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Chang D, González APG, Migaly J. Management of neuroendocrine tumors of the rectum. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Korngold EK, Moreno C, Kim DH, Fowler KJ, Cash BD, Chang KJ, Gage KL, Gajjar AH, Garcia EM, Kambadakone AR, Liu PS, Macomber M, Marin D, Pietryga JA, Santillan CS, Weinstein S, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Staging of Colorectal Cancer: 2021 Update. J Am Coll Radiol 2022; 19:S208-S222. [PMID: 35550803 DOI: 10.1016/j.jacr.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/19/2022]
Abstract
Preoperative imaging of rectal carcinoma involves accurate assessment of the primary tumor as well as distant metastatic disease. Preoperative imaging of nonrectal colon cancer is most beneficial in identifying distant metastases, regardless of primary T or N stage. Surgical treatment remains the definitive treatment for colon cancer, while organ-sparing approach may be considered in some rectal cancer patients based on imaging obtained before and after neoadjuvant treatment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Elena K Korngold
- Oregon Health and Science University, Portland, Oregon; Section Chief, Body Imaging; Chair, P&T Committee; Modality Chief, CT.
| | - Courtney Moreno
- Emory University, Atlanta, Georgia; Chair America College of Radiology CT Colonography Registry Committee
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; Vice Chair of Education (University of Wisconsin Dept of Radiology)
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; ACR LI-RADS Working Group Chair
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association; Chief of GI, UTHealth
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Director of MRI, Associate Chief of Abdominal Imaging; ACR Chair of Committee on C-RADS
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aakash H Gajjar
- PRiSMA Proctology Surgical Medicine & Associates, Houston, Texas; American College of Surgeons
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital; Medical Director, Martha's Vineyard Hospital Imaging
| | - Peter S Liu
- Cleveland Clinic, Cleveland, Ohio; Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland OH
| | | | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Cynthia S Santillan
- University of California San Diego, San Diego, California; Vice Chair of Clinical Operations for Department of Radiology
| | - Stefanie Weinstein
- University of California San Francisco, San Francisco, California; Associate Chief of Radiology, San Francisco VA Health Systems
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director MR and CT at VCUHS; Section Chief Abdominal Imaging VCUHS
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Nardone V, Boldrini L, Grassi R, Franceschini D, Morelli I, Becherini C, Loi M, Greto D, Desideri I. Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment. Cancers (Basel) 2021; 13:cancers13143590. [PMID: 34298803 PMCID: PMC8303203 DOI: 10.3390/cancers13143590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary This review based on a literature search aims at showing the impact of Texture Analysis in the prediction of response to neoadjuvant radiotherapy and/or chemoradiotherapy. The manuscript explores radiomics approaches in different fields of neoadjuvant radiotherapy, including esophageal cancer, lung cancer, sarcoma and rectal cancer in order to shed a light in the setting of neoadjuvant radiotherapy that can be used to tailor the best subsequent therapeutical strategy. Abstract Introduction: Neoadjuvant radiotherapy is currently used mainly in locally advanced rectal cancer and sarcoma and in a subset of non-small cell lung cancer and esophageal cancer, whereas in other diseases it is under investigation. The evaluation of the efficacy of the induction strategy is made possible by performing imaging investigations before and after the neoadjuvant therapy and is usually challenging. In the last decade, texture analysis (TA) has been developed to help the radiologist to quantify and identify the parameters related to tumor heterogeneity, which cannot be appreciated by the naked eye. The aim of this narrative is to review the impact of TA on the prediction of response to neoadjuvant radiotherapy and or chemoradiotherapy. Materials and Methods: Key references were derived from a PubMed query. Hand searching and ClinicalTrials.gov were also used. Results: This paper contains a narrative report and a critical discussion of radiomics approaches in different fields of neoadjuvant radiotherapy, including esophageal cancer, lung cancer, sarcoma, and rectal cancer. Conclusions: Radiomics can shed a light on the setting of neoadjuvant therapies that can be used to tailor subsequent approaches or even to avoid surgery in the future. At the same, these results need to be validated in prospective and multicenter trials.
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Affiliation(s)
- Valerio Nardone
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (V.N.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Boldrini
- Radiation Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (V.N.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Italy;
| | - Ilaria Morelli
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
- Correspondence: ; Tel.: +39-055-7947719
| | - Carlotta Becherini
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
| | - Mauro Loi
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy; (M.L.); (D.G.); (I.D.)
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy; (M.L.); (D.G.); (I.D.)
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy; (M.L.); (D.G.); (I.D.)
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy
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Suarez-Weiss KE, Jhaveri KS, Harisinghani MG. MRI Evaluation of Rectal Cancer Following Preoperative Chemoradiotherapy. Semin Roentgenol 2020; 56:177-185. [PMID: 33858644 DOI: 10.1053/j.ro.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Kartik S Jhaveri
- Division of Diagnostic Radiology, University of Toronto University Health Network, Mt. Sinai and WCH, Toronto, Canada
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Ye D, Zhu Z, Chen F, Lie C, Li W, Lin Y, Qiu S. Correlation Between Endorectal Ultrasound and Magnetic Resonance Imaging for Predicting the Circumferential Resection Margin in Patients With Mid-Low Rectal Cancer Without Preoperative Chemoradiotherapy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:569-577. [PMID: 31617244 DOI: 10.1002/jum.15135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess the correlation between endorectal ultrasound (ERUS) and magnetic resonance imaging (MRI) in predicting the circumferential resection margin (CRM) status of patients with mid-low rectal cancer without preoperative chemoradiotherapy. METHODS Twenty patients with rectal cancer who did not receive preoperative chemoradiotherapy and underwent ERUS and MRI examinations before total mesorectal excision from May 2018 to April 2019 were included in this study. The patient and tumor characteristics, lymph nodes, tumor stages, ERUS and MRI predictors of the CRM status, and postoperative pathologic results were recorded. The closest distance between the deepest portion of lesion invasion and the mesorectal fascia was independently measured on MRI and ERUS images by 2 observers. The observers were blinded to the pathologic results. Measurements from ERUS and MRI were compared. RESULTS The mean distance between the distal edge of the lesion and the anal verge was 5.7 cm (range, 3.1-8.1 cm). The ERUS and pathologic evaluations of CRM involvement were consistent in 90% of the cases. The MRI and pathologic evaluations of CRM involvement were concordant in 95% of the cases. The Cohen κ coefficient of ERUS and MRI was 0.608 (P = .007). The correlation coefficient of ERUS and MRI for assessing the closest distance from the edge of cancer invasion to the mesorectal fascia was 0.99 (P = .0005). CONCLUSIONS Endorectal ultrasound and MRI assessments of the preoperative CRM status appear to be highly consistent. Endorectal ultrasound can be used as a complementary tool with MRI to predict the CRM status of patients with mid-low rectal cancer without preoperative chemoradiotherapy.
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Affiliation(s)
- Dalin Ye
- Department of Ultrasound, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhimin Zhu
- Department of Ultrasound, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fei Chen
- Department of Ultrasound, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chaowei Lie
- Department of Radiology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenlu Li
- Department of Pathology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunyong Lin
- Department of Ultrasound, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shaodong Qiu
- Department of Ultrasound, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Chandarana M, Arya S, de Menezes JL, Engineer R, Ostwal V, Patil P, Kumar S, Dusane R, D'souza A, Saklani A. Can CRM Status on MRI Predict Survival in Rectal Cancers: Experience from the Indian Subcontinent. Indian J Surg Oncol 2019; 10:364-371. [PMID: 31168263 DOI: 10.1007/s13193-019-00894-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/07/2019] [Indexed: 12/16/2022] Open
Abstract
To determine the role of MRI as a predictor of circumferential resection margin (CRM) involvement. To study the impact of CRM status on MRI on recurrence and survival, in correlation with pathology. Analysis of a prospective database was performed over a period of 1 year. All patients with adenocarcinoma of rectum were included in the study. The MRI at presentation for all patients irrespective of stage (MRIT), pre-NACTRT MRI (MRI1) for patients with locally advanced tumours, and post-NACTRT MRI (MRI2) of these patients were analysed separately. The status of CRM on MRI was compared to that on histopathology and as a predictor of recurrence and survival. Two hundred twenty-one patients were included with a median follow-up 30 months. Sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were 50%, 65.46%, 5.63%, 96.95% and 64.85% for MRIT; 50%, 55.32%, 5.97%, 95.12% and 55.03% for MRI1; and 77.78%, 63.29%, 10.77%, 98.04% and 64.07% for MRI2, respectively. On multivariate analysis, pathological positive margin alone predicted a poor overall survival (OS) whereas involved CRM on pathology and MRIT predicted poorer disease-free survival (DFS) and local recurrence. Pre-treatment and post-treatment MRI scans have a moderate sensitivity, specificity and accuracy and a high negative predictive value to predict CRM status on pathology. Pathological CRM status is the only factor to impact OS, DFS and LR on multivariate analysis. CRM status on MRI at presentation (MRIT) does impact DFS and local recurrence but not OS.
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Affiliation(s)
- Mihir Chandarana
- 1Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK.,2Specialty Registrar, Forth Valley Royal Hospital, Larbert, UK
| | - Supreeta Arya
- 3Department of Radiology, Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India
| | | | - Reena Engineer
- 5Department of Radiotherapy, Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India
| | - Vikas Ostwal
- 6Department of Medical Oncology, Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India
| | - Prachi Patil
- 7Department of Medical Gastroenterology, Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India
| | - Suman Kumar
- 8Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India
| | - Rohit Dusane
- 8Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India
| | - Ashwin D'souza
- 9Department of Gastro-intestinal surgery, Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India
| | - Avanish Saklani
- 9Department of Gastro-intestinal surgery, Tata Memorial Centre, Dr. E. Borges road, Parel, Mumbai, 400012 India
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Fowler KJ, Kaur H, Cash BD, Feig BW, Gage KL, Garcia EM, Hara AK, Herman JM, Kim DH, Lambert DL, Levy AD, Peterson CM, Scheirey CD, Small W, Smith MP, Lalani T, Carucci LR. ACR Appropriateness Criteria ® Pretreatment Staging of Colorectal Cancer. J Am Coll Radiol 2018; 14:S234-S244. [PMID: 28473079 DOI: 10.1016/j.jacr.2017.02.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 12/17/2022]
Abstract
Colorectal cancers are common tumors in the United States and appropriate imaging is essential to direct appropriate care. Staging and treatment differs between tumors arising in the colon versus the rectum. Local staging for colon cancer is less integral to directing therapy given radical resection is often standard. Surgical options for rectal carcinoma are more varied and rely on accurate assessment of the sphincter, circumferential resection margins, and peritoneal reflection. These important anatomic landmarks are best appreciated on high-resolution imaging with transrectal ultrasound or MRI. When metastatic disease is suspected, imaging modalities that provide a global view of the body, such as CT with contrast or PET/CT may be indicated. Rectal cancer often metastasizes to the liver and so MRI of the liver with and without contrast provides accurate staging for liver metastases. This article focuses on local and distant staging and reviews the appropriateness of different imaging for both variants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Kathryn J Fowler
- Principal Author, Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
| | - Harmeet Kaur
- Co-author, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Joseph M Herman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - David H Kim
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | - Drew L Lambert
- University of Virginia Health System, Charlottesville, Virginia
| | - Angela D Levy
- Georgetown University Hospital, Washington, District of Columbia
| | | | | | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tasneem Lalani
- Speciality Chair, Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Laura R Carucci
- Panel Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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8
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Zhu L, Pan Z, Ma Q, Yang W, Shi H, Fu C, Yan X, Du L, Yan F, Zhang H. Diffusion Kurtosis Imaging Study of Rectal Adenocarcinoma Associated with Histopathologic Prognostic Factors: Preliminary Findings. Radiology 2016; 284:66-76. [PMID: 27929929 DOI: 10.1148/radiol.2016160094] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To determine the correlation between diffusion kurtosis imaging (DKI)-derived parameters and prognostic factors for rectal adenocarcinoma. Materials and Methods This study was approved by the local institute review board, and written informed consent was obtained from each patient. Data from 56 patients (median age, 59.5 years; age range, 31-86 years) with rectal adenocarcinoma between April 2014 and September 2015 were involved in this prospective study. DKI (b = 0, 700, 1400, and 2100 sec/mm2) and conventional diffusion-weighted imaging (b = 0, 1000 sec/mm2) were performed. Kurtosis and diffusivity from DKI and apparent diffusion coefficients (ADCs) from diffusion-weighted imaging were measured by two radiologists. Student t test, receiver operating characteristic curves, and Spearman correlation were used for statistical analysis. Results Kurtosis was significantly higher in high-grade than in low-grade rectal adenocarcinomas on the basis of both the number of poorly differentiated clusters (PDCs) (1.136 ± 0.086 vs 0.988 ± 0.060, P < .05) and World Health Organization (WHO) grades (1.103 ± 0.086 [standard deviation] vs 1.034 ± 0.103, P < .05). In PDC grading, the diffusivity and ADC were significantly lower in high-grade tumors than in low-grade tumors (1.187 ± 0.150 vs 1.306 ± 0.129 and 1.020 ± 0.113 vs 1.108 ± 0.097, respectively; P < .05) and showed similar correlations with histologic grades (r = -0.486 and r = -0.406, respectively; P > .05). Compared with both diffusivity and ADC, kurtosis showed significantly higher sensitivity (83.3% [20 of 24] vs 70.8% [17 of 24] and 70.8% [17 of 24], respectively) and specificity (96.8% [31 of 32] vs 84.4% [24 of 32] and 81.3% [26 of 32], respectively). Kurtosis showed a better correlation with PDC grades than with WHO grades (r = 0.797 vs r = 0.293, P < .05). Kurtosis was significantly higher in pN1-2 than in pN0 tumors (1.086 ± 0.103 vs 1.009 ± 0.086, P < .05). Conclusion Kurtosis derived from DKI demonstrated a higher correlation with histologic grades compared with diffusivity and ADC. It also showed better performance in differentiating between high- and low-grade rectal adenocarcinomas and between pN1-2 and pN0 tumors. © RSNA, 2016.
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Affiliation(s)
- Lan Zhu
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Zilai Pan
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Qian Ma
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Wenjie Yang
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Hongyuan Shi
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Caixia Fu
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Xu Yan
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Lianjun Du
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Fuhua Yan
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Huan Zhang
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
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Fraum TJ, Owen JW, Fowler KJ. Beyond Histologic Staging: Emerging Imaging Strategies in Colorectal Cancer with Special Focus on Magnetic Resonance Imaging. Clin Colon Rectal Surg 2016; 29:205-15. [PMID: 27582645 DOI: 10.1055/s-0036-1584288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Imaging plays an increasingly important role in the staging and management of colorectal cancer. In recent years, magnetic resonance imaging (MRI) has supplanted transrectal ultrasound as the preferred modality for the locoregional staging of rectal cancer. Furthermore, the advent of both diffusion-weighted imaging and hepatobiliary contrast agents has significantly enhanced the ability of MRI to detect colorectal liver metastases. In clinical practice, MRI routinely provides prognostic information, helps to guide surgical strategy, and determines the need for neoadjuvant therapies related to both the primary tumor and metastatic disease. Expanding on these roles for MRI, positron emission tomography (PET)/MRI is the newest clinical hybrid imaging modality and combines the metabolic information of PET with the high soft tissue contrast of MRI. The addition of PET/MRI to the clinical staging armamentarium has the potential to provide comprehensive state-of-the-art colorectal cancer staging in a single examination.
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Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Joseph W Owen
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
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10
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Moreno CC, Sullivan PS, Kalb BT, Tipton RG, Hanley KZ, Kitajima HD, Dixon WT, Votaw JR, Oshinski JN, Mittal PK. Magnetic resonance imaging of rectal cancer: staging and restaging evaluation. ACTA ACUST UNITED AC 2016; 40:2613-29. [PMID: 25759246 DOI: 10.1007/s00261-015-0394-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Magnetic resonance imaging is used to non-invasively stage and restage rectal adenocarcinomas. Accurate staging is important as the depth of tumor extension and the presence or absence of lymph node metastases determines if an individual will undergo preoperative neoadjuvant chemoradiation. Accurate description of tumor location is important for presurgical planning. The relationship of the tumor to the anal sphincter in addition to the depth of local invasion determines the surgical approach used for resection. High-resolution T2-weighted imaging is the primary sequence used for initial staging. The addition of diffusion-weighted imaging improves accuracy in the assessment of treatment response on restaging scans. Approximately 10%-30% of individuals will experience a complete pathologic response following chemoradiation with no residual viable tumor found in the resected specimen at histopathologic assessment. In some centers, individuals with no residual tumor visible on restaging MR who are thought to be at high operative risk are monitored with serial imaging and a "watch and wait" approach in lieu of resection. Normal rectal anatomy, MR technique utilized for staging and restaging scans, and TMN staging are reviewed. An overview of surgical techniques used for resection including newer, minimally invasive endoluminal techniques is included.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA.
| | - Patrick S Sullivan
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Bobby T Kalb
- Department of Medical Imaging, The University of Arizona School of Medicine, Tucson, AZ, 85724, USA
| | - Russell G Tipton
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Krisztina Z Hanley
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Hiroumi D Kitajima
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - W Thomas Dixon
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - John R Votaw
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - John N Oshinski
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Pardeep K Mittal
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
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11
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Gravante G, Hemingway D, Stephenson JA, Sharpe D, Osman A, Haines M, Pirjamali V, Sorge R, Yeung JM, Norwood M, Miller A, Boyle K. Rectal cancers with microscopic circumferential resection margin involvement (R1 resections): Survivals, patterns of recurrence, and prognostic factors. J Surg Oncol 2016; 114:642-648. [DOI: 10.1002/jso.24360] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/20/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Gianpiero Gravante
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
| | - David Hemingway
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
| | | | - David Sharpe
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
| | - Ahmed Osman
- Department of Oncology; Leicester Royal Infirmary; Leicester United Kingdom
| | - Melissa Haines
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
| | - Vafa Pirjamali
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
| | - Roberto Sorge
- Laboratory of Biometry; Department of Human Physiology; University of Tor Vergata; Rome Italy
| | - Justin Ming Yeung
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
| | - Michael Norwood
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
| | - Andrew Miller
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
| | - Kirsten Boyle
- Department of Colorectal Surgery; Leicester Royal Infirmary; Leicester United Kingdom
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12
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Characteristics and Prognostic Significance of Preoperative Magnetic Resonance Imaging-Assessed Circumferential Margin in Rectal Cancer. Gastroenterol Res Pract 2015; 2015:410150. [PMID: 26089866 PMCID: PMC4452312 DOI: 10.1155/2015/410150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/20/2015] [Accepted: 05/11/2015] [Indexed: 12/22/2022] Open
Abstract
Purpose. To study the characteristics and prognostic significance of preoperative magnetic resonance imaging- (MRI-) assessed circumferential margin (CRM) in rectal cancer. Methods. Patients underwent preoperative high resolution pelvic MRI, followed by resection of primary tumor. The relationship between MRI-assessed CRM and pathological CRM (pCRM) was studied, and survival analysis was used to determine the prognostic significance of MRI-assessed CRM. Results. Of all the 203 patients, the total accuracy of MRI-assessed CRM for predicting involvement of pCRM was 84.2%, sensitivity was 50%, and specificity was 86.8%. Anterior tumors were more possible to assess involvement of CRM by MRI, while the false positive rate was significantly higher than lateral or posterior tumor (87.5% versus 50%, p = 0.0002). The 3-year local recurrence, disease-free survival, and overall survival rates were 35.6%, 58.1%, and 85.2% in patients with involved mrCRM, compared with 8.9%, 78.9%, and 92.3% in patients with clear mrCRM. In multivariate analysis, MRI-assessed CRM found an independent risk factor for local recurrence, with a hazard ratio of 3.49 (p = 0.003). Conclusions. High resolution MRI was accurate to assess CRM preoperatively, while anterior tumor should be assessed more cautiously. Involvement of mrCRM was significantly associated with local recurrence regardless of pCRM status.
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Burdan F, Sudol-Szopinska I, Staroslawska E, Kolodziejczak M, Klepacz R, Mocarska A, Caban M, Zelazowska-Cieslinska I, Szumilo J. Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions. Eur J Med Res 2015; 20:4. [PMID: 25586770 PMCID: PMC4304171 DOI: 10.1186/s40001-014-0078-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/16/2014] [Indexed: 12/13/2022] Open
Abstract
Endorectal ultrasonography (ERUS) and magnetic resonance imaging (MRI) allow exploring the morphology of the rectum in detail. Use of such data, especially assessment of the rectal wall, is an important tool for ascertaining the perianal fistula localization as well as stage of the cancer and planning it appropriate treatment, as stage T3 tumors are usually treated with neoadjuvant therapy, whereas T2 tumors are initially managed surgically. The only advantage of ERUS over MRI is the possibility of assessing T1 tumors that could be treated by transanal endoscopic microsurgery. However, MRI is better for visualizing most radiological prognostic features in rectal or anal cancer such as a circumferential resection margin less than 1 mm, T stage at T1-T2 or T3 tumors with extramural extension less than 5 mm, absence of extramural vascular invasion, N stage at N0/N1, and tumors located in the middle or upper third of the rectum. It can also evaluate the intersphincteric space or levator ani muscle involvement. Increased signal on diffusion weighted imaging (DWI) and low apparent diffusion coefficient (ADC) values as well as an irregular contour and heterogeneous internal signal intensity seem to predict the involvement of pelvic lymphatic nodes better than their size alone. Computed tomography as well as other examination techniques, including digital rectal examination, contrast edema, recto- and colonoscopy, are less useful in staging of rectal cancer but still are very important screening tools.
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Affiliation(s)
- Franciszek Burdan
- St. John's Cancer Centre, 7 Jaczewskiego Str., 20-090, Lublin, Poland. .,Department of Human Anatomy, Medical University of Lublin, 4 Jaczewskiego Str., 20-090, Lublin, Poland.
| | - Iwona Sudol-Szopinska
- Department of Radiology, Institute of Rheumatology, 1 Spartanska Str., 02-637, Warsaw, Poland. .,Department of Diagnostic Imaging, Second Faculty of Medicine, Medical University of Warsaw, 8 Kondratowicza Str., 03-242, Warsaw, Poland.
| | | | | | - Robert Klepacz
- Department of Clinical Pathomorphology, Medical University of Lublin, 1 Ceramiczna Str., 20-059, Lublin, Poland.
| | | | - Marek Caban
- St. John's Cancer Centre, 7 Jaczewskiego Str., 20-090, Lublin, Poland.
| | | | - Justyna Szumilo
- Department of Clinical Pathomorphology, Medical University of Lublin, 1 Ceramiczna Str., 20-059, Lublin, Poland.
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14
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Akashi M, Nakahusa Y, Yakabe T, Egashira Y, Koga Y, Sumi K, Noshiro H, Irie H, Tokunaga O, Miyazaki K. Assessment of aggressiveness of rectal cancer using 3-T MRI: correlation between the apparent diffusion coefficient as a potential imaging biomarker and histologic prognostic factors. Acta Radiol 2014; 55:524-31. [PMID: 24005562 DOI: 10.1177/0284185113503154] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) permits non-invasive assessment of tumor characteristics. PURPOSE To assess the value of DW-MRI as a potential non-invasive marker of tumor aggressiveness in rectal cancer by analyzing the relationship between tumoral apparent diffusion coefficient (ADC) values of MRI and histopathologic prognostic parameters that are not affected by preoperative chemoradiation therapy. MATERIAL AND METHODS Forty patients with rectal cancer were assessed with primary staging 3-T MRI, including DWI, before undergoing surgical therapy. In all patients, surgery was performed without neoadjuvant therapy. Mean tumor ADC was measured and compared between subgroups based on pretreatment carcinoembryonic antigen (CEA) levels, MRI parameters (e.g. postoperative local recurrence), and histopathologic parameters, including A (invasive distance: A1, T-stage; A2, mesorectal fascia [MRF] status), B (differentiation grade: B1, poorly differentiated; B2, moderately differentiated; B3, well differentiated), C (others: C1, N-stage; C2, lymphangiovascular invasion). RESULTS Mean tumor ADCs were different when comparing groups stratified by histologic differentiation grades (P=0.0192). There was no significant difference in mean ADCs when stratifying patients according to CEA levels, T-stage, N-stage, MRF status, presence of lymphangiovascular invasion, or the presence of local recurrence. CONCLUSION Significant correlations were found between mean ADC values and differentiation grade. ADC may be useful as an imaging biomarker of tumor aggressiveness, but it cannot serve as an independent biomarker of advanced rectal cancer.
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Affiliation(s)
- Michiaki Akashi
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
- Department of Pathology and Biodefense, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuji Nakahusa
- Department of Surgery, Hukuoka Red Cross Hospital, Hukouoka, Japan
| | - Tomomi Yakabe
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshiyuki Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Yasuo Koga
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kenji Sumi
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirokazu Noshiro
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Osamu Tokunaga
- Department of Pathology and Biodefense, Faculty of Medicine, Saga University, Saga, Japan
| | - Kohji Miyazaki
- Department of General Surgery, Faculty of Medicine, Saga University, Saga, Japan
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15
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Clinical implication of negative conversion of predicted circumferential resection margin status after preoperative chemoradiotherapy for locally advanced rectal cancer. Eur J Radiol 2014; 83:245-9. [DOI: 10.1016/j.ejrad.2013.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 11/20/2022]
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Partovi S, Robbin MR, Steinbach OC, Kohan A, Rubbert C, Vercher-Conejero JL, Kolthammer JA, Faulhaber P, Paspulati RM, Ros PR. Initial experience of MR/PET in a clinical cancer center. J Magn Reson Imaging 2013; 39:768-80. [PMID: 24006287 DOI: 10.1002/jmri.24334] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/09/2013] [Indexed: 12/20/2022] Open
Abstract
Magentic Resonance/positron emission tomography (PET) has been introduced recently for imaging of clinical patients. This hybrid imaging technology combines the inherent strengths of MRI with its high soft-tissue contrast and biological sequences with the inherent strengths of PET, enabling imaging of metabolism with a high sensitivity. In this article, we describe the initial experience of MR/PET in a clinical cancer center along with a review of the literature. For establishing MR/PET in a clinical setting, technical challenges, such as attenuation correction and organizational challenges, such as workflow and reimbursement, have to be overcome. The most promising initial results of MR/PET have been achieved in anatomical areas where high soft-tissue and contrast resolution is of benefit. Head and neck cancer and pelvic imaging are potential applications of this hybrid imaging technology. In the pediatric population, MR/PET can decrease the lifetime radiation dose. MR/PET protocols tailored to different types of malignancies need to be developed. After the initial exploration phase, large multicenter trials are warranted to determine clinical indications for this exciting hybrid imaging technology and thereby opening new horizons in molecular imaging.
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Affiliation(s)
- Sasan Partovi
- Department of Radiology, UH Seidman Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Dewhurst C, Rosen MP, Blake MA, Baker ME, Cash BD, Fidler JL, Greene FL, Hindman NM, Jones B, Katz DS, Lalani T, Miller FH, Small WC, Sudakoff GS, Tulchinsky M, Yaghmai V, Yee J. ACR Appropriateness Criteria pretreatment staging of colorectal cancer. J Am Coll Radiol 2013; 9:775-81. [PMID: 23122343 DOI: 10.1016/j.jacr.2012.07.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/31/2012] [Indexed: 02/06/2023]
Abstract
Because virtually all patients with colonic cancer will undergo some form of surgical therapy, the role of preoperative imaging is directed at determining the presence or absence of synchronous carcinomas or adenomas and local or distant metastases. In contrast, preoperative staging for rectal carcinoma has significant therapeutic implications and will direct the use of radiation therapy, surgical excision, or chemotherapy. CT of the chest, abdomen, and pelvis is recommended for the initial evaluation for the preoperative assessment of patients with colorectal carcinoma. Although the overall accuracy of CT varies directly with the stage of colorectal carcinoma, CT can accurately assess the presence of metastatic disease. MRI using endorectal coils can accurately assess the depth of bowel wall penetration of rectal carcinomas. Phased-array coils provide additional information about lymph node involvement. Adding diffusion-weighted imaging to conventional MRI yields better diagnostic accuracy than conventional MRI alone. Transrectal ultrasound can distinguish layers within the rectal wall and provides accurate assessment of the depth of tumor penetration and perirectal spread, and PET and PET/CT have been shown to alter therapy in almost one-third of patients with advanced primary rectal cancer. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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18
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Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, Part 1: Tumors of the Brain, Head and Neck, Chest, Abdomen, and Pelvis. J Nucl Med 2012; 53:928-38. [DOI: 10.2967/jnumed.112.105338] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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19
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Dean CJ, Sykes JR, Cooper RA, Hatfield P, Carey B, Swift S, Bacon SE, Thwaites D, Sebag-Montefiore D, Morgan AM. An evaluation of four CT-MRI co-registration techniques for radiotherapy treatment planning of prone rectal cancer patients. Br J Radiol 2012; 85:61-8. [PMID: 22190750 DOI: 10.1259/bjr/11855927] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES MRI is the preferred staging modality for rectal carcinoma patients. This work assesses the CT-MRI co-registration accuracy of four commercial rigid-body techniques for external beam radiotherapy treatment planning for patients treated in the prone position without fiducial markers. METHODS 17 patients with biopsy-proven rectal carcinoma were scanned with CT and MRI in the prone position without the use of fiducial markers. A reference co-registration was performed by consensus of a radiologist and two physicists. This was compared with two automated and two manual techniques on two separate treatment planning systems. Accuracy and reproducibility were analysed using a measure of target registration error (TRE) that was based on the average distance of the mis-registration between vertices of the clinically relevant gross tumour volume as delineated on the CT image. RESULTS An automated technique achieved the greatest accuracy, with a TRE of 2.3 mm. Both automated techniques demonstrated perfect reproducibility and were significantly faster than their manual counterparts. There was a significant difference in TRE between registrations performed on the two planning systems, but there were no significant differences between the manual and automated techniques. CONCLUSION For patients with rectal cancer, MRI acquired in the prone treatment position without fiducial markers can be accurately registered with planning CT. An automated registration technique offered a fast and accurate solution with associated uncertainties within acceptable treatment planning limits.
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Affiliation(s)
- C J Dean
- Department of Medical Physics, St James's Institute of Oncology, Leeds, UK.
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20
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Yu SKT, Patel UB, Tait DM, Brown G. Primary staging and response assessment postchemoradiotherapy in rectal cancer. COLORECTAL CANCER 2012. [DOI: 10.2217/crc.11.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SUMMARY Initial assessment of newly diagnosed patients with rectal cancer includes clinical examination, colonoscopy, pelvic MRI and CT scan of the thorax, abdomen and pelvis. Radiological staging can objectively evaluate both surgical and biological prognostic features of rectal cancer. MRI has emerged to be the most useful preoperative prognostic staging tool and it can predict the risk of tumor involvement of surgical circumferential resection margin. An agreed definition of favorable tumor response to chemoradiotherapy is controversial. The importance of detecting and assessing good versus poor responders to chemoradiotherapy is of increasing relevance. MRI has been found to be useful in assessing tumor response postchemoradiotherapy, especially the assessment of potential circumferential resection margin and magnetic resonance tumor regression grade. These imaging markers predict survival outcomes for good and poor responders and provide an opportunity for clinicians to offer additional neoadjuvant and adjuvant treatments to reduce local or distance failure for the poor responders.
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Affiliation(s)
- Stanley KT Yu
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Uday B Patel
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Diana M Tait
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
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21
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Curvo-Semedo L, Lambregts DMJ, Maas M, Beets GL, Caseiro-Alves F, Beets-Tan RGH. Diffusion-weighted MRI in rectal cancer: apparent diffusion coefficient as a potential noninvasive marker of tumor aggressiveness. J Magn Reson Imaging 2012; 35:1365-71. [PMID: 22271382 DOI: 10.1002/jmri.23589] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 12/15/2011] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the value of diffusion-weighted MR imaging (DWI) as a potential noninvasive marker of tumor aggressiveness in rectal cancer, by analyzing the relationship between tumoral apparent diffusion coefficient (ADC) values and MRI and histological prognostic parameters. MATERIALS AND METHODS Fifty rectal cancer patients underwent primary staging MRI including DWI before surgery and neo-adjuvant therapy. In 47, surgery was preceded by short-course radiation therapy (n = 28) or long-course chemoradiation therapy (n = 19). Mean tumor ADC was measured and compared between subgroups based on pretreatment CEA levels, MRI parameters (mesorectal fascia - MRF - status; T-stage; N-stage) and histological parameters (differentiation grade: poorly differentiated, poorly moderately differentiated, moderately differentiated, moderately well differentiated, well-differentiated; lymphangiovascular invasion). RESULTS Mean tumor ADCs differ between MRF-free versus MRF-invaded tumors (P = 0.013), the groups of cN0 versus cN+ cancers (P = 0.011), and between the several groups of histological differentiation grades (P = 0.025). There was no significant difference in mean ADCs between the various groups of CEA levels, the T stage, and the presence of lymphangiovascular invasion. CONCLUSION Lower ADC values were associated with a more aggressive tumor profile. Significant correlations were found between mean ADC values and radiological MRF status, N stage and differentiation grade. ADC has the potential to become an imaging biomarker of tumor aggressiveness profile.
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Affiliation(s)
- Luís Curvo-Semedo
- Universitary Clinic of Radiology, Coimbra University Hospitals, Coimbra, Portugal
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22
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Quaia E, Ulcigrai V, Coss M, De Paoli L, Ukmar M, Zanconati F, De Pellegrin A, De Manzini N, Cova MA. Spectral presaturation inversion recovery MR imaging sequence after gadolinium injection to differentiate fibrotic scar tissue and neoplastic strands in the mesorectal fat in patients undergoing restaging of rectal carcinoma after neoadjuvant chemo- and radiation therapy. Acad Radiol 2011; 18:1365-75. [PMID: 21971257 DOI: 10.1016/j.acra.2011.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 07/27/2011] [Accepted: 07/28/2011] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES To retrospectively assess the value of spectral presaturation by inversion-recovery (SPIR) magnetic resonance (MR) imaging sequence after gadolinium injection to differentiate fibrotic scar tissue and tumoral infiltration within the mesorectal fat in patients with rectal carcinoma undergoing MR restaging after neoadjuvant chemo- and radiation therapy (CRT). MATERIALS AND METHODS Forty-three consecutive patients (mean age, 65.8 years; range, 46-85 years; male:female, 29:14) with locally advanced rectal carcinoma underwent CRT followed by surgery. MR imaging was performed before and after completion of CRT by using T2-weighted turbo spin-echo and T1-weighted SPIR sequences before and after gadolinium injection, and MR images were assessed by two radiologists in consensus. Logistic regression was conducted to test the significance of the MR image findings with histology. RESULTS After CRT the disease was either limited to the rectal wall (n = 18 patients) or presented perirectal infiltration (n = 25) on histology. In 21 patients, mesorectal enhancing strands were observed. Reticular-shaped enhancing strands reaching the mesorectal fascia presented the highest correlation with tumor infiltration of the mesorectal fat (OR 130.33, 95% CI: 4.1-4220.29; logistic regression), whereas linear-shaped enhancing strands either reaching or not reaching the mesorectal fascia (OR 0.25 or 0.1, 95% CI: 0.024-2.6 or 0.01-1.07) revealed the lowest correlation. CONCLUSIONS Reticular-shaped enhancing strands on SPIR MR imaging after gadolinium injection are associated with tumor infiltration of the mesorectal fat.
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Dent OF, Chapuis PH, Haboubi N, Bokey L. Magnetic resonance imaging cannot predict histological tumour involvement of a circumferential surgical margin in rectal cancer. Colorectal Dis 2011; 13:974-81. [PMID: 20594199 DOI: 10.1111/j.1463-1318.2010.02358.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Several recent studies have attempted to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting the likelihood of tumour involvement of the postoperative circumferential resection margin (CRM) in rectal cancer with the intention of selecting patients who might benefit from neoadjuvant therapy and as a guide to surgery. The aim of this study was to assess whether such studies can provide a valid answer as to whether preoperative MRI can accurately predict CRM involvement by tumour. METHOD The study design and methodology of studies on this topic were critically examined. RESULTS Features identified as affecting the efficacy of these studies were: representativeness of patients, definition of the margin assessed by MRI and by histology, lack of blinding of surgeons and pathologists to MRI results, effect of neoadjuvant treatment, and number of patients studied. CONCLUSION Because of methodological inadequacies in studies completed to date, there is insufficient evidence of the ability of a positive MRI result to predict an involved CRM. Although MRI may be able to identify a tumour that has extended to the mesorectal fascia and/or intersphincteric plane, logically, it cannot indicate where the surgical boundary of the resection will ultimately lie, and therefore cannot validly predict an involved CRM and should not be relied upon for this purpose.
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Affiliation(s)
- O F Dent
- Department of Colorectal Surgery, Concord Hospital and Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.
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24
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Bellows CF, Jaffe B, Bacigalupo L, Pucciarelli S, Gagliardi G. Clinical significance of magnetic resonance imaging findings in rectal cancer. World J Radiol 2011; 3:92-104. [PMID: 21532870 PMCID: PMC3084438 DOI: 10.4329/wjr.v3.i4.92] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/06/2011] [Accepted: 04/13/2011] [Indexed: 02/06/2023] Open
Abstract
Staging of rectal cancer is essential to help guide clinicians to decide upon the correct type of surgery and determine whether or not neoadjuvant therapy is indicated. Magnetic resonance imaging (MRI) is currently one of the most accurate modalities on which to base treatment decisions for patients with rectal cancer. MRI can accurately detect the mesorectal fascia, assess the invasion of the mesorectum or surrounding organs and predict the circumferential resection margin. Although nodal disease remains a difficult radiological diagnosis, new lymphographic agents and diffusion weighted imaging may allow identification of metastatic nodes by criteria other then size. In light of this, we have reviewed the literature on the accuracy of specific MRI findings for staging the local extent of primary rectal cancer. The aim of this review is to establish a correlation between MRI findings, prognosis, and available treatment options.
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25
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Hermanek P, Hohenberger W, Fietkau R, Rödel C. Individualized magnetic resonance imaging-based neoadjuvant chemoradiation for middle and lower rectal carcinoma. Colorectal Dis 2011; 13:39-47. [PMID: 19863611 DOI: 10.1111/j.1463-1318.2009.02076.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM In most institutions neoadjuvant chemoradiation for middle and lower rectal carcinoma is currently given to patients with tumours of clinical stages II or III (cT3,4 and/or N1,2). The possibility of a reduction in the use of neoadjuvant chemoradiation by an individualized magnetic resonance imaging (MRI)-based indication for neoadjuvant chemoradiation was analysed. METHOD Assessment of the pathological and oncological principles indicating for neoadjuvant treatment was used to determine the prognostic importance of the distance between the tumour and the circumferential resection margin and pretherapeutic assessment using modern MRI. RESULTS Based on the results of pretreatment MRI scanning, a proposal is presented for the treatment of middle and lower rectal carcinoma with neoadjuvant chemoradiation. Adopting this proposal, the frequency of neoadjuvant chemoradiation decreased from 70% to 35% and the early and late adverse effects of this therapy were reduced. In contrast, the expected locoregional recurrence rate increased from 6% to 11% if all quality criteria were met and to 18% if not. CONCLUSION An MRI-based indication for neoadjuvant chemoradiation is justified only for centres with regular quality assurance of MRI, surgery, radiotherapy and pathology. The proposal needs confirmation by long-term follow up and by prospective studies with larger numbers of patients.
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Affiliation(s)
- P Hermanek
- Department of Surgery, University Hospital Erlangen, Germany.
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26
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Anderson EM, Betts M, Slater A. The value of true axial imaging for CT staging of colonic cancer. Eur Radiol 2010; 21:1286-92. [DOI: 10.1007/s00330-010-2019-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/21/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
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Anderson EM, Betts M, Slater A. The value of true axial imaging for CT staging of colonic cancer. Eur Radiol 2010. [PMID: 21110194 DOI: 10.1007/s00330-010-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the effect of true axial computed tomography on the accuracy of staging of colonic cancers. METHOD Fifty consecutive datasets were independently assessed by three radiologists, experienced in colorectal cancer staging. The first read was of standard axial images only. The second read was 6 weeks later and true axial images, through the tumour and perpendicular to its long axis, were included. RESULTS The overall accuracy for tumour staging was 56% for reader 1, 48% for reader 2 and 64% for reader 3 for standard axial CT. This improved to 72% (p = 0.012), 66% (p = 0.012) and 80% (p = 0.021) when the true axial images were added. For nodal staging, overall accuracy improved from 56% to 70% (p = 0.065) for reader 1, 58% to 76% (p = 0.012) for reader 2 and 60% to 76% (p = 0.021) for reader 3 between reads. CONCLUSION The accuracy of CT staging of colonic tumours is significantly improved by reviewing images reconstructed in a plane perpendicular to the long axis of the tumour. The accuracy achieved by this analysis is similar to that of CT colonography but avoids the extra complexity, additional cost and increased complications.
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Affiliation(s)
- Ewan M Anderson
- Churchill Cancer Centre, Old Road, Headington, Oxford, OX3 7LJ, UK.
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Prete F, Prete FP. Laparoscopic surgery for rectal cancer. Lancet Oncol 2010; 11:918-9; author reply 920-1. [PMID: 20932488 DOI: 10.1016/s1470-2045(10)70200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review. Insights Imaging 2010; 1:245-267. [PMID: 22347920 PMCID: PMC3259411 DOI: 10.1007/s13244-010-0037-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/11/2010] [Accepted: 07/26/2010] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience.
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Ais Conde G, Fadrique Fernández B, Vázquez Santos P, López Pérez J, Picatoste Merino M, Manzanares Sacristán J. [Rectal cancer: which patients benefit from radiotherapy?]. Cir Esp 2010; 87:350-5. [PMID: 20413110 DOI: 10.1016/j.ciresp.2010.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 02/23/2010] [Accepted: 03/06/2010] [Indexed: 02/07/2023]
Abstract
The prognosis of patients with rectal cancer has improved in recent years, particularly as regards the lower probability of local recurrence. These positive results are obtained through correct preoperative staging and an adequate surgical resection of the affected lesion, as well as a multidisciplinary therapeutic approach. Based on the available scientific evidence, our aim is to clarify the framework in which options for the right therapy can be taken, especially in relation to the preoperative staging and its limitations, with regards to radiotherapy and its indications. We also emphasize the need of a tailor-made approach for each case.
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Affiliation(s)
- Guillermo Ais Conde
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital General de Segovia, Segovia, Spain.
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Hermanek P, Merkel S, Fietkau R, Rödel C, Hohenberger W. Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TME [corrected] surgery. Implications for treatment decisions. Int J Colorectal Dis 2010; 25:359-68. [PMID: 20012295 DOI: 10.1007/s00384-009-0864-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS For rectal carcinoma treated according to the concept of total mesorectal excision (TME surgery), the independent influence of regional lymph node metastasis on the locoregional recurrence risk is still in discussion. A reliable assessment of this risk is important for an individualised selective indication for neoadjuvant radio-/radiochemotherapy. METHODS Analysis of literature, especially of the last 20 years, and consideration of pathological and oncological basic research. Multivariate analysis of data of the Erlangen Registry of Colorectal Carcinoma. RESULTS The clinical assessment of the pretherapeutic regional lymph node status by the present available imaging methods is still unreliable. The analysis of the association between pretherapeutic regional lymph node status and locoregional recurrence risk has to be based on follow-up data of patients treated by primary surgery and has to be distinguished between patients treated by conventional and optimised quality-assured TME surgery, respectively. Data from Erlangen show an increase of the local recurrence risk for patients with at least four involved regional lymph nodes. CONCLUSIONS For patients with at least four involved regional lymph nodes, a neoadjuvant radiochemotherapy may be indicated. However, today, the pretherapeutic diagnosis is uncertain and results in overtherapy in 40%. Thus, in case of positive lymph node findings by imaging methods, the benefits and risk of neoadjuvant therapy in such situations should always be discussed with the patient in the sense of informed consent and shared decision.
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Affiliation(s)
- Paul Hermanek
- Department of Surgery, University Hospital, Krankenhausstr. 12, 91054, Erlangen, Germany
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Kim SH, Lee JM, Park HS, Eun HW, Han JK, Choi BI. Accuracy of MRI for predicting the circumferential resection margin, mesorectal fascia invasion, and tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging 2009; 29:1093-101. [PMID: 19388124 DOI: 10.1002/jmri.21742] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the diagnostic accuracy of MRI for predicting the circumferential resection margin (CRM), mesorectal fascia (MRF) invasion, and the tumor response to neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer. MATERIALS AND METHODS Sixty-five consecutive patients with locally advanced rectal cancer (> or =T3 or lymph node-positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. Two blinded radiologists independently reviewed both the pre- and post-CRT rectal MR images and measured the post-CRT CRM; they recorded their confidence level with respect to the MRF invasion and tumor response using a 5-point scale. The diagnostic accuracy of each reviewer was calculated using receiver operating characteristic curve (ROC) analysis. RESULTS The measured CRM was not significantly different from the reference standard (mean difference, -1.4 mm; 95% limits of agreement, -8.3-5.4 mm; interclass correlation coefficient, 0.82). The diagnostic accuracy (A(z)) for determining MRF invasion was 0.890 for reviewer 1 (95% confidence interval [CI], 0.788-0.954) and 0.829 for reviewer 2 (95% CI, 0.715-0.911). The A(z) for predicting complete or near-complete regression was 0.791 for reviewer 1 (95% CI, 0.672-0.882) and 0.735 for reviewer 2 (95% CI, 0.611-0.837). CONCLUSION MRI provides accurate information regarding the CRM of locally advanced rectal cancer after neoadjuvant CRT; it also shows relatively high accuracy for predicting MRF invasion and moderate accuracy for assessing tumor response.
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Affiliation(s)
- Seung Ho Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Liang XM, Tang GY, Cheng YS, Zhou B. Evaluation of a rabbit rectal VX2 carcinoma model using computed tomography and magnetic resonance imaging. World J Gastroenterol 2009; 15:2139-44. [PMID: 19418587 PMCID: PMC2678585 DOI: 10.3748/wjg.15.2139] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish a rabbit rectal VX2 carcinoma model for the study of rectal carcinoma.
METHODS: A suspension of VX2 cells was injected into the rectum wall under the guidance of X-ray fluoroscopy. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to observe tumor growth and metastasis at different phases. Pathological changes and spontaneous survival time of the rabbits were recorded.
RESULTS: Two weeks after VX2 cell implantation, the tumor diameter ranged 4.1-5.8 mm and the success implantation rate was 81.8%. CT scanning showed low-density foci of the tumor in the rectum wall, while enhanced CT scanning demonstrated asymmetrical intensification in tumor foci. MRI scanning showed a low signal of the tumor on T1-weighted imaging and a high signal of the tumor on T2-weighted imaging. Both types of signals were intensified with enhanced MRI. Metastases to the liver and lung could be observed 6 wk after VX2 cell implantation, and a large area of necrosis appeared in the primary tumor. The spontaneous survival time of rabbits with cachexia and multiple organ failure was about 7 wk after VX2 cell implantation.
CONCLUSION: The rabbit rectal VX2 carcinoma model we established has a high stability, and can be used in the study of rectal carcinoma.
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McMahon CJ, Smith MP. Magnetic resonance imaging in locoregional staging of rectal adenocarcinoma. Semin Ultrasound CT MR 2009; 29:433-53. [PMID: 19166041 DOI: 10.1053/j.sult.2008.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A comprehensive overview of the current status of magnetic resonance imaging (MRI) in the locoregional assessment and management of rectal adenocarcinoma is presented. Staging systems for rectal cancer and treatment strategies in its management are discussed to give the reader the context that shapes MRI acquisition techniques and interpretation. Findings on MRI are detailed and their accuracy reviewed based on currently available evidence. Optimization of MRI acquisition and relevant pelvic anatomy are reviewed. A detailed description of our approach in interpreting MRI for locoregional staging of rectal cancer is given and future directions are also introduced.
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Affiliation(s)
- Colm J McMahon
- Department of Radiology, Beth israel Deaconess Medical Center, Boston, MA 02215, USA
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Adeyemo D, Hutchinson R. Preoperative staging of rectal cancer: pelvic MRI plus abdomen and pelvic CT. Does extrahepatic abdomen imaging matter? A case for routine thoracic CT. Colorectal Dis 2009; 11:259-63. [PMID: 18513197 DOI: 10.1111/j.1463-1318.2008.01588.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the quality of preoperative magnetic resonance imaging (MRI) staging of rectal cancer, and the clinical significance of abdomen and pelvic computed tomogram (CT) scans in preoperative staging of rectal cancer in a district general hospital. We postulated that the 'metastatic yield' of extrahepatic abdominal imaging is poor, and rarely altered management of rectal cancer. METHODS This is a retrospective study of preoperative MRI, CT scans and postoperative histology results of patients who had definitive surgery for rectal cancer at the Mid-Staffordshire General Hospitals NHS Trust over a 36-month period. Preoperative multiplanar pelvic MRI locoregional staging was compared with eventual histology. The incidence of and significance of abdomen and pelvic CT detected pathology (including metastasis) in the management of rectal cancers was also assessed. RESULTS Preoperative pelvic MRI correctly predicted 'clear' Circumferential resection margins, in 28 of 29 patients who had primary surgery. This is comparable with many published studies. Significant CT detected pathology (including metastasis) on preoperative abdomen and pelvic CT scans was uncommon, and did not influence management of any rectal cancer patient in our study. DISCUSSION Given that exclusive CT detected significant pathology caudal to the liver (extrahepatic abdomen) is rare, can full abdomen and pelvic CT scans be justified for preoperative staging of rectal cancers? - especially where chest X rays are employed for lung staging. Preoperative thoracic and upper abdomen CT scan may be a more productive use of resources. Full abdominal scans may be more appropriate for selection of rectal cancer patients with isolated liver metastasis for metastasectomy.
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Affiliation(s)
- D Adeyemo
- University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK.
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Rosenberg R, Herrmann K, Gertler R, Künzli B, Essler M, Lordick F, Becker K, Schuster T, Geinitz H, Maak M, Schwaiger M, Siewert JR, Krause B. The predictive value of metabolic response to preoperative radiochemotherapy in locally advanced rectal cancer measured by PET/CT. Int J Colorectal Dis 2009; 24:191-200. [PMID: 19050900 DOI: 10.1007/s00384-008-0616-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND To evaluate the value of positron emission tomography using fluorodeoxyglucose and computer tomography scan (FDG-PET/CT) for prediction of histopathological response of preoperative radiochemotherapy (RCTX) in patients with rectal carcinoma. METHODS Thirty patients with uT3 rectal carcinoma were examined by FDG-PET/CT at baseline, 14 days after initiation, and after completion of preoperative RCTX. The FDG decreases seen with PET scanning from baseline to day 14 (early metabolic response) and after completion of therapy (late metabolic response) were compared with histopathological tumor response. One patient denied surgery after RCTX. RESULTS The mean (+/-SD) reduction of tumor FDG uptake in histopathologically responding compared to non-responding tumors was -44.3% (+/-20.1%) versus -29.6% (+/-13.1%) (p = 0.085) at day 14 and -66.0% (+/-20.3%) versus -48.3% (+/-23.4%) (p = 0.040) after completion of RCTX. Best differentiation of histopathological tumor response was achieved by a cut-off value of 35% reduction of initial FDG uptake at day 14 and 57.5% after completion of therapy. Applying the cut-off values as a criterion for metabolic response, histopathological response was predicted with a sensitivity of 74% (14/19) at day 14 and 79% (15/19) after completion of therapy. The positive predictive value for early metabolic response was 82% (14/17) and for late metabolic response was 83% (15/18). Histopathological evidence of accumulated peritumoral inflammation cells was associated with a minor FDG decrease in five histopathologically responding patients, and influenced the results with negative predictive values of 58% (7/12) and 64% (7/11) at the early and late time points, respectively. CONCLUSIONS Metabolic response to a preoperative RCTX using FDG-PET/CT in rectal cancer patients can be correlated with histopathological response, but FDG uptake of peritumoral inflammation cells limited the results and led to false negative results.
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Affiliation(s)
- Robert Rosenberg
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
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Ferris N, Welman CJ. . . . But the tool continues to improve. ANZ J Surg 2008; 78:121-2. [PMID: 18269471 DOI: 10.1111/j.1445-2197.2007.04421.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nick Ferris
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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