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Yuan Y, Tong D, Liu M, Lu H, Shen F, Shi X. An MRI-based pelvimetry nomogram for predicting surgical difficulty of transabdominal resection in patients with middle and low rectal cancer. Front Oncol 2022; 12:882300. [PMID: 35957878 PMCID: PMC9357897 DOI: 10.3389/fonc.2022.882300] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The current work aimed to develop a nomogram comprised of MRI-based pelvimetry and clinical factors for predicting the difficulty of rectal surgery for middle and low rectal cancer (RC). Methods Consecutive mid to low RC cases who underwent transabdominal resection between June 2020 and August 2021 were retrospectively enrolled. Univariable and multivariable logistic regression analyses were carried out for identifying factors (clinical factors and MRI-based pelvimetry parameters) independently associated with the difficulty level of rectal surgery. A nomogram model was established with the selected parameters for predicting the probability of high surgical difficulty. The predictive ability of the nomogram model was assessed by the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results A total of 122 cases were included. BMI (OR = 1.269, p = 0.006), pelvic inlet (OR = 1.057, p = 0.024) and intertuberous distance (OR = 0.938, p = 0.001) independently predicted surgical difficulty level in multivariate logistic regression analysis. The nomogram model combining these predictors had an area under the ROC curve (AUC) of 0.801 (95% CI: 0.719–0.868) for the prediction of a high level of surgical difficulty. The DCA suggested that using the nomogram to predict surgical difficulty provided a clinical benefit. Conclusions The nomogram model is feasible for predicting the difficulty level of rectal surgery, utilizing MRI-based pelvimetry parameters and clinical factors in mid to low RC cases.
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Affiliation(s)
- Yuan Yuan
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Dafeng Tong
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Minglu Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Haidi Lu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, Shanghai, China
- *Correspondence: Xiaohui Shi, ; Fu Shen,
| | - Xiaohui Shi
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
- *Correspondence: Xiaohui Shi, ; Fu Shen,
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Yuan Y, Lu H, Ma X, Chen F, Zhang S, Xia Y, Wang M, Shao C, Lu J, Shen F. Is rectal filling optimal for MRI-based radiomics in preoperative T staging of rectal cancer? Abdom Radiol (NY) 2022; 47:1741-1749. [PMID: 35267070 DOI: 10.1007/s00261-022-03477-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether rectal filling with ultrasound gel is clinically more beneficial in preoperative T staging of patients with rectal cancer (RC) using radiomics model based on magnetic resonance imaging (MRI). METHODS A total of 94 RC patients were assigned to cohort 1 (leave-one-out cross-validation [LOO-CV] set) and 230 RC patients were assigned to cohort 2 (test set). Patients were grouped according to different pathological T stages. The radiomics features were extracted through high-resolution T2-weighted imaging for all volume of interests in the two cohorts. Optimal features were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. Model 1 (without rectal filling) and model 2 (with rectal filling) were constructed. LOO-CV was adopted for radiomics model building in cohort 1. Thereafter, the cohort 2 was used to test and verify the effectiveness of the two models. RESULTS Totally, 204 patients were enrolled, including 60 cases in cohort 1 and 144 cases in cohort 2. Finally, seven optimal features with LASSO were selected to build model 1 and nine optimal features were used for model 2. The ROC curves showed an AUC of 0.806 and 0.946 for model 1 and model 2 in cohort 1, respectively, and an AUC of 0.783 and 0.920 for model 1 and model 2 in cohort 2, respectively (p = 0.021). CONCLUSION The radiomics model with rectal filling showed an advantage for differentiating T1 + 2 from T3 and had less inaccurate categories in the test cohort, suggesting that this model may be useful for T-stage evaluation.
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Affiliation(s)
- Yuan Yuan
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China
| | - Haidi Lu
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China
| | - Xiaolu Ma
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China
| | - Fangying Chen
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China
| | - Shaoting Zhang
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China
| | - Yuwei Xia
- Huiying Medical Technology Co., Ltd, B2, Dongsheng Science and Technology Park, HaiDian District, Beijing, China
| | - Minjie Wang
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, No.168 Changhai Road, Shanghai, 200433, China.
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Zhuang Z, Zhang Y, Wei M, Yang X, Wang Z. Magnetic Resonance Imaging Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:709070. [PMID: 34327144 PMCID: PMC8315047 DOI: 10.3389/fonc.2021.709070] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
Background Magnetic resonance imaging (MRI)-based lymph node staging remains a significant challenge in the treatment of rectal cancer. Pretreatment evaluation of lymph node metastasis guides the formulation of treatment plans. This systematic review aimed to evaluate the diagnostic performance of MRI in lymph node staging using various morphological criteria. Methods A systematic search of the EMBASE, Medline, and Cochrane databases was performed. Original articles published between 2000 and January 2021 that used MRI for lymph node staging in rectal cancer were eligible. The included studies were assessed using the QUADAS-2 tool. A bivariate random-effects model was used to conduct a meta-analysis of diagnostic test accuracy. Results Thirty-seven studies were eligible for this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of preoperative MRI for the lymph node stage were 0.73 (95% confidence interval [CI], 0.68–0.77), 0.74 (95% CI, 0.68–0.80), and 7.85 (95% CI, 5.78–10.66), respectively. Criteria for positive mesorectal lymph node metastasis included (A) a short-axis diameter of 5 mm, (B) morphological standard, including an irregular border and mixed-signal intensity within the lymph node, (C) a short-axis diameter of 5 mm with the morphological standard, (D) a short-axis diameter of 8 mm with the morphological standard, and (E) a short-axis diameter of 10 mm with the morphological standard. The pooled sensitivity/specificity for these criteria were 75%/64%, 81%/67%, 74%/79%, 72%/66%, and 62%/91%, respectively. There was no significant difference among the criteria in sensitivity/specificity. The area under the receiver operating characteristic (ROC) curve values of the fitted summary ROC indicated a diagnostic accuracy rate of 0.75–0.81. Conclusion MRI scans have minimal accuracy as a reference index for pretreatment staging of various lymph node staging criteria in rectal cancer. Multiple types of evidence should be used in clinical decision-making.
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Affiliation(s)
- Zixuan Zhuang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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The Effect of Rectal Distention on the Intravoxel Incoherent Motion Parameters: Using Sonography Transmission Gel. J Comput Assist Tomogr 2020; 44:759-765. [DOI: 10.1097/rct.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stijns RC, Scheenen TW, de Wilt JH, Fütterer JJ, Beets-Tan RG. The influence of endorectal filling on rectal cancer staging with MRI. Br J Radiol 2018; 91:20180205. [PMID: 29888969 DOI: 10.1259/bjr.20180205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess the influence of endorectal filling (EF) on rectal cancer staging. METHODS 47 patients who underwent a staging MRI of rectal cancer in the period from 2011 to 2014 were included. The MRI protocol included T2 weighted fast spin echo sequences without and with EF at 3 T (EF-MRI). Images were scored by two readers for T-stage, distance of the lower pole of the tumour to the anorectal junction, distance to the mesorectal fascia (MRF), and number of (suspicious) lymph nodes. Agreement in T-staging was calculated using the Cohen's κ value. Comparison of continuous variables was performed using Wilcoxon matched pairs signed-rank test. RESULTS The interobserver agreement for T-staging with and without EF-MRI showed a poor agreement between both readers (weighted κ = 0.156, weighted κ = 0.037, respectively). Tumours tended to be overstaged more prominently with EF-MRI. The accuracy of predicting the pathological T-stage slightly improved from 55% with EF to 64% without EF for Reader 1 and from 59 to 68% for Reader 2, respectively. The distance of the tumour to the anorectal junction increased from 33.9 to 49.3 mm (p < 0.001) after EF for Reader 2. EF-MRI did not significantly influence the number of (suspicious) lymph nodes and distance to the mesorectal fascia. CONCLUSION EF-MRI did not lead to an improved tumour staging and it has the potential to influence the distance to a key anatomical landmark. EF-MRI is therefore not recommended in primary staging rectal cancer. Advances in knowledge: EF-MRI may not be used as an additional tool to stage rectal cancer patients, as it does not seem to facilitate in locoregionally staging the disease.
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Affiliation(s)
- Rutger Ch Stijns
- 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tom Wj Scheenen
- 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Johannes Hw de Wilt
- 2 Department of Surgery, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Jurgen J Fütterer
- 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Regina Gh Beets-Tan
- 3 Department of Radiology, The Netherlands Cancer Institute , Amsterdam , The Netherlands.,4 GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands
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Ibrahim RM, Said K. Benefits & pitfalls of administration of rectal gel enema in MRI assessment of rectal cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kang KA, Jang KM, Kim SH, Kang TW, Cha DI. Risk factor assessment to predict the likelihood of a diagnosis of metastasis for indeterminate hepatic lesions found at computed tomography in patients with rectal cancer. Clin Radiol 2017; 72:473-481. [PMID: 28258741 DOI: 10.1016/j.crad.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 12/17/2022]
Abstract
AIM To assess the significant factors on rectal magnetic resonance imaging (MRI) to predict the likelihood of a diagnosis of metastasis for indeterminate hepatic lesions found at computed tomography (CT) in patients with rectal cancer. MATERIALS AND METHODS A total of 207 patients with rectal cancer who underwent preoperative contrast-enhanced abdominopelvic CT, and rectal and liver MRI were included. Univariate analysis and multivariate logistic regression were used to evaluate the determining factors for the significance of indeterminate hepatic lesions on CT in patients with rectal cancer. RESULTS Hepatic metastases were diagnosed in 29 (20.9%) of 139 patients who had indeterminate hepatic lesions on preoperative CT obtained for rectal cancer. On univariate analysis, carcinoembryonic antigen level, N stage, mesorectal fascia (MRF) invasion, diameter of superior haemorrhoidal vein, and mesorectal vascular lesion (MVL) grade on rectal MRI (p<0.05) were associated with the possibility of metastasis for indeterminate hepatic lesions on CT. On multivariate analysis, MVL grade and MRF invasion on rectal MRI were independent factors associated with the possibility of metastasis for indeterminate hepatic lesions on CT (p<0.0005 and p=0.0066, respectively). CONCLUSION MVL grade and MRF invasion on rectal MRI are independent factors for estimating hepatic metastasis among indeterminate hepatic lesions on CT in patients with rectal cancer.
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Affiliation(s)
- K A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K M Jang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea.
| | - S H Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - T W Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - D I Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
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Palmucci S, Piccoli M, Piana S, Foti P, Siverino R, Mauro L, Milone P, Ettorre G. Diffusion MRI for rectal cancer staging: ADC measurements before and after ultrasonographic gel lumen distension. Eur J Radiol 2017; 86:119-126. [DOI: 10.1016/j.ejrad.2016.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 01/22/2023]
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Moreno CC, Sullivan PS, Mittal PK. MRI Evaluation of Rectal Cancer: Staging and Restaging. Curr Probl Diagn Radiol 2016; 46:234-241. [PMID: 28089690 DOI: 10.1067/j.cpradiol.2016.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) plays an important role in the staging and restaging of rectal cancer. Multiplanar high-resolution (≤3-mm section thickness) T2-weighted images are the primary sequences used for rectal cancer staging. No preprocedural bowel cleansing regimen, intravenous contrast material, nor endorectal coil is necessary. MRI is highly accurate for differentiating T1-T2 disease from T3 and T4 disease, an important distinction as patients with T3 and T4 tumors typically undergo preoperative neoadjuvant chemoradiation before resection. At MRI, the muscularis propria appears as a thin black line encircling the outer wall of the rectum, and tumor extension through this line indicates T3 disease. Further tumor extension into adjacent organs indicates T4 disease. Endorectal ultrasound is generally preferred to differentiate T1 (submucosal involvement) from T2 (extension into but no disruption of muscularis propria) disease. MRI is also accurate in the assessment of tumor involvement of the mesorectal fascia. Tumor involvement of the mesorectal fascia increases the likelihood of recurrence following resection. MRI is less accurate for determination of lymph node status, though heterogeneous signal intensity and irregular margins are suggestive of node positive disease. Approximately 10%-30% of patients who undergo preoperative chemoradiation experience a complete pathologic response that is defined as no residual tumor found at histopathologic analysis of the resected specimen. The addition of diffusion-weighted images to T2-weighted images improves the accuracy of restaging examinations for determination of complete pathologic responders.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
| | - Patrick S Sullivan
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Pardeep K Mittal
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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Diagnostic Accuracy of MRI for Assessment of T Category and Circumferential Resection Margin Involvement in Patients With Rectal Cancer: A Meta-Analysis. Dis Colon Rectum 2016; 59:789-99. [PMID: 27384098 DOI: 10.1097/dcr.0000000000000611] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prognosis of rectal cancer is directly related to the stage of the tumor at diagnosis. Accurate preoperative staging is essential for selecting patients to receive optimal treatment. OBJECTIVE The purpose of this study was to evaluate the diagnostic performance of MRI in tumor staging and circumferential resection margin involvement in rectal cancer. DATA SOURCES A systematic literature search was performed in MEDLINE, EMBASE, PubMed, Cochrane Database of Systematic Reviews, and Web of Science database. STUDY SELECTION Original articles from 2000 to 2016 on the diagnostic performance of MRI in the staging of rectal cancer and/or assessment of mesorectal fascia status were eligible. MAIN OUTCOME MEASURES Pooled diagnostic statistics including sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated for invasion of muscularis propria, perirectal tissue, and adjacent organs and for circumferential resection margin involvement through bivariate random-effects modeling. Summary receiver operating characteristic curves were fitted, and areas under summary receiver operating characteristic curves were counted to evaluate the diagnostic performance of MRI for each outcome. RESULTS Thirty-five studies were eligible for this meta-analysis. Preoperative MRI revealed the highest sensitivity of 0.97 (95% CI, 0.96-0.98) and specificity of 0.97 (95% CI, 0.96-0.98) for muscularis propria invasion and adjacent organ invasion. Areas under summary receiver operating characteristic curves indicated good diagnostic accuracy for each outcome, with the highest of 0.9515 for the assessment of adjacent organ invasion. Significant heterogeneity existed among studies. There was no notable publication bias for each outcome. LIMITATIONS This meta-analysis revealed relatively high diagnostic accuracy for preoperative MRI, although significant heterogeneity existed. Therefore, exploration should be focused on standardized interpretation criteria and optimal MRI protocols for future studies. CONCLUSIONS MRI showed relatively high diagnostic accuracy for preoperative T staging and circumferential resection margin assessment and should be reliable for clinical decision making.
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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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JOURNAL CLUB: Preoperative MRI Evaluation of Primary Rectal Cancer: Intrasubject Comparison With and Without Rectal Distention. AJR Am J Roentgenol 2016; 207:32-9. [PMID: 27144835 DOI: 10.2214/ajr.15.15383] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether rectal distention influences the accuracy of MRI for tumor staging and for measuring of maximal extramural depth of tumor spread and distance between tumor and mesorectal fascia (MRF). SUBJECTS AND METHODS Fifty patients with rectal carcinoma underwent MRI before and after rectal distention. Both sets of MR images were reviewed by two radiologists. The scores for depiction of the mass (1-4 scale), T and N category, distance from normal rectal wall to MRF, maximal extramural depth of tumor spread, and distance between tumor and MRF were evaluated. RESULTS The visualization scores on MR images obtained with the rectum distended were significantly higher than those on images obtained without distention (90% vs 58% for score 4, p < 0.001). The accuracy of T category assessed on distended images was slightly higher than the accuracy on nondistended images (88.6% vs 84.1% for observer 1, 84.1% vs 81.8% for observer 2), but the accuracy of N category was stable. The distance between normal rectal wall and MRF was significantly less on distended images than on nondistended images (p < 0.05). However, there was no significant difference between nondistended and distended images for maximal extramural depth and distance between tumor and MRF (p > 0.05). CONCLUSION Rectal distention significantly improved visualization of tumors on MR images. It also improved T category assessment to some extent. Although the distance between normal rectal wall and MRF was significantly less with rectal distention than without rectal distention, maximal extramural depth and the distance between tumor and MRF did not vary significantly with or without rectal distention.
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Usefulness of hydrogel-CT for detecting and staging of rectosigmoid colon cancer. Eur J Radiol 2016; 85:1020-6. [PMID: 27130066 DOI: 10.1016/j.ejrad.2016.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE To demonstrate the usefulness of hydrogel-CT for detecting and staging of rectosigmoid colon cancer. MATERIALS AND METHODS Fifty-four patients with rectosigmoid colon cancers underwent routine CT without (n=27) and with (n=27) rectum distension using a sonographic gel. Rectum distensibility and tumor visualization were evaluated. T and N stages on CT independently recorded by two radiologists were correlated with pathologic staging. Staging accuracies were compared using Fisher's exact test. Diagnostic performances in differentiating <T3 from ≥T3 and N0 from ≥N1 were evaluated using areas under the receiver operating characteristic curves (AZ). RESULTS Rectum distensibility (3.52) and tumor visualization (3.70) were significantly more scored in the distended group than in the control group (1.44 and 2.04) (P<0.0001). Pathologic and CT staging were more correlated in the distended group in both reviewers. Accuracy for staging was higher in the distended group (T: 50-85.2%/N: 59.3-92.6%) than in the control group (T: 45.5-62.5%/N: 33.3-59.3%) without statistical significance except N staging for reviewer 2 (P=0.0091). AZ values for T and N staging in the distended group (T: 0.827-0.989/N: 0.858-0.980) were also higher than in the control group (T: 0.817-0.907/N: 0.544-0.654). CONCLUSION Hydrogel-CT can provide better diagnostic performance for T and N staging of rectosigmoid colon cancer.
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Kennedy E, Vella ET, Blair Macdonald D, Wong CS, McLeod R. Optimisation of preoperative assessment in patients diagnosed with rectal cancer. Clin Oncol (R Coll Radiol) 2015; 27:225-45. [PMID: 25656631 DOI: 10.1016/j.clon.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/18/2014] [Accepted: 01/06/2015] [Indexed: 12/14/2022]
Abstract
AIMS Treatment decision making for patients with rectal cancer is complex and optimal preoperative assessment is important to ensure patients receive appropriate and high-quality care. Therefore, our objective was to develop an evidence-based, multidisciplinary guideline to assist physicians treating rectal cancer to ensure that preoperative assessment is optimal. MATERIALS AND METHODS A multidisciplinary expert panel of physicians who treat rectal cancer was selected as members of the Cancer Care Ontario Preoperative Assessment for Rectal Cancer Guideline Development Group (GDG). This group initially met to identify important clinical questions with respect to optimisation of preoperative assessment in patients diagnosed with rectal cancer. A systematic review, specific to each of these clinical questions, was then conducted using MEDLINE, EMBASE and the Cochrane Library databases. The GDG met at regular intervals to review the evidence and to develop guidelines to address each of the clinical questions. RESULTS The GDG identified seven important clinical questions with respect to the optimisation of preoperative assessment in patients diagnosed with rectal cancer. The clinical questions pertained to: (i) investigations required to assess distant metastasis (one question); (ii) imaging for local staging of rectal cancer (five questions); (iii) multidisciplinary cancer conference (MCC) (one question); (iv) restaging-magnetic resonance imaging (one question). The systematic reviews related to these clinical questions yielded 31 articles that were abstracted and reviewed by the GDG. Based on the systematic reviews, a guideline was developed containing seven recommendations that were either adapted from existing guidelines, based on review of the evidence or by consensus when evidence was limited. CONCLUSIONS A set of seven recommendations have been developed in order to optimise pretreatment assessment in patients with rectal cancer by promoting evidence-based practice. These guidelines are based on the best available evidence and have been peer reviewed by two independent multidisciplinary expert panels for relevance and validity.
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Affiliation(s)
- E Kennedy
- Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - E T Vella
- Program in Evidence-based Care, Cancer Care Ontario, McMaster University, Juravinski Hospital Site, Hamilton, Ontario, Canada
| | | | - C S Wong
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - R McLeod
- Mount Sinai Hospital, Toronto, Ontario, Canada
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Mallett S, Halligan S, Collins GS, Altman DG. Exploration of analysis methods for diagnostic imaging tests: problems with ROC AUC and confidence scores in CT colonography. PLoS One 2014; 9:e107633. [PMID: 25353643 PMCID: PMC4212964 DOI: 10.1371/journal.pone.0107633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Different methods of evaluating diagnostic performance when comparing diagnostic tests may lead to different results. We compared two such approaches, sensitivity and specificity with area under the Receiver Operating Characteristic Curve (ROC AUC) for the evaluation of CT colonography for the detection of polyps, either with or without computer assisted detection. METHODS In a multireader multicase study of 10 readers and 107 cases we compared sensitivity and specificity, using radiological reporting of the presence or absence of polyps, to ROC AUC calculated from confidence scores concerning the presence of polyps. Both methods were assessed against a reference standard. Here we focus on five readers, selected to illustrate issues in design and analysis. We compared diagnostic measures within readers, showing that differences in results are due to statistical methods. RESULTS Reader performance varied widely depending on whether sensitivity and specificity or ROC AUC was used. There were problems using confidence scores; in assigning scores to all cases; in use of zero scores when no polyps were identified; the bimodal non-normal distribution of scores; fitting ROC curves due to extrapolation beyond the study data; and the undue influence of a few false positive results. Variation due to use of different ROC methods exceeded differences between test results for ROC AUC. CONCLUSIONS The confidence scores recorded in our study violated many assumptions of ROC AUC methods, rendering these methods inappropriate. The problems we identified will apply to other detection studies using confidence scores. We found sensitivity and specificity were a more reliable and clinically appropriate method to compare diagnostic tests.
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Affiliation(s)
- Susan Mallett
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Gary S. Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Doug G. Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
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Saklani AP, Bae SU, Clayton A, Kim NK. Magnetic resonance imaging in rectal cancer: A surgeon’s perspective. World J Gastroenterol 2014; 20:2030-2041. [PMID: 24616572 PMCID: PMC3934473 DOI: 10.3748/wjg.v20.i8.2030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/27/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) in rectal cancer was first investigated in 1999 and has become almost mandatory in planning rectal cancer treatment. MRI has a high accuracy in predicting circumferential resection margin involvement and is used to plan neoadjuvant therapy. The accuracy of MRI in assessing mesorectal lymph nodes remains moderate, as there are no reliable criteria to assess nodal involvement. MRI seems to be good in assessing peritoneal involvement in upper rectal cancer; this however has been assessed in only a few studies and needs further research. For low rectal cancers, mesorectum is thin at the level of levator ani especially in relation to prostate; so predicting circumferential resection margin involvement is not easy. However high spatial resolution coronal imaging shows levator muscles, sphincter complex and intersphincteric plane accurately. This is used to stage low rectal tumors and plan plane of surgery (standard surgery, intersphincteric resection, Extralevator abdominoperineal resection). While most centres perform MRI post chemoradiotherapy, its role in accurate staging post neoadjuvant therapy remains debatable. THe role of Diffusion weighted MRI post neoadjuvant therapy is being evaluated in research settings.
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Jhaveri KS, Sadaf A. Role of MRI for staging of rectal cancer. Expert Rev Anticancer Ther 2014; 9:469-81. [DOI: 10.1586/era.09.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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18
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Iannicelli E, Di Renzo S, Ferri M, Pilozzi E, Di Girolamo M, Sapori A, Ziparo V, David V. Accuracy of high-resolution MRI with lumen distention in rectal cancer staging and circumferential margin involvement prediction. Korean J Radiol 2014; 15:37-44. [PMID: 24497790 PMCID: PMC3909859 DOI: 10.3348/kjr.2014.15.1.37] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 08/23/2013] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the accuracy of magnetic resonance imaging (MRI) with lumen distention for rectal cancer staging and circumferential resection margin (CRM) involvement prediction. Materials and Methods Seventy-three patients with primary rectal cancer underwent high-resolution MRI with a phased-array coil performed using 60-80 mL room air rectal distention, 1-3 weeks before surgery. MRI results were compared to postoperative histopathological findings. The overall MRI T staging accuracy was calculated. CRM involvement prediction and the N staging, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed for each T stage. The agreement between MRI and histological results was assessed using weighted-kappa statistics. Results The overall MRI accuracy for T staging was 93.6% (k = 0.85). The accuracy, sensitivity, specificity, PPV and NPV for each T stage were as follows: 91.8%, 86.2%, 95.5%, 92.6% and 91.3% for the group ≤ T2; 90.4%, 94.6%, 86.1%, 87.5% and 94% for T3; 98,6%, 85.7%, 100%, 100% and 98.5% for T4, respectively. The predictive CRM accuracy was 94.5% (k = 0.86); the sensitivity, specificity, PPV and NPV were 89.5%, 96.3%, 89.5%, and 96.3% respectively. The N staging accuracy was 68.49% (k = 0.4). Conclusion MRI performed with rectal lumen distention has proved to be an effective technique both for rectal cancer staging and involved CRM predicting.
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Affiliation(s)
- Elsa Iannicelli
- Radiology Institute, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy. ; Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy
| | - Sara Di Renzo
- Radiology Institute, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy. ; Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy
| | - Mario Ferri
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy
| | - Emanuela Pilozzi
- Department of Clinical and Molecular Sciences, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy
| | - Marco Di Girolamo
- Radiology Institute, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy. ; Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy
| | - Alessandra Sapori
- Radiology Institute, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy. ; Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy
| | - Vincenzo Ziparo
- Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy
| | - Vincenzo David
- Radiology Institute, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy. ; Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University of Rome, Sapienza, Sant'Andrea Hospital, Rome 00189, Italy
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Al-Sukhni E, Milot L, Fruitman M, Beyene J, Victor JC, Schmocker S, Brown G, McLeod R, Kennedy E. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 2012; 19:2212-23. [PMID: 22271205 DOI: 10.1245/s10434-011-2210-5] [Citation(s) in RCA: 360] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is increasingly being used for rectal cancer staging. The purpose of this study was to determine the accuracy of phased array MRI for T category (T1-2 vs. T3-4), lymph node metastases, and circumferential resection margin (CRM) involvement in primary rectal cancer. METHODS Medline, Embase, and Cochrane databases were searched using combinations of keywords relating to rectal cancer and MRI. Reference lists of included articles were also searched by hand. Inclusion criteria were: (1) original article published January 2000-March 2011, (2) use of phased array coil MRI, (3) histopathology used as reference standard, and (4) raw data available to create 2×2 contingency tables. Patients who underwent preoperative long-course radiotherapy or chemoradiotherapy were excluded. Two reviewers independently extracted data. Sensitivity, specificity, and diagnostic odds ratio were estimated for each outcome using hierarchical summary receiver-operating characteristics and bivariate random effects modeling. RESULTS Twenty-one studies were included in the analysis. There was notable heterogeneity among studies. MRI specificity was significantly higher for CRM involvement [94%, 95% confidence interval (CI) 88-97] than for T category (75%, 95% CI 68-80) and lymph nodes (71%, 95% CI 59-81). There was no significant difference in sensitivity between the three elements as a result of wide overlapping CIs. Diagnostic odds ratio was significantly higher for CRM (56.1, 95% CI 15.3-205.8) than for lymph nodes (8.3, 95% CI 4.6-14.7) but did not differ significantly from T category (20.4, 95% CI 11.1-37.3). CONCLUSIONS MRI has good accuracy for both CRM and T category and should be considered for preoperative rectal cancer staging. In contrast, lymph node assessment is poor on MRI.
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Affiliation(s)
- Eisar Al-Sukhni
- Department of Surgery, Mount Sinai Hospital, and University of Toronto, Toronto, ON, Canada
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Fasih N, Virmani V, Walsh C, McInnes M, MacDonald B, Kielar A, Prasad Shanbhogue AK. Double-contrast Magnetic Resonance Imaging in Preoperative Evaluation of Rectal Cancer: Use of Aqueous Jelly as Luminal Contrast. Can Assoc Radiol J 2011; 62:122-4. [DOI: 10.1016/j.carj.2010.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 03/01/2010] [Accepted: 03/01/2010] [Indexed: 11/29/2022] Open
Affiliation(s)
- Najla Fasih
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Vivek Virmani
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Cynthia Walsh
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Mattew McInnes
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Blair MacDonald
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Ania Kielar
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
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Spolverato G, Pucciarelli S, Bertorelle R, De Rossi A, Nitti D. Predictive factors of the response of rectal cancer to neoadjuvant radiochemotherapy. Cancers (Basel) 2011; 3:2176-94. [PMID: 24212803 PMCID: PMC3757411 DOI: 10.3390/cancers3022176] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 04/08/2011] [Accepted: 04/11/2011] [Indexed: 02/07/2023] Open
Abstract
Locally advanced rectal cancer is currently treated with pre-operative radiochemotherapy (pRCT), but the response is not uniform. Identification of patients with higher likelihood of responding to pRCT is clinically relevant, as patients with resistant tumors could be spared exposure to radiation or DNA-damaging drugs that are associated with adverse side effects. To highlight predictive biomarkers of response to pRCT, a systematic search of PubMed was conducted with a combination of the following terms: "rectal", "predictive", "radiochemotherapy", "neoadjuvant", "response" and "biomarkers". Genetic polymorphisms in epithelial growth factor receptor (EGFR) and thymidylate synthase (TS) genes, the expression of several markers, such as EGFR, bcl-2/bax and cyclooxygenase (COX)-2, and circulating biomarkers, such as serum carcinoembryonic antigen (CEA) level, are promising as predictor markers, but need to be further evaluated. The majority of the studies did not support the predictive value of p53, while the values of Ki-67, TS and p21 is still controversial. Gene expression profiles of thousands of genes using microarrays, microRNA studies and the search for new circulating molecules, such as human telomerase reverse transcriptase mRNA and cell-free DNA, are providing interesting results that might lead to the identification of new useful biomarkers. Evaluation of biomarkers in larger, prospective trials are required to guide therapeutic strategies.
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Affiliation(s)
- Gaya Spolverato
- Department of Oncology and Surgical Sciences, Section of Surgery, University of Padova, Padova 35128, Italy; E-Mails: (G.S.); (S.P.); (D.N.)
| | - Salvatore Pucciarelli
- Department of Oncology and Surgical Sciences, Section of Surgery, University of Padova, Padova 35128, Italy; E-Mails: (G.S.); (S.P.); (D.N.)
| | | | - Anita De Rossi
- Istituto Oncologico Veneto-IRCCS, Padova 35128, Italy; E-Mail: (R.B.)
- Department of Oncology and Surgical Sciences, Section of Oncology, University of Padova, Padova 35128, Italy
| | - Donato Nitti
- Department of Oncology and Surgical Sciences, Section of Surgery, University of Padova, Padova 35128, Italy; E-Mails: (G.S.); (S.P.); (D.N.)
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Observer variation of magnetic resonance imaging and diffusion weighted imaging in pelvic lymph node detection. Eur J Radiol 2011; 78:71-4. [DOI: 10.1016/j.ejrad.2009.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 04/14/2009] [Indexed: 11/21/2022]
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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: 51] [Impact Index Per Article: 3.6] [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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24
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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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25
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Piippo U, Pääkkö E, Mäkinen M, Mäkelä J. Local staging of rectal cancer using the black lumen magnetic resonance imaging technique. Scand J Surg 2009; 97:237-42. [PMID: 18812273 DOI: 10.1177/145749690809700306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The treatment of rectal cancer is comprised of surgery and possible adjuvant therapy depending on the stage of the tumour. This prospective study evaluates the accuracy of magnetic resonance imaging (MRI) in the preoperative staging of rectal cancer using an endorectal and intravenous contrast. MATERIALS AND METHODS 37 consecutive patients with rectal cancer were imaged using a mixture of ferumoxsil and methylcellulose endorectally, and a gadolinium contrast intravenously. 33 tumours were resected and 4 tumours were considered unresectable during operation. The images were reviewed for local staging of the tumours. A tumour confined to the rectal wall was classified as a negative finding and a tumour invading through muscularis propria as a positive finding. The results were correlated with the histopathologic t stage (n = 33), or the clinical status (n = 4). RESULTS AND CONCLUSIONS of 37 cases, 20 (51 %) were true positive, and 11 (28%) were true negative. There were 3 false negative and 3 false positive cases. The sensitivity was 87%, specificity 79%, and diagnostic accuracy 84%. for the non-contrast images the figures were 78%, 79% and 78%, respectively. We consider black lumen magnetic resonance imaging to be a useful method for preoperative local staging of rectal cancer.
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Affiliation(s)
- U Piippo
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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Diagnostic accuracy of 3.0-Tesla rectal magnetic resonance imaging in preoperative local staging of primary rectal cancer. Invest Radiol 2008; 43:587-93. [PMID: 18648259 DOI: 10.1097/rli.0b013e31817e9083] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of 3.0-T rectal magnetic resonance imaging (MRI) in the preoperative local staging of primary rectal cancer. MATERIALS AND METHODS Forty-two patients with surgically and pathologically proven primary rectal cancer who underwent preoperative gadobenate dimeglumine-enhanced 3.0-T rectal MRI, were enrolled in this retrospective study. Two radiologists, who were blinded to the pathology results, independently reviewed the MR images and recorded their confidence level for determination of perirectal extension, and regional lymph node (LN) involvement using a 5-point scale. The diagnostic accuracy of each reviewer for local staging was calculated by receiver operating characteristic (ROC) curve analysis. Interobserver agreement was also calculated using linear weighted kappa statistics. RESULTS The diagnostic accuracy (area under the ROC curve, Az) for determining perirectal extension was for reviewer 1, 0.860 (95% confidence interval, 0.72-0.95) and for reviewer 2, 0.853 (0.71-0.94), respectively. The Az for determination of regional LN involvement was for reviewer 1, 0.902 (0.77-0.97) and for reviewer 2, 0.843 (0.70-0.94), respectively. Interobserver agreement included, respectively, good, and moderate agreement for perirectal extension, and regional LN involvement (kappa = 0.662, and 0.522, respectively). CONCLUSIONS 3.0-T rectal MRI can provide accurate information of perirectal extension and regional LN involvement in the preoperative local staging of primary rectal cancer.
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Sonography transmission gel as endorectal contrast agent for tumor visualization in rectal cancer. AJR Am J Roentgenol 2008; 191:186-9. [PMID: 18562744 DOI: 10.2214/ajr.07.3067] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of our study is to show the usefulness and safety of sonography transmission gel as an endorectal contrast agent in preoperative rectal MRI for tumor visualization in rectal cancer. CONCLUSION Sonography transmission gel is an effective and safe endorectal contrast agent for rectal MRI.
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28
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3-T MRI of rectal carcinoma: preoperative diagnosis, staging, and planning of sphincter-sparing surgery. AJR Am J Roentgenol 2008; 190:1271-8. [PMID: 18430843 DOI: 10.2214/ajr.07.2505] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the accuracy of 3-T MRI in the preoperative diagnosis, staging, and planning of surgical management of rectal carcinoma. SUBJECTS AND METHODS Thirty-eight patients (23 men, 15 women) with clinically suspected rectal carcinoma underwent 3-T MRI. Coronal, axial, and sagittal T2-weighted sequences with and without fat suppression; axial T1-weighted spin-echo sequences; axial T1-weighted gradient-echo sequences with and without fat suppression; oblique 2D MR hydrography; and 3D fat-suppressed dynamic contrast-enhanced MRI were performed. Image quality with these sequences was evaluated by three radiologists experienced in body MRI. The significance of difference in results with the sequences was tested. The manner in which MRI staging and feasibility of sphincter-sparing surgery agreed with operative and pathologic findings was evaluated with kappa statistics. RESULTS Rectal carcinoma was identified on MRI and confirmed histologically in all 38 patients. MRI findings were correctly predictive of T category in 35 cases (accuracy, 92.1%). In 31 (96.9%) of 32 resectable cases,sphincter-sparing surgical approaches were accurately chosen on the basis of MRI findings. Among the 11 sequences, 3D fat-suppressed dynamic contrast-enhanced MRI best delineated tumor margins. Coronal and axial T2-weighted images also well depicted tumor margins with minimal artifact. T2-weighted images were superior to unenhanced T1-weighted images. CONCLUSION MRI of rectal cancer at 3 T is accurate for prediction of T category and the feasibility of sphincter-sparing surgery. The best images were obtained with coronal, sagittal, and axial T2-weighted sequences and 3D fat-suppressed dynamic contrast-enhanced MRI.
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Rao SX, Zeng MS, Xu JM, Qin XY, Chen CZ, Li RC, Hou YY. Assessment of T staging and mesorectal fascia status using high-resolution MRI in rectal cancer with rectal distention. World J Gastroenterol 2007; 13:4141-6. [PMID: 17696238 PMCID: PMC4205321 DOI: 10.3748/wjg.v13.i30.4141] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the accuracy of high-resolution magnetic resonance imaging (MRI) using phased-array coil for preoperative assessment of T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.
METHODS: In a prospective study of 67 patients with primary rectal cancer, high-resolution magnetic resonance imaging (in-plane resolution, 0.66 × 0.56) with phased-array coil were performed for T-staging and measurement of distance between the tumor and the mesorectal fascia. The assessment of MRI was compared with postoperative histopathologic findings. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were evaluated.
RESULTS: The overall magnetic resonance accuracy was 85.1% for T staging and 88% for predicting mesorectal fascia involvement. Magnetic resonance sensitivity, specificity, accuracy, positive predictive value, and negative predictive value was 70%, 97.9%, 89.6%, 93.3% and 88.5% for ≤ T2 tumors, 90.5%, 76%, 85.1%, 86.4% and 82.6% for T3 tumors, 100%, 95.2%, 95.5%, 62.5% and 100% for T4 tumors, and 80%, 90.4%, 88%, 70.6% and 94% for predicting mesorectal fascia involvement, respectively.
CONCLUSION: High-resolution MRI enables accurate preoperative assessment for T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.
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Affiliation(s)
- Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Shanghai Medical Imaging Institute, 180 Fenglin Rd, Shanghai 200032, China
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Hoeffel C, Marra MD, Azizi L, Tran Van K, Crema MD, Lewin M, Arrivé L, Tubiana JM. [External phased-array MR imaging preoperative assessment of rectal cancer]. ACTA ACUST UNITED AC 2007; 87:1821-30. [PMID: 17213766 DOI: 10.1016/s0221-0363(06)74162-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The main problem associated with rectal cancer treatment is tumor recurrence. Randomized controlled studies have shown that adjuvant preoperative radiation therapy is effective for reducing local recurrence. These studies have also demonstrated that there are groups of rectal cancer patients with differing degrees of risk for local recurrence. At one end of the spectrum is the low-risk group: patients with superficial rectal cancer, who can be treated with surgery alone. At the other end is the high-risk group: patients with a close or involved resection margin at total mesorectal excision, the very advanced tumors that require a longer course of chemotherapy and radiation therapy, and extensive surgery. Paramount for this selection and differentiated treatment is a reliable preoperative test that can be used to distinguish these groups of patients. In this review article, we will discuss the role of high-resolution phased array MRI among the other imaging modalities such as endorectal MRI, endorectal US, and CT. We will also discuss and illustrate MR imaging results in terms of T stage, circumferential resection margin, locally advanced rectal cancer, and N stage.
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Affiliation(s)
- C Hoeffel
- Université Paris-Descartes, Faculté de médecine Cochin-Port-Royal, 24 rue du Faubourg St-Jacques, 75014 Paris.
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Maretto I, Pomerri F, Pucciarelli S, Mescoli C, Belluco E, Burzi S, Rugge M, Muzzio PC, Nitti D. The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 2006; 14:455-61. [PMID: 17139456 DOI: 10.1245/s10434-006-9269-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/17/2006] [Accepted: 10/18/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND We performed this study to prospectively evaluate the postchemoradiotherapy performance of transrectal ultrasonography (TRUS), pelvic computed tomography (CT) scan and magnetic resonance imaging (MRI), and endoscopic biopsies for predicting the pathologic complete response of rectal cancer patients. METHODS Four weeks after completion of preoperative chemoradiotherapy, 46 consecutive patients with mid to low rectal cancer were prospectively evaluated by proctoscopy, TRUS, and pelvic CT scan and MRI. On the basis of T and N status, patients were classified as T0 or T1-4 and N-negative or N-positive. For each staging modality used, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Findings were compared with the pathologic tumor-node-metastasis stage. RESULTS On histopathologic analysis, 12 patients had pT0 and 34 had pT1-4 lesions; out of 45 assessable patients, 9 were N-positive. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting T status (T0 vs. T >or=1) were 77%, 33%, 74%, 36%, and 64%, respectively, for TRUS; 100%, 0%, 74%, not assessable, and 74% for CT; and 100%, 0%, 77%, not assessable, and 77% for MRI. The corresponding figures in predicting N status (N-negative vs. N-positive) were, respectively, 37%, 67%, 21%, 81%, and 61% for TRUS; 78%, 58%, 32%, 91%, and 62% for CT; and 33%, 74%, 25%, 81%, and 65% for MRI. CONCLUSIONS Current rectal cancer staging modalities after chemoradiotherapy allow good prediction of node-negative cases, although none of them is able to predict the pathologic complete response on the rectal wall.
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Affiliation(s)
- Isacco Maretto
- Department of Oncological and Surgical Sciences, Clinica Chirurgica II, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
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Chun HK, Choi D, Kim MJ, Lee J, Yun SH, Kim SH, Lee SJ, Kim CK. Preoperative Staging of Rectal Cancer: Comparison of 3-T High-Field MRI and Endorectal Sonography. AJR Am J Roentgenol 2006; 187:1557-62. [PMID: 17114550 DOI: 10.2214/ajr.05.1234] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to compare phased-array 3-T MRI and endorectal sonography in the preoperative staging of rectal cancer. MATERIALS AND METHODS During an 8-month period, 24 patients with rectal cancer underwent both 3-T MRI performed with phased-array coils and 7.5- to 10-MHz endorectal sonography in the 3 weeks before surgical resection. Three radiologists independently reviewed the MR and endorectal sonographic images. The histopathologic findings in resected specimens were used to evaluate the sensitivities and specificities of these techniques for invasion of the muscularis propria and perirectal tissue and for lymph node involvement. Receiver operating characteristic (ROC) analysis was used to compare the diagnostic accuracies of the techniques. RESULTS For muscularis propria invasion, the mean sensitivities of both MRI and endorectal sonography were 100%, and the mean specificities were 66.7% and 61.1%, respectively. The differences in the mean sensitivities and specificities were not statistically significant (p > 0.05 in each case). For perirectal tissue invasion, MRI and endorectal sonography had comparable sensitivities and specificities (91.1% vs 100%, 92.6% vs 81.5%; p > 0.05 in each case). They also had similar sensitivities and specificities for lymph node involvement (63.6% vs 57.6%, 92.3% vs 82.1%; p > 0.05 in each case). ROC curves for muscularis propria invasion and lymph node involvement showed no differences in diagnostic accuracy. The mean area under the ROC curve for endorectal sonography (A(Z) = 0.996) for perirectal tissue invasion, however, showed higher accuracy than that of MRI (A(Z) = 0.938, p = 0.028). CONCLUSION The sensitivity, specificity, and accuracy of 3-T MRI were similar to those of endorectal sonography for muscularis propria invasion and lymph node involvement, but for perirectal tissue invasion, 3-T MRI was less accurate than endorectal sonography.
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Affiliation(s)
- Ho-Kyung Chun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Berbaum KS. God, like the Devil, is in the details. Acad Radiol 2006; 13:1311-6. [PMID: 17070448 DOI: 10.1016/j.acra.2006.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 09/22/2006] [Accepted: 09/22/2006] [Indexed: 10/24/2022]
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Tatli S, Mortele KJ, Breen EL, Bleday R, Silverman SG. Local staging of rectal cancer using combined pelvic phased-array and endorectal coil MRI. J Magn Reson Imaging 2006; 23:534-40. [PMID: 16523466 DOI: 10.1002/jmri.20533] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To assess the accuracy of MRI, using a pelvic phased-array coil and an endorectal coil, for preoperative local staging of rectal cancer. MATERIALS AND METHODS Fifty-one patients (26 males and 25 females) with adenocarcinoma of the rectum underwent preoperative MRI and surgical resection of their tumors. Surgical pathology staging was compared to MRI staging (using the TNM classification) obtained both retrospectively by a reader blinded to surgical findings and prospectively (radiological reports). In addition, patients were stratified according to surgical treatment groups (stage I = T1-2/N0, stage II = T3/N0, stage III = Tx/N1-2). RESULTS At pathology, 36 of 51 (68%) tumors were classified as T0-T2, and 15 (32%) were classified as T3. Overall, the sensitivity and specificity of MRI readings for T3 staging were 93% and 86%, respectively (positive predictive value (PPV) = 74%, negative predictive value (NPV) = 97%, accuracy = 88%). MRI correctly predicted lymph node metastases in 11 of 13 patients with a sensitivity of 85% and specificity of 69% (PPV = 58%, NPV = 90%, accuracy = 74%). MRI correctly predicted surgical treatment groups in 33 of 39 (85%) patients. Interobserver agreement between the retrospective and prospective readings was excellent (kappa = 0.85) for prediction of T3 tumor and good (kappa = 0.80) for prediction of nodal involvement. CONCLUSION Combined endorectal and pelvic phased-array coil MRI can be used reliably to select which patients should receive preoperative chemoradiotherapy. It is highly predictive in terms of excluding T3 tumors, but still has limitations in predicting lymph node metastasis.
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Affiliation(s)
- Servet Tatli
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Slater A, Halligan S, Taylor SA, Marshall M. Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin. Clin Radiol 2006; 61:65-70. [PMID: 16356818 DOI: 10.1016/j.crad.2005.08.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 07/05/2005] [Accepted: 08/03/2005] [Indexed: 02/07/2023]
Abstract
AIM To determine the effect of rectal distension, used by some workers to facilitate staging, on mesorectal tissues. SUBJECTS AND METHODS Ninety-seven consecutive rectal cancer staging MRI examinations were identified of which 76 were analysable: 48 studies were performed using rectal insufflation of 100 ml room air and 28 were performed without distension. Median age was 69 and 72 years, respectively. In each patient a single experienced observer measured the distance from the outer rectal wall to the inner margin of the mesorectal fascia at four locations (12, 3, 6 and 9 o'clock), excluding sites of tumour involvement, from the T1-weighted axial image at the level of the sacro-coccygeal junction. The two groups of measurements were compared using Mann-Whitney test statistic, and frequencies then categorized into <5 mm or > or =5 mm, and compared using Fisher's exact test. RESULTS The median distance between the rectal wall and mesorectal fascia in the distended group was approximately half that found in the non-distended group, and significantly lower at the 3, 6 and 9 o'clock positions (p<0.001). 68/167 (41%) of measurements were 5mm or less, compared with 19/104 (18%) in the non-distended group (p<0.001). CONCLUSION Rectal distension before MRI significantly reduces the distance between the rectal wall and mesorectal fascia. Although this is advocated to facilitate visualization of the primary tumour, it potentially affects the accuracy with which a clear circumferential resection margin can be predicted.
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Affiliation(s)
- A Slater
- Department of Specialist Radiology, University College Hospital
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Affiliation(s)
- Nancy A Obuchowski
- Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, USA
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