of image phase. Here, the effect of motion‐induced susceptibility artifacts on the phase difference was studied in the context of mild radio frequency hyperthermia in the pelvis. Methods First, the respiratory‐induced field variations were disentangled from digestive gas motion in the pelvis. The projection onto dipole fields (PDF) as well as the Laplacian boundary value (LBV) algorithm were applied on the phase difference data to eliminate motion‐induced susceptibility artifacts. Both background field removal (BFR) algorithms were studied using simulations of susceptibility artifacts, a phantom heating experiment, and volunteer and patient heating data. Results Respiratory‐induced field variations were negligible in the presence of the filled water bolus. Even though LBV and PDF showed comparable results for most data, LBV seemed more robust in our data sets. Some data sets suggested that PDF tends to overestimate the background field, thus removing phase attributed to temperature. The BFR methods even corrected for susceptibility variations induced by a subvoxel displacement of the phantom. The method yielded successful artifact correction in 2 out of 4 patient treatment data sets during the entire treatment duration of mild RF heating of cervical cancer. The heating pattern corresponded well with temperature probe data. Conclusion The application of background field removal methods in PRFS‐based MR thermometry has great potential in various heating applications and body regions to reduce motion‐induced susceptibility artifacts that originate outside the region of interest, while conserving temperature‐induced PRFS. In addition, BFR automatically removes up to a first‐order spatial B0 drift.
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Affiliation(s)
- Mingming Wu
- Munich School of Bioengineering, TUM Department of Physics, Technical University of Munich, Garching, Germany
| | | | - Paul Baron
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Eduardo Coello
- Munich School of Bioengineering, TUM Department of Physics, Technical University of Munich, Garching, Germany.,GE Healthcare, Munich, Germany
| | | | | | - Axel Haase
- Munich School of Bioengineering, TUM Department of Physics, Technical University of Munich, Garching, Germany
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Engels RR, Israël B, Padhani AR, Barentsz JO. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 1: Acquisition. Eur Urol 2020; 77:457-468. [DOI: 10.1016/j.eururo.2019.09.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
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Haak HE, Maas M, Lahaye MJ, Boellaard TN, Delli Pizzi A, Mihl C, van der Zee D, Fabris C, van der Sande ME, Melenhorst J, Beets-Tan RGH, Beets GL, Lambregts DMJ. Selection of Patients for Organ Preservation After Chemoradiotherapy: MRI Identifies Poor Responders Who Can Go Straight to Surgery. Ann Surg Oncol 2020; 27:2732-2739. [PMID: 32172333 DOI: 10.1245/s10434-020-08334-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether magnetic resonance imaging (MRI) can accurately identify poor responders after chemoradiotherapy (CRT) who will need to go straight to surgery, and to evaluate whether results are reproducible among radiologists with different levels of expertise. METHODS Seven independent readers with different levels of expertise retrospectively evaluated the restaging MRIs (T2-weighted + diffusion-weighted imaging [T2W + DWI]) of 62 patients and categorized them as (1) poor responders - highly suspicious of tumor; (2) intermediate responders - tumor most likely; and (3) good - potential (near) complete responders. The reference standard was histopathology after surgery (or long-term follow-up in the case of a watch-and-wait program). RESULTS Fourteen patients were complete responders and 48 had residual tumor. The median percentage of patients categorized by the seven readers as 'poor', 'intermediate', and 'good' responders was 21% (range 11-37%), 50% (range 23-58%), and 29% (range 23-42%), respectively. The vast majority of poor responders had histopathologically confirmed residual tumor (73% ypT3-4), with a low rate (0-5%) of 'missed complete responders'. Of the 14 confirmed complete responders, a median percentage of 71% were categorized in the MR-good response group and 29% were categorized in the MR-intermediate response group. CONCLUSIONS Radiologists of varying experience levels should be able to use MRI to identify the ± 20% subgroup of poor responders who will definitely require surgical resection after CRT. This may facilitate more selective use of endoscopy, particularly in general settings or in centers with limited access to endoscopy.
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Affiliation(s)
- Hester E Haak
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Andrea Delli Pizzi
- ITAB Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University, Chieti, Italy
| | - Casper Mihl
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Cristina Fabris
- Department of Radiology, Policlinico G.B. Rossi, University of Verona, Verona, Italy
| | - Marit E van der Sande
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
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Zhang Q, van Houdt PJ, Lambregts DMJ, van Triest B, Kop MPM, Coolen BF, Strijkers GJ, van der Heide UA, Nederveen AJ. Locally advanced rectal cancer: 3D diffusion-prepared stimulated-echo turbo spin-echo versus 2D diffusion-weighted echo-planar imaging. Eur Radiol Exp 2020; 4:9. [PMID: 32030561 PMCID: PMC7005244 DOI: 10.1186/s41747-019-0138-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Diffusion-weighted imaging (DWI) has shown great value in rectal cancer imaging. However, traditional DWI with echo-planar imaging (DW-EPI) often suffers from geometrical distortions. We applied a three-dimensional diffusion-prepared stimulated-echo turbo spin-echo sequence (DPsti-TSE), allowing geometrically undistorted rectal DWI. We compared DPsti-TSE with DW-EPI for locally advanced rectal cancer DWI. Methods For 33 prior-to-treatment patients, DWI images of the rectum were acquired with DPsti-TSE and DW-EPI at 3 T using b-values of 200 and 1000 s/mm2. Two radiologists conducted a blinded scoring of the images considering nine aspects of image quality and anatomical quality. Tumour apparent diffusion coefficient (ADC) and distortions were compared quantitatively. Results DPsti-TSE scored significantly better than DW-EPI in rectum distortion (p = 0.005) and signal pileup (p = 0.001). DPsti-TSE had better tumour Dice similarity coefficient compared to DW-EPI (0.84 versus 0.80, p = 0.010). Tumour ADC values were higher for DPsti-TSE compared to DW-EPI (1.47 versus 0.86 × 10-3 mm2/s, p < 0.001). Radiologists scored DPsti-TSE significantly lower than DW-EPI on aspects of overall image quality (p = 0.001), sharpness (p < 0.001), quality of fat suppression (p < 0.001), tumour visibility (p = 0.009), tumour conspicuity (p = 0.010) and rectum wall visibility (p = 0.005). Conclusions DPsti-TSE provided geometrically less distorted rectal cancer diffusion-weighted images. However, the image quality of DW-EPI over DPsti-TSE was referred on the basis of several image quality criteria. A significant bias in tumour ADC values from DPsti-TSE was present. Further improvements of DPsti-TSE are needed until it can replace DW-EPI.
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Affiliation(s)
- Qinwei Zhang
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, Room Z0-178, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands.
| | - Petra J van Houdt
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Baukelien van Triest
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Marnix P M Kop
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, Room Z0-178, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
| | - Bram F Coolen
- Amsterdam UMC, Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Amsterdam UMC, Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, the Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Aart J Nederveen
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, Room Z0-178, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
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Abstract
In recent years, rectal MRI has become a central diagnostic tool in rectal cancer staging. Indeed, rectal MR has the ability to accurately evaluate a number of important findings that may impact patient management, including distance of the tumor to the mesorectal fascia, presence of extramural vascular invasion (EMVI), presence of lymph nodes, and involvement of the peritoneum/anterior peritoneal reflection. Many of these findings are difficult to assess in nonexpert hands. In this review, we present a practical approach for radiologists to provide high-quality interpretations at initial baseline exams, based on recent guidelines from the Society of Abdominal Radiology, Rectal and Anal Cancer Disease Focused Panel. Practical pearls and pitfalls are discussed, focusing on optimization of technique including, patient preparation and protocol recommendations, interpretation, and essentials of reporting.
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Krdzalic J, Maas M, Gollub MJ, Beets-Tan RGH. Guidelines for MR imaging in rectal cancer: Europe versus United States. Abdom Radiol (NY) 2019; 44:3498-3507. [PMID: 31605186 DOI: 10.1007/s00261-019-02251-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to compare and contrast recently published guidelines for staging and reporting of MR imaging in rectal cancer from the European Society of Gastrointestinal and Abdominal Radiology and the North American Society of Abdominal Radiology. These guidelines were assessed on the presence of consensus and disagreement. Items were compared by two reviewers, and items with agreement and disagreement between the guidelines were identified and are presented in the current paper. Differences between guidelines are discussed to offer insights in practice variations between both continents and among expert centers, which to some extent may explain the differences between guidelines.
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Affiliation(s)
- J Krdzalic
- Department of Radiology, Zuyderland Medical Center, PO Box 5500, 6130MB, Heerlen/Sittard, The Netherlands
| | - M Maas
- Department of Radiology, The Netherlands Cancer Institute, PO Box 90203, 1006BE, Amsterdam, The Netherlands.
| | - M J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - R G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, PO Box 90203, 1006BE, Amsterdam, The Netherlands
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Caglic I, Barrett T. Optimising prostate mpMRI: prepare for success. Clin Radiol 2019; 74:831-840. [PMID: 30611559 DOI: 10.1016/j.crad.2018.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/06/2018] [Indexed: 01/06/2023]
Abstract
Multiparametric magnetic resonance imaging (MRI) now plays an essential role in prostate cancer diagnosis and management. The increasing use of MRI before biopsy makes obtaining images of the highest quality vital. The European Society of Urogenital Radiology (ESUR) 2012 guidelines and subsequent Prostate Imaging -Reporting Data System (PI-RADS) version 2 recommendations in 2015 address the technical considerations for optimising MRI acquisition; however, the quality of the multiparametric sequences employed depends not only on the hardware and software utilised and scanning parameters selected, but also on patient-related factors, for which current guidance is lacking. Patient preparation factors include bowel peristalsis, rectal distension, the presence of total hip replacement (THR), post-biopsy haemorrhage, and abstinence from ejaculation. New evidence has been accrued since the release of PI-RADS v2, and this review aims to explore the key issues of patient preparation and their potential to further optimise the image quality of mpMRI.
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Affiliation(s)
- I Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - T Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Barrett T, Rajesh A, Rosenkrantz AB, Choyke PL, Turkbey B. PI-RADS version 2.1: one small step for prostate MRI. Clin Radiol 2019; 74:841-852. [PMID: 31239107 DOI: 10.1016/j.crad.2019.05.019] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022]
Abstract
Multiparametric (mp) prostate magnetic resonance imaging (MRI) is playing an increasingly prominent role in the diagnostic work-up of patients with suspected prostate cancer. Performing mpMRI before biopsy offers several advantages including biopsy avoidance under certain clinical circumstances and targeting biopsy of suspicious lesions to enable the correct diagnosis. The success of the technique is heavily dependent on high-quality image acquisition, interpretation, and report communication, all areas addressed by previous versions of the Prostate Imaging-Reporting and Data System (PI-RADS) recommendations. Numerous studies have validated the approach, but the widespread adoption of PI-RADS version 2 has also highlighted inconsistencies and limitations, particularly relating to interobserver variability for evaluation of the transition zone. These limitations are addressed in the recently released version 2.1. In this article, we highlight the key changes proposed in PI-RADS v2.1 and explore the background reasoning and evidence for the recommendations.
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Affiliation(s)
- T Barrett
- Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Cambridge CB2 0QQ, UK.
| | - A Rajesh
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Radiology Department, Gwendolen Road, Leicester LE5 4PW, UK
| | - A B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 1st Ave, Third Floor, New York, NY 10016, USA
| | - P L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - B Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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The Diagnostic Performance of MRI for Detection of Extramural Venous Invasion in Colorectal Cancer: A Systematic Review and Meta-Analysis of the Literature. AJR Am J Roentgenol 2019; 213:575-585. [PMID: 31063424 DOI: 10.2214/ajr.19.21112] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE. The purpose of this article is to perform a systematic review and meta-analysis regarding the diagnostic test accuracy of MRI for detecting extramural venous invasion (EMVI) in patients with colorectal cancer. MATERIALS AND METHODS. PubMed and EMBASE were searched up to November 9, 2018. We included diagnostic accuracy studies that used MRI for EMVI detection in patients with colorectal cancer, using pathologic analysis as the reference standard. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity and specificity were pooled and plotted in a hierarchic summary ROC plot. Metaregression analysis using several clinically relevant covariates was performed. RESULTS. Fourteen studies (n = 1751 patients) were included. Study quality was moderate in general. Pooled sensitivity was 0.61 (95% CI, 0.49-0.71), and pooled specificity was 0.87 (95% CI, 0.79-0.92). There was substantial heterogeneity according to the Cochran Q test (p < 0.01) and Higgins I2 heterogeneity index (98% and 95% for sensitivity and specificity, respectively). Publication bias was present (p = 0.01). Higher rates of advanced T category, use of high-resolution MRI, and use of antispasmodic drugs were shown to significantly affect heterogeneity (p < 0.01). Location of primary tumor, preoperative treatment status, study design, definition of reference standard, magnetic field strength, and use of functional MRI were not statistically significant (p = 0.17-0.92). CONCLUSION. MRI shows moderate sensitivity and good specificity for the detection of EMVI in colorectal cancer. The use of high-resolution MRI may improve diagnostic performance.
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Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ. MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management. Radiographics 2019; 39:367-387. [PMID: 30768361 DOI: 10.1148/rg.2019180114] [Citation(s) in RCA: 231] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of rectal MRI and increased radiologist awareness of the key rectal cancer TNM staging features, the mortality rate of rectal cancer has been declining over the past few decades in adults over 50 years of age. Currently, rectal MRI plays a key role in the pre- and posttreatment evaluation of rectal cancer, assisting the multidisciplinary team in tailoring the most appropriate treatment option. The benefits achieved with rectal MRI are strictly dependent on obtaining good-quality images, which is important for the characterization of the main anatomic structures and their relationship with the tumor. In primary staging, rectal MRI helps the radiologist (a) describe the tumor location and morphology, (b) provide its T and N categories, (c) detect the presence of extramural vascular invasion, and (d) identify its relationship with surrounding structures, including the sphincter complex and involvement of the mesorectal fascia. These features help diagnose locally advanced rectal tumors (categories T3c-d, T4, N1, and N2), for which neoadjuvant chemoradiotherapy (CRT) is indicated. In restaging after neoadjuvant CRT, in addition to reassessing the features noted during primary staging, rectal MRI can help in the assessment of treatment response, especially with the emergence of nonsurgical approaches such as "watch and wait." ©RSNA, 2019.
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Affiliation(s)
- Natally Horvat
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Camila Carlos Tavares Rocha
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Brunna Clemente Oliveira
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Iva Petkovska
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Marc J Gollub
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
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Lambregts DMJ, Boellaard TN, Beets-Tan RGH. Response evaluation after neoadjuvant treatment for rectal cancer using modern MR imaging: a pictorial review. Insights Imaging 2019; 10:15. [PMID: 30758688 PMCID: PMC6375095 DOI: 10.1186/s13244-019-0706-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation. MRI is one of the main tools used to assess response, but has difficulties in assessing response within areas of post-radiation fibrosis. Hence, MR sequences such as diffusion-weighted imaging are increasingly adopted in clinical MR protocols to improve the differentiation between tumor and fibrosis. In this pictorial review, we discuss the strengths and weaknesses of modern MR imaging, including functional imaging sequences such as diffusion-weighted MRI, for response evaluation after chemoradiation treatment and provide the main pearls and pitfalls for image interpretation.
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Affiliation(s)
- Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Thierry N Boellaard
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, The Netherlands
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Tang X, Zhang SP, Luo Y, Xia LG, Gong JS. A Novel Magnetic Resonance Rectography for Rectal Cancer Staging. Chin Med J (Engl) 2018; 131:2506-2507. [PMID: 30334541 PMCID: PMC6202590 DOI: 10.4103/0366-6999.243556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Xue Tang
- Department of Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, China
| | - Shi-Pai Zhang
- Department of Gastrointestinal Surgery, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, China
| | - Yan Luo
- Department of Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, China
| | - Li-Gang Xia
- Department of Gastrointestinal Surgery, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, China
| | - Jing-Shan Gong
- Department of Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, China
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