|
1
|
Lin YK, Zhu LL, Zhao J, Xiang ZL. Radiotherapy volume delineation based on MRI and 18F-FDG-PET/MRI in locally recurrent rectal cancer. Abdom Radiol (NY) 2025:10.1007/s00261-025-04859-2. [PMID: 40095014 DOI: 10.1007/s00261-025-04859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 02/19/2025] [Accepted: 02/23/2025] [Indexed: 03/19/2025]
Abstract
OBJECTIVE To evaluate the value of 18F-FDG-positron emission tomography (PET)/magnetic resonance imaging (MRI) functional imaging in the radiotherapy of locally recurrent rectal cancer by comparing the target volume delineation based on PET/MRI and MRI. MATERIALS AND METHODS Twenty-six patients who were diagnosed with locally recurrent rectal cancer were included in this study. Patients underwent PET/MRI, and the target volume was delineated independently by three radiation oncologists. The degree of overlap, spatial consistency, and difference in the target volume delineated based on the two methods were compared. The efficacy of PET/MRI and MRI in detecting metastatic lymph nodes was analyzed. RESULTS In radiotherapy for patients with recurrent rectal cancer, the gross tumor volume (GTV), clinical target area (CTV), and nodal gross tumor volume (GTVn) delineated based on MRI and PET/MRI were correlated (P < 0.001, P < 0.001, and P < 0.001, respectively). Differences in CTV were statistically significant (P < 0.001), and the CTV greatly overlapped spatially. There is spatial heterogeneity in GTV and GTVn based on the two imaging modalities. Metastatic lymph node analysis revealed that the detection efficiency of the two modalities was the same at the population level. There was no significant difference in the number of metastatic lymph nodes detected (P = 0.521). CONCLUSION PET/MRI can improve the accuracy of target volume delineation and has similar advantages to MRI in assessing the number of metastatic lymph nodes in patients with recurrent rectal cancer.
Collapse
Affiliation(s)
- Yu-Kun Lin
- Department of Radiation Oncology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong New District, Shanghai, China
| | - Lei-Lei Zhu
- Department of Radiation Oncology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong New District, Shanghai, China
| | - Jun Zhao
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong New District, Shanghai, China.
| | - Zuo-Lin Xiang
- Department of Radiation Oncology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong New District, Shanghai, China.
| |
Collapse
|
|
2
|
Zhang YZ, Song M, Li S, Tie J, Zhu XG, Li YH, Wu AW, Cai Y, Wang WH. Comparison of prognosis for T4b rectal cancer with different pelvic compartment involvement treated using neoadjuvant chemoradiotherapy and implications for refinement of the current T staging system: A retrospective cohort study. Transl Oncol 2025; 53:102313. [PMID: 39908966 PMCID: PMC11847518 DOI: 10.1016/j.tranon.2025.102313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 11/25/2024] [Accepted: 01/30/2025] [Indexed: 02/07/2025] Open
Abstract
PURPOSE Although classified as one stage, T4b rectal cancer actually represents a group of heterogeneous diseases. Our study aimed to assess the prognosis difference of T4b rectal cancer involving inferior pelvic and other pelvic compartments. This information may be helpful in refinement of the current T staging system. METHODS We retrospectively analysed data from 195 patients with magnetic resonance imaging-identified locally advanced T4b rectal cancer who received neoadjuvant chemoradiotherapy between January 2010 and December 2019. 104 patients had only inferior pelvic compartment involvement (group A) while 91 patients had anterior, posterior or lateral pelvic compartment involvement (group B). Short-term and long-term outcomes were compared between the two groups. RESULTS After neoadjuvant therapy, 80.8 % patients (84/104) in group A and 92.3 % patients (84/91) in group B underwent surgery. The R0 resection rates were 97.6 % and 89.3 %, respectively. 8.7 % patients (9/104) in group A achieved clinical complete response and adopted watch-and-wait strategy. Patients in group A had significantly superior 5-year progression-free survival (PFS) (67.8 % vs. 55.5 %, P = 0.032) and overall survival (OS) (89.6 % vs. 71.8 %, P = 0.001) than group B. Multivariable Cox regression analysis also identified pelvic compartment involvement classification as an independent predictor of PFS (hazard ratio 1.776, P = 0.046) and OS (hazard ratio 3.477, P = 0.004). CONCLUSION T4b rectal cancers with involvement limited to the inferior pelvic compartment had superior prognosis compared to those involving other pelvic compartments. These differences should be investigated further and taken into consideration in refinement of the current T staging system.
Collapse
Affiliation(s)
- Yang-Zi Zhang
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Maxiaowei Song
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shuai Li
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jian Tie
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiang-Gao Zhu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yong-Heng Li
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ai-Wen Wu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yong Cai
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Wei-Hu Wang
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China.
| |
Collapse
|
|
3
|
Liu LY, Liu LH. Imaging Strategies for Rectal Cancer Initial Staging: Does Pelvic Computed Tomography Provide Significantly Additional Findings when High-resolution Magnetic Resonance Imaging has Been Performed? Curr Med Imaging 2020; 16:1029-1033. [PMID: 33081663 DOI: 10.2174/1573405615666191019092606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/05/2019] [Accepted: 10/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Initial staging of rectal cancer is done by high-resolution magnetic resonance imaging (MRI), however, pelvic computed tomography (CT) is also frequently used. The aim of this study was to evaluate the added clinical benefit of pelvic CT or whether it can alter the initial staging or not. METHODS The study was composed of 187 patients with rectal cancer. Firstly, imaging except pelvic CT was evaluated. Secondly, the pelvic CT was evaluated and the staging was adjusted according to the new findings. Subsequently, the two staging results were compared to investigate the added clinical benefit of pelvic CT. RESULTS Compared with the imaging data except pelvic CT, new findings revealed by the pelvic CT included metastases of the pelvic bone (n = 1) and pelvic peritoneum (n = 3). However, the new findings did not change the primary staging. Of the three patients with pelvic peritoneal metastasis, two were already determined with peritoneal involvement and ascites by abdominal CT, and the third patient was observed with liver and distant lymph node metastasis. Thus, none of their initial stagings needed to be changed. CONCLUSION The addition of pelvic CT to the pre-treatment imaging strategy cannot provide added clinical benefit for the primary evaluation of rectal cancer.
Collapse
Affiliation(s)
- Li-Yan Liu
- Department of Radiology, Tengzhou Maternal and Child Health Hospital, Tengzhou Children's Hospital, Tengzhou, China
| | - Li-Heng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
|
4
|
McColl M, Fayad LM, Morris C, Ahlawat S. Pelvic bone tumor resection: what a radiologist needs to know. Skeletal Radiol 2020; 49:1023-1036. [PMID: 32072185 DOI: 10.1007/s00256-020-03395-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 02/02/2023]
Abstract
Pelvic bone tumors present a diagnostic and therapeutic challenge. Due to the deep anatomic location and resultant late clinical presentation, pelvic bone tumors tend to be large and located in close proximity to pelvic viscera as well as vital neurovascular structures. Operative management of pelvic bone tumors is indicated for a variety of orthopedic oncologic conditions. In general, limb-sparing pelvic resection rather than hemipelvectomy with amputation of the ipsilateral limb is considered when a functional limb can be preserved without compromising the surgical margins. There are various options for pelvic resection and reconstruction, and the selection depends on tumor histology, anatomic location, and extent. The decision regarding choice of surgical procedure and reconstruction method for a pelvic bone tumor requires a thorough knowledge of the pelvic anatomy, and careful inspection of the anatomic extent. The surgical plan must strike a balance between acceptable functional outcome and acceptable morbidity. In this review, we describe the different types of pelvic resection techniques, and the vital role preoperative imaging plays in defining the anatomic extent of a pelvic bone tumor and subsequent surgical planning.
Collapse
Affiliation(s)
- Michael McColl
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Carol Morris
- Division of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, 21287, MD, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| |
Collapse
|
|
5
|
The added value of pelvic surveillance by MRI during postoperative follow-up of rectal cancer, with a focus on abbreviated MRI. Eur Radiol 2020; 30:3113-3124. [PMID: 32072254 DOI: 10.1007/s00330-020-06711-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the added value of MRI over CT for the detection of pelvic recurrence during postoperative surveillance after rectal cancer surgery and to compare the diagnostic accuracy for pelvic recurrence achieved with abbreviated MRI (aMRI) with that of conventional enhanced MRI (cMRI). METHODS Patients who underwent rectal cancer surgery followed by MRI in addition to the standard CT follow-up protocol were evaluated retrospectively. Two readers independently scored images from CT, cMRI, and aMRI, which consisted of T2-weighted and diffusion-weighted imaging, to rate the likelihood of recurrence. Diagnostic accuracy and ROC curves were calculated. The patients were divided into two groups for risk-adapted surveillance according to risk of recurrence: high-risk (n = 157) and low-risk (n = 169) groups. RESULTS In total, 579 MRIs from 326 patients were assessed. A total of 48 pelvic recurrences occurred in 33 patients. The AUC in cMRI, aMRI, and CT were 0.98, 0.99, and 0.84, respectively. The difference in performance between CT and cMRI or aMRI for identifying recurrence was statistically significant (p < 0.001). Both cMRI and aMRI showed superior performance compared with CT in the high-risk group (p < 0.001), but this was not the case in the low-risk group (p = 0.13). Furthermore, the diagnostic accuracy of aMRI was similar to that of cMRI. CONCLUSIONS The addition of MRI to the postoperative surveillance protocol may result in an improvement in the detection of pelvic recurrence after rectal cancer surgery. For patients at high risk of recurrence, an aMRI surveillance may be justified to improve the diagnostic yield. KEY POINTS • The addition of MRI to the postoperative surveillance protocol improved the diagnostic yield in patients at a high risk of recurrence. • Abbreviated non-enhanced MRI with DWI allows detection of pelvic recurrence with a diagnostic accuracy that is similar to that of contrast-enhanced MRI (AUC, 0.99 and 0.98, respectively; p = 0.12). • Abbreviated MRI that is restricted to high spatial resolution structural imaging and diffusion-weighted imaging takes less time and can be carried out without the need for injection of a contrast agent.
Collapse
|
|
6
|
Laporte GA, Zanini LAG, Zanvettor PH, Oliveira AF, Bernado E, Lissa F, Coelho MJP, Ribeiro R, Araujo RLC, Barrozo AJJ, da Costa AF, de Barros Júnior AP, Lopes A, Santos APM, Azevedo BRB, Sarmento BJQ, Marins CAM, Loureiro CMB, Galhardo CAV, Gatelli CN, Quadros CA, Pinto CV, Uchôa DNAO, Martins DRS, Doria-Filho E, Ribeiro EKMA, Pinto ERF, Dos Santos EAS, Gozi FAM, Nascimento FC, Fernandes FG, Gomes FKL, Nascimento GJS, Cucolicchio GO, Ritt GF, de Oliveira GG, Ayala GP, Guimarães GC, Ianaze GC, Gobetti GA, Medeiros GM, Güth GZ, Neto HFC, Figueiredo HF, Simões JC, Ferrari JC, Furtado JPR, Vieira LJ, Pereira LF, de Almeida LCF, Tayeh MRA, Figueiredo PHM, Pereira RSAV, Macedo RO, Sacramento RMM, Cardoso RM, Zanatto RM, Martinho RAM, Araújo RG, Pinheiro RN, Reis RJ, Goiânia SBS, Costa SRP, Foiato TF, Silva TC, Carneiro VCG, Oliveira VR, Casteleins WA. Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer. J Surg Oncol 2019; 121:718-729. [PMID: 31777095 DOI: 10.1002/jso.25759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high-dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. METHODS A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. RESULTS Most conducts and management strategies reviewed were strongly recommended by the participants. CONCLUSIONS Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.
Collapse
Affiliation(s)
| | | | | | | | - Enio Bernado
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | - Fernando Lissa
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | - Reitan Ribeiro
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | | | | - Andre Lopes
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | - Cláudio V Pinto
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | | | | - Eric R F Pinto
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | - Gunther P Ayala
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | | | | - Gustavo Z Güth
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | - João C Simões
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | - José C Ferrari
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | - Lucas F Pereira
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | | | | - Ramon O Macedo
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | - Rosilene J Reis
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | | - Tyrone C Silva
- Brazilian Society of Surgical Oncology, Rio de Janeiro, Brazil
| | | | | | | |
Collapse
|
|
7
|
Jung S, Parajuli A, Yu CS, Park SH, Lee JS, Kim AY, Lee JL, Kim CW, Yoon YS, Park IJ, Lim SB, Kim JC. Sensitivity of Various Evaluating Modalities for Predicting a Pathologic Complete Response After Preoperative Chemoradiation Therapy for Locally Advanced Rectal Cancer. Ann Coloproctol 2019; 35:275-281. [PMID: 31726004 PMCID: PMC6863003 DOI: 10.3393/ac.2019.01.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/07/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We investigated the sensitivity of various evaluating modalities in predicting a pathologic complete response (pCR) after preoperative chemoradiation therapy (PCRT) for locally advanced rectal cancer (LARC). METHODS From a population of 2,247 LARC patients who underwent PCRT followed by surgery at Asan Medical Center, Seoul, Korea from January 2007 to June 2016, we retrospectively analyzed 313 patients (14.1%) who showed a pCR after surgery. Transrectal ultrasound (TRUS), high-resolution magnetic resonance imaging (MRI), abdominopelvic computed tomography (AP-CT), and endoscopy were performed within 2 weeks prior to surgery. RESULTS Of the 313 patients analyzed, 256 (81.8%) had a pCR after radical surgery and 57 (18.2%) showed total regression after local excision. Preoperative TRUS, MRI, and AP-CT were performed in 283, 305, and 139 patients, respectively. Among these 3 groups, a prediction of a pCR of the primary tumor was made in 41 (14.5%), 51 (16.7%), and 27 patients (19.4%), respectively, before surgery. A prediction of a clinical N0 stage was made in 204 patients (88.3%) using TRUS, 130 (52.2%) using MRI, and 78 (65.5%) using AP-CT. Of the 211 patients who underwent endoscopy, 87 (41.2%) had a mention of clinical CR in their records. A prediction of a pathologic CR was made for 124 patients (39.6%) through at least one diagnostic modality. CONCLUSION The various evaluation methods for predicting a pCR after PCRT show a predictive sensitivity of 0.15-0.41 for primary tumors and 0.52-0.88 for lymph nodes. Endoscopy is a relatively superior modality for predicting the pCR of the primary tumor of LARC patients.
Collapse
Affiliation(s)
- Sungwoo Jung
- Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Anuj Parajuli
- Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Ho Park
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ah Young Kim
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
8
|
Ippolito D, Drago SG, Talei Franzesi CR, Casiraghi A, Sironi S. Diagnostic value of fourth-generation iterative reconstruction algorithm with low-dose CT protocol in assessment of mesorectal fascia invasion in rectal cancer: comparison with magnetic resonance. Abdom Radiol (NY) 2017; 42:2251-2260. [PMID: 28429055 DOI: 10.1007/s00261-017-1138-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of the article is to compare the diagnostic performance about radiation dose and image quality of low-dose CT with iterative reconstruction algorithm (iDose4) and standard-dose CT in the assessment of mesorectal fascia (MRF) invasion in rectal cancer patients. MATERIALS AND METHODS Ninety-one patients with biopsy-proven primary rectal adenocarcinoma underwent CT staging: 42 underwent low-dose CT, 49 underwent standard CT protocol. Low-dose contrast-enhanced MDCT scans were performed on a 256 (ICT, Philips) scanner using 120 kV, automated mAs modulation, iDose4 iterative reconstruction algorithm. Standard-dose MDCT scans were performed on the same scanner with 120 kV, 200-300 mAs. All patients underwent a standard lower abdomen MR study (on 1.5T magnet), including multiplanar sequences, considered as reference standard. Diagnostic accuracy of MRF assessment was determined on CT images for both CT protocols and compared with MRI images. Dose-length product (DLP) and CT dose index (CTDI) calculated for both groups were compared and statistically analyzed. RESULTS Low-dose protocol with iDose4 showed high diagnostic quality in assessment of MRF with significant reduction (23%; p = 0.0081) of radiation dose (DLP 2453.47) compared to standard-dose examination (DLP 3194.32). CONCLUSIONS Low-dose protocol combined with iDose4 reconstruction algorithm offers high-quality images, obtaining significant radiation dose reduction, useful in the evaluation of MRF involvement in rectal cancer patients.
Collapse
Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy.
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - Silvia Girolama Drago
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - C R Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Alessandra Casiraghi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, H. Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, BG, Italy
| |
Collapse
|
|
9
|
Fusco R, Petrillo M, Granata V, Filice S, Sansone M, Catalano O, Petrillo A. Magnetic Resonance Imaging Evaluation in Neoadjuvant Therapy of Locally Advanced Rectal Cancer: A Systematic Review. Radiol Oncol 2017; 51:252-262. [PMID: 28959161 PMCID: PMC5611989 DOI: 10.1515/raon-2017-0032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to present an update concerning several imaging modalities in diagnosis, staging and pre-surgery treatment response assessment in locally advanced rectal cancer (LARC). Modalities include: traditional morphological magnetic resonance imaging (MRI), functional MRI such as dynamic contrast enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI). A systematic review about the diagnostic accuracy in neoadjuvant therapy response assessment of MRI, DCE-MRI, DWI and Positron Emission Tomography/Computed Tomography (PET/CT) has been also reported. Methods Several electronic databases were searched including PubMed, Scopus, Web of Science, and Google Scholar. All the studies included in this review reported findings about therapy response assessment in LARC by means of MRI, DCE-MRI, DWI and PET/CT with details about diagnostic accuracy, true and false negatives, true and false positives. Forest plot and receiver operating characteristic (ROC) curves analysis were performed. Risk of bias and the applicability at study level were calculated. Results Twenty-five papers were identified. ROC curves analysis demonstrated that multimodal imaging integrating morphological and functional MRI features had the best accuracy both in term of sensitivity and specificity to evaluate preoperative therapy response in LARC. DCE-MRI following to PET/CT showed high diagnostic accuracy and their results are also more reliable than conventional MRI and DWI alone. Conclusions Morphological MRI is the modality of choice for rectal cancer staging permitting a correct assessment of the disease extent, of the lymph node involvement, of the mesorectal fascia and of the sphincter complex for surgical planning. Multimodal imaging and functional DCE-MRI may also help in the assessment of treatment response allowing to guide the surgeon versus conservative strategies and/or tailored approach such as “wait and see” policy.
Collapse
Affiliation(s)
- Roberta Fusco
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Mario Petrillo
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Vincenza Granata
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Salvatore Filice
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies, Università degli Studi di Napoli Federico II, Via Claudio, Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Antonella Petrillo
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS -Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| |
Collapse
|
|
10
|
Bai RJ, Ren SH, Jiang HJ, Li JP, Liu XC, Xue LM. Accuracy of Multi-Slice Spiral Computed Tomography for Preoperative Tumor Node Metastasis (TNM) Staging of Colorectal Carcinoma. Med Sci Monit 2017; 23:3470-3479. [PMID: 28715364 PMCID: PMC5528007 DOI: 10.12659/msm.902649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background With the advances in imaging technologies, multi-slice spiral computed tomography (MSCT) has demonstrated superiority in the diagnosis and staging of colorectal carcinoma. In the current study, preoperative TNM staging of colorectal carcinoma by using MSCT was conducted and compared with the corresponding postoperative pathological examination findings, in order to evaluate the accuracy of preoperative MSCT for TNM staging. Material/Methods Combinations of biphasic or triphasic enhanced-phase MSCT scans were obtained for 76 patients with colorectal carcinoma, and the TNM stage was determined based on imaging reconstruction from various angles and perspectives to display the size, location, and affected range of tumors. The preoperative TNM stage was compared with the postoperative pathological stage, and the consistency between the 2 methods was tested by the κ test using SPSS 17.0 software. Results Among the different combinations of enhanced-phase MSCT scanning, triphasic MSCT imaging, comprising the arterial, portal venous, and delayed phases, showed the highest accuracy rates, at 81.6% (62/76), 82.89% (63/76), and 96.1% (73/76) for T, N, and M staging, respectively, with κ values of 0.72, 0.65, and 0.56, respectively, indicating consistency with the postoperative pathological staging. Conclusions Combined MSCT scanning comprising the arterial phase, portal venous phase, and delayed phase showed satisfying consistency with the postoperative pathological analysis results for TNM staging of colorectal carcinoma. Thus, MSCT is an important clinical value for improving the accuracy of TNM staging and for planning the appropriate colorectal cancer treatment.
Collapse
Affiliation(s)
- Rong-Jie Bai
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China (mainland)
| | - Shao-Hua Ren
- Department of Radiology, The First Hospital of Harbin, Harbin, Heilongjiang, China (mainland)
| | - Hui-Jie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Jin-Ping Li
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Xiao-Cheng Liu
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Li-Ming Xue
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| |
Collapse
|
|
11
|
Inoue A, Ohta S, Nitta N, Yoshimura M, Shimizu T, Tani M, Kushima R, Murata K. MRI can be used to assess advanced T-stage colon carcinoma as well as rectal carcinoma. Jpn J Radiol 2016; 34:809-819. [PMID: 27757786 DOI: 10.1007/s11604-016-0591-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/29/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the feasibility of assessing advanced T-stage (T3-T4) colorectal carcinomas by correlating MRI with histopathological findings. MATERIALS AND METHODS The study population comprised 31 patients with 32 lesions (22 colon and 10 rectal carcinomas). The relationship between the tumor and bowel layers on T2- and contrast-enhanced T1-weighted images (T2WI, CE-T1WI), bowel wall deformity, and the linear architecture of subserosal fat on T2WI scans was independently assessed by two radiologists. Diagnostic ability and interobserver agreement were evaluated using Fisher's exact test and kappa statistics, respectively. RESULTS The sensitivity/specificity for disrupting the outer layer on T2WI scans for the differentiation between Tis-T2 and T3-T4 colorectal carcinoma was 100/75 % (p < 0.05) for both observers; on CE-T1WI, it was 88.0/50 % (p = 0.13) for one and 96.0/50 % (p = 0.11) for the other. The sensitivity/specificity for recognizing the reticulated linear architecture to distinguish T3 from T4 colon carcinoma was 83.3/84.6 % (p < 0.05) for one reader and 100/92.3 % (p < 0.05) for the other reader. CONCLUSION Disruption of the outer low-intensity layer on T2WI scans was the most important finding for the diagnosis of T3-T4 colorectal carcinoma. The reticulated linear architecture of the fat tissue was suggestive of T4 colon carcinoma.
Collapse
Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga Universitiy of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Shinichi Ohta
- Department of Radiology, Shiga Universitiy of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga Universitiy of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masahiro Yoshimura
- Department of Radiology, Shiga Universitiy of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tomoharu Shimizu
- Department of Surgery, Shiga Universitiy of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga Universitiy of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Ryoji Kushima
- Department of Pathology, Shiga Universitiy of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga Universitiy of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| |
Collapse
|
|
12
|
Ippolito D, Drago SG, Franzesi CT, Fior D, Sironi S. Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion. World J Gastroenterol 2016; 22:4891-4900. [PMID: 27239115 PMCID: PMC4873881 DOI: 10.3748/wjg.v22.i20.4891] [Citation(s) in RCA: 10] [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: 01/28/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the diagnostic accuracy of multidetector-row computed tomography (MDCT) as compared with conventional magnetic resonance imaging (MRI), in identifying mesorectal fascia (MRF) invasion in rectal cancer patients. METHODS Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner (ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 mAs. Imaging data were reviewed as axial and as multiplanar reconstructions (MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images (DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed. RESULTS According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91 (41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged (45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant (P = 0.02). CONCLUSION New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.
Collapse
|
|
13
|
Horie H, Togashi K, Utano K, Miyakura Y, Lefor AT, Yasuda Y. Predicting rectal cancer T stage using circumferential tumor extent determined by computed tomography colonography. Asian J Surg 2016; 39:29-33. [DOI: 10.1016/j.asjsur.2015.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 01/17/2015] [Accepted: 03/04/2015] [Indexed: 12/28/2022] Open
|
|
14
|
Does gadolinium-based contrast material improve diagnostic accuracy of local invasion in rectal cancer MRI? A multireader study. AJR Am J Roentgenol 2015; 204:W160-7. [PMID: 25615776 DOI: 10.2214/ajr.14.12599] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE. The purpose of this study was to compare reader accuracy and agreement on rectal MRI with and without gadolinium administration in the detection of T4 rectal cancer. MATERIALS AND METHODS. In this study, two radiologists and one fellow independently interpreted all posttreatment MRI studies for patients with locally advanced or recurrent rectal cancer using unenhanced images alone or combined with contrast-enhanced images, with a minimum interval of 4 weeks. Readers evaluated involvement of surrounding structures on a 5-point scale and were blinded to pathology and disease stage. Sensitivity, specificity, negative predictive value, positive predictive value, and AUC were calculated and kappa statistics were used to describe interreader agreement. RESULTS. Seventy-two patients (38 men and 34 women) with a mean age of 61 years (range, 32-86 years) were evaluated. Fifteen patients had 32 organs invaded. Global AUCs without and with gadolinium administration were 0.79 and 0.77, 0.91 and 0.86, and 0.83 and 0.78 for readers 1, 2, and 3, respectively. AUCs before and after gadolinium administration were similar. Kappa values before and after gadolinium administration for pairs of readers ranged from 0.5 to 0.7. CONCLUSION. On the basis of pathology as a reference standard, the use of gadolinium during rectal MRI did not significantly improve radiologists' agreement or ability to detect T4 disease.
Collapse
|
|
15
|
Raman SP, Chen Y, Fishman EK. Evolution of imaging in rectal cancer: multimodality imaging with MDCT, MRI, and PET. J Gastrointest Oncol 2015; 6:172-84. [PMID: 25830037 DOI: 10.3978/j.issn.2078-6891.2014.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 12/13/2014] [Indexed: 12/13/2022] Open
Abstract
Magnetic resonance imaging (MRI), multidetector computed tomography (MDCT), and positron emission tomography (PET) are complementary imaging modalities in the preoperative staging of patients with rectal cancer, and each offers their own individual strengths and weaknesses. MRI is the best available radiologic modality for the local staging of rectal cancers, and can play an important role in accurately distinguishing which patients should receive preoperative chemoradiation prior to total mesorectal excision. Alternatively, both MDCT and PET are considered primary modalities when performing preoperative distant staging, but are limited in their ability to locally stage rectal malignancies. This review details the role of each of these three modalities in rectal cancer staging, and how the three imaging modalities can be used in conjunction.
Collapse
Affiliation(s)
- Siva P Raman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Yifei Chen
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N. Caroline Street, Baltimore, MD 21287, USA
| |
Collapse
|
|
16
|
Capek S, Sullivan PS, Howe BM, Smyrk TC, Amrami KK, Spinner RJ, Dozois EJ. Recurrent rectal cancer causing lumbosacral plexopathy with perineural spread to the spinal nerves and the sciatic nerve: An anatomic explanation. Clin Anat 2014; 28:136-43. [DOI: 10.1002/ca.22450] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Stepan Capek
- Department of Neurosurgery; Mayo Clinic; Rochester Minnesota
- International Clinical Research Center, St. Anne's University Hospital Brno; Brno Czech Republic
| | | | | | - Thomas C. Smyrk
- Department of Surgical Pathology; Mayo Clinic; Rochester Minnesota
| | | | | | - Eric J. Dozois
- Division of Colon & Rectal Surgery; Mayo Clinic; Rochester Minnesota
| |
Collapse
|
|
17
|
Charlton ME, Mattingly-Wells LR, Marcet JE, McMahon Waldschmidt BC, Cromwell JW. Association between surgeon characteristics and their preferences for guideline-concordant staging and treatment for rectal cancer. Am J Surg 2014; 208:817-823. [PMID: 24997492 DOI: 10.1016/j.amjsurg.2014.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Rectal cancer guidelines recommend transrectal ultrasound or magnetic resonance imaging for locoregional staging and neoadjuvant chemoradiation therapy (CRT) for Stage II/III disease, but studies show these are underutilized. We examined how surgeon preferences align with guidelines or vary by training. METHODS Questionnaires on training, years of practice, and staging/treatment preferences were sent to surgeons practicing in Florida. RESULTS Of 759 surveys distributed, 321 (42%) responded; 158 were excluded because they were trainees, not treating rectal cancer, or not board certified/eligible. Among the remaining 163, 71% were general surgeons, 18% colorectal surgeons, and 11% surgical oncologists. Colorectal surgeons and surgical oncologists were more likely than general surgeons to prefer transrectal ultrasound/magnetic resonance imaging (79% vs 50%; P < .01), and neoadjuvant CRT (71% vs 45%; P < .01). Differences remained significant after adjusting for years in practice. CONCLUSION Increased focus on appropriate use of staging procedures and neoadjuvant CRT within general surgery training/educational programs is warranted.
Collapse
Affiliation(s)
- Mary E Charlton
- Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Drive, Iowa City, IA 52242, USA; VA Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.
| | | | - Jorge E Marcet
- Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Brenna C McMahon Waldschmidt
- Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Drive, Iowa City, IA 52242, USA
| | - John W Cromwell
- Division of Gastrointestinal Surgery, Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Iowa College of Medicine, Iowa City, IA, USA
| |
Collapse
|
|
18
|
Furey E, Jhaveri KS. Magnetic Resonance Imaging in Rectal Cancer. Magn Reson Imaging Clin N Am 2014; 22:165-90, v-vi. [DOI: 10.1016/j.mric.2014.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
|
19
|
Alberda WJ, Burger JWA, Beets-Tan RB, Verhoef C. Challenges in determining the benefits of restaging after chemoradiotherapy for locally advanced rectal cancer. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.14.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Wijnand J Alberda
- Erasmus MC Cancer Institute, Department of Surgery, Division of Surgical Oncology, Rotterdam, The Netherlands
| | - Jacobus WA Burger
- Erasmus MC Cancer Institute, Department of Surgery, Division of Surgical Oncology, Rotterdam, The Netherlands
| | - Regina B Beets-Tan
- Maastricht University Medical Center, Department of Radiology, Maastricht, The Netherlands
| | - Cornelis Verhoef
- Erasmus MC Cancer Institute, Department of Surgery, Division of Surgical Oncology, Rotterdam, The Netherlands
| |
Collapse
|
|
20
|
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: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
|
21
|
Dickman R, Kundel Y, Levy-Drummer R, Purim O, Wasserberg N, Fenig E, Sulkes A, Brenner B. Restaging locally advanced rectal cancer by different imaging modalities after preoperative chemoradiation: a comparative study. Radiat Oncol 2013; 8:278. [PMID: 24286200 PMCID: PMC4222036 DOI: 10.1186/1748-717x-8-278] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 11/17/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To compare the accuracy of different imaging modalities, alone and in combination in predicting findings at surgery after preoperative chemoradiation for locally advanced rectal cancer. METHODS Following chemoradiation, tumors were reclassified on the basis of findings on pelvic computed tomography (CT) (94 patients), endorectal ultrasonography (EUS) (138 patients) alone or by both CT and EUS (80 patients). The ability of the imaging modalities, to predict the pathologic T status, N status, and TNM stage at surgery was evaluated and compared. RESULTS Mean age of the patients was 64.5 years (range 28-88 years); 55% were male. CT and EUS combined had a positive predictive value of 20% for pathologic pT1 stage, 29% for pT1, 29% for pT2, and 58% for pT3. Predictive values for the operative TNM stage were 50% for stage I, 45% for stage II, and 31% for stage III. These values did not exceed those for each modality alone. CONCLUSION The performance of preoperative CT and EUS in predicting the T and TNM stage of rectal cancer at surgery is poor. Neither modality alone nor the two combined is sufficiently accurate to serve as the basis for decisions regarding treatment modification.
Collapse
Affiliation(s)
- Ram Dickman
- Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | - Ofer Purim
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nir Wasserberg
- Department of Surgery B, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Eyal Fenig
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| |
Collapse
|
|
22
|
Brændengen M, Guren MG, Glimelius B. Target Volume Definition in Rectal Cancer: What Is the Best Imaging Modality? CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
23
|
Pretherapeutic Diagnosis and Staging. Updates Surg 2013. [DOI: 10.1007/978-88-470-2670-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
24
|
Abstract
Accurate pretherapeutic staging of rectal cancer is crucial for further therapeutic management and important for prognosis. The most accurate diagnostic tools in the assessment of T and N categories of rectal cancer are endorectal ultrasound (EUS) and magnetic resonance imaging (MRI). Furthermore, MRI can accurately predict the distance of the tumor to the colorectal membrane (CRM) and computed tomography (CT) is more suitable for detecting distant metastases. In the routine care of rectal cancer EUS is the most frequently used diagnostic tool for local staging. The achieved accuracy for determining T category by EUS in routine clinical staging is lower than results reported in the literature. Furthermore, the accuracy of EUS depends on the experience of the examiner. Currently the frequency of using MRI for routine clinical staging of rectal cancer is low and in one out of five cases the local staging of rectal cancer is exclusively carried out by CT.
Collapse
Affiliation(s)
- H Ptok
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | | | | |
Collapse
|
|
25
|
Beets-Tan RGH, Beets GL. Local staging of rectal cancer: a review of imaging. J Magn Reson Imaging 2011; 33:1012-9. [PMID: 21509856 DOI: 10.1002/jmri.22475] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
During the past decades the management of patients with rectal cancer has substantially changed, with a significant reduction in local recurrence rates following the introduction of better imaging, better surgery, and more efficient neoadjuvant therapy. This review discusses the clinically relevant information radiologists should know on staging of rectal cancer patients. The crucial role of the radiologist in patient management is explained. Furthermore, the evidence for the use of magnetic resonance imaging (MRI) in staging and restaging of rectal cancer patients as well as the main features that need to be evaluated when interpreting rectal cancer MRI are given. New diagnostic challenges as a result of new treatment options are also discussed.
Collapse
Affiliation(s)
- Regina G H Beets-Tan
- GROW School for Oncology & Developmental Biology, Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | | |
Collapse
|
|
26
|
Lizarazu A, Enríquez-Navascués JM, Placer C, Carrillo A, Sainz-Lete A, Elósegui JL. [Surgical approach to the locoregional recurrence of cancer of the rectum]. Cir Esp 2011; 89:269-74. [PMID: 21429480 DOI: 10.1016/j.ciresp.2011.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 11/19/2022]
Abstract
A literature review has been made on the pelvic recurrence of rectal cancer using the MedLine, Ovid, EMBASE, Cochrane and Cinahl data bases. Assessment of the locoregional recurrence must be made using imaging tests in order to rule out the presence of metastasis, as well as for locating its exact location within the pelvis. As the only curative treatment should be complete resection of the recurrence with negative margins, a pre-operative CT, NMR, endorectal ultrasound and PET-CT must be performed to determine its resectability. For a potential cure, radical resections must be made, with the technique varying according to whether the location is central (axial), posterior (presacral) or lateral, as well as treatment directed at the primary tumour. Neoadjuvant treatments, brachiterapy and intra-operative radiotherapy improve the local control results and survival in these patients.
Collapse
Affiliation(s)
- Aintzane Lizarazu
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Donostia, San Sebastián, España
| | | | | | | | | | | |
Collapse
|
|
27
|
Abstract
Over the last decades the therapy of rectal carcinoma has shown continuous improvement. Due to improvements in operative techniques, such as the establishment of total mesorectal excision (TME) and the combination of surgery and (neo-) adjuvant radiochemotherapy, the incidence of locally recurrent rectal cancer could be improved from nearly 50% to less then 10%. Nevertheless recurrent rectal carcinoma remains a severe problem. Predictive factors relating to locally recurrent rectal cancer are surgical experience, localization of the tumor, circumferential resection margins, stage-oriented multimodal therapy and a suitable oncological procedure for the primary tumor. In addition the tumor-specific biology also seems to be a relevant risk factor for recurrence. Operative treatment of locally recurrent rectal cancer was seen for a long time as a palliative procedure. Newer data show that resection of locally recurrent rectal cancer can be carried out with a curative intention in experienced institutions with a long-term 5 year survival of about 30% and mortality around 5%. The composite sacropelvic resection technique is a reasonable option in the curative treatment of locally recurrent rectal cancer. For the future the focus must be on improvements in the primary therapy of rectal carcinoma to avoid local recurrence. In addition early diagnosis of local recurrence and multimodal therapies will be of decisive importance.
Collapse
|
|
28
|
Samee A, Selvasekar CR. Current trends in staging rectal cancer. World J Gastroenterol 2011; 17:828-34. [PMID: 21412492 PMCID: PMC3051133 DOI: 10.3748/wjg.v17.i7.828] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/12/2010] [Accepted: 11/19/2010] [Indexed: 02/06/2023] Open
Abstract
Management of rectal cancer has evolved over the years. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hot spots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. In future, functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy.
Collapse
|
|
29
|
Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer. Eur Radiol 2011; 21:1250-8. [PMID: 21240647 PMCID: PMC3088810 DOI: 10.1007/s00330-010-2052-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 11/22/2010] [Accepted: 11/25/2010] [Indexed: 12/30/2022]
Abstract
Objectives To evaluate the accuracy of standard MRI, diffusion-weighted MRI (DWI) and fusion images for the diagnosis of locally recurrent rectal cancer in patients with a clinical suspicion of recurrence. Methods Forty-two patients with a clinical suspicion of recurrence underwent 1.5-T MRI consisting of standard T2-weighted FSE (3 planes) and an axial DWI (b0,500,1000). Two readers (R1,R2) independently scored the likelihood of recurrence; [1] on standard MRI, [2] on standard MRI+DWI, and [3] on T2-weighted+DWI fusion images. Results 19/42 patients had a local recurrence. R1 achieved an area under the ROC-curve (AUC) of 0.99, sensitivity 100% and specificity 83% on standard MRI versus 0.98, 100% and 91% after addition of DWI (p = 0.78). For R2 these figures were 0.87, 84% and 74% on standard MRI and 0.91, 89% and 83% with DWI (p = 0.09). Fusion images did not significantly improve the performance. Interobserver agreement was κ0.69 for standard MRI, κ0.82 for standard MRI+DWI and κ0.84 for the fusion images. Conclusions MRI is accurate for the diagnosis of locally recurrent rectal cancer in patients with a clinical suspicion of recurrence. Addition of DWI does not significantly improve its performance. However, with DWI specificity and interobserver agreement increase. Fusion images do not improve accuracy.
Collapse
|
|
30
|
Dresen RC, Kusters M, Daniels-Gooszen AW, Cappendijk VC, Nieuwenhuijzen GAP, Kessels AGH, de Bruïne AP, Beets GL, Rutten HJT, Beets-Tan RGH. Absence of tumor invasion into pelvic structures in locally recurrent rectal cancer: prediction with preoperative MR imaging. Radiology 2010; 256:143-50. [PMID: 20574091 DOI: 10.1148/radiol.10090725] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To retrospectively assess the accuracy of preoperative magnetic resonance (MR) imaging for identification of tumor invasion into pelvic structures in patients with locally recurrent rectal cancer scheduled to undergo curative resection. MATERIALS AND METHODS The institutional review board approved this study, and informed consent was waived because of the retrospective nature of the study. Preoperative MR images in 40 consecutive patients with locally recurrent rectal cancer scheduled to undergo curative treatment between October 2003 and November 2006 were analyzed retrospectively. Four observers with different levels of experience in reading pelvic MR images assessed tumor invasion into the following structures: bladder, uterus or seminal vesicles, vagina or prostate, left and right pelvic walls, and sacrum. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and a receiver operating characteristic curve was constructed. Surgical and/or histopathologic findings were used as the reference standard. Interobserver agreement was measured by using kappa statistics. RESULTS Preoperative MR imaging was accurate for the prediction of tumor invasion into structures with negative predictive values of 93%-100% and areas under receiver operating characteristic curves of 0.79-1.00 for all structures and observers. Positive predictive values were 53%-100%. Disease was overstaged in 11 (observer 1), 22 (observer 2), 10 (observer 3), and nine (observer 4) structures and was understaged in nine (observer 3) and two (observer 4) structures. Assessment failures were mainly because of misinterpretation of diffuse fibrosis, especially at the pelvic side walls. Interobserver agreement ranged between 0.64 and 0.99 for experienced observers. CONCLUSION Preoperative MR imaging is accurate for the prediction of absence of tumor invasion into pelvic structures. MR imaging may be useful as a preoperative road map for surgical procedure and may thus increase chances of complete resection. Interpretation of diffuse fibrosis remains difficult.
Collapse
Affiliation(s)
- Raphaëla C Dresen
- Department of Radiology, Maastricht University Medical Center, Postbus 5800, Maastricht, the Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
31
|
de Wilt JHW, Vermaas M, Ferenschild FTJ, Verhoef C. Management of locally advanced primary and recurrent rectal cancer. Clin Colon Rectal Surg 2010; 20:255-63. [PMID: 20011207 DOI: 10.1055/s-2007-984870] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Treatment for patients with locally advanced and recurrent rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Adequate preoperative imaging of the pelvis is therefore important to identify those patients who are candidates for multimodality treatment, including preoperative chemoradiation protocols, intraoperative radiotherapy, and extended surgical resections. Much effort should be made to select patients with these advanced tumors for treatment in specialized referral centers. This has been shown to reduce morbidity and mortality and improve long-term survival rates. In this article, we review the best treatment options for patients with locally advanced and recurrent rectal cancer. We also emphasize the necessity of a multidisciplinary team, including a radiologist, radiation oncologist, urologist, surgical oncologist, plastic surgeon, and gynecologist in the diagnosis and treatment of patients with these pelvic tumors.
Collapse
Affiliation(s)
- Johannes H W de Wilt
- Department of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
|
32
|
Herrmann KA, Paspulati RM, Lauenstein T, Reiser MF. Benefits and challenges in bowel MR imaging at 3.0 T. Top Magn Reson Imaging 2010; 21:165-175. [PMID: 21847036 DOI: 10.1097/rmr.0b013e31822a3294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Abdominal imaging at 3.0 T has shown to be challenging because of a number of artifacts and effects related to the physics at higher field strength. For bowel imaging at 3.0 T, artifacts due to magnetic field inhomogeneities, standing waves, increased susceptibility, and greater chemical shift effects are of particular concern because they are likely to affect the assessment of relevant structures and counterbalance the benefits of higher signal-to-noise ratio. Regarding small- and large-bowel magnetic resonance imaging, the benefits of higher field strengths translate mainly in better contrast-to-noise ratio of contrast-enhanced T1-weighted gradient echo and T2-weighted imaging, whereas steady-state free precession sequences seem to suffer from serious degradation of image quality. The present article summarizes the technical challenges in bowel imaging at 3.0 T, provides an overview of performance compared with 1.5 T in small- and large-bowel diseases including the rectum, and revises the current literature.
Collapse
Affiliation(s)
- Karin A Herrmann
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, University Hospitals Munich, Munich, Germany.
| | | | | | | |
Collapse
|
|
33
|
Abstract
BACKGROUND Here we present a concise review on the evaluation and management of locally recurrent rectal cancer, which despite marked reductions in the rate of recurrent rectal cancer remains an important problem. METHODS This educational review discusses the diagnosis, evaluation, and management of recurrent rectal cancer. RESULTS Despite improvements in both the neoadjuvant and surgical management of rectal cancer, local recurrence is still an important problem, with documented recurrence rates of 4% to 8%. The local management of recurrence requires a team of specialist. Accurate detection and diagnosis followed by chemoradiotherapy and surgical resection may result in 5-year survival rates of up to 35%. CONCLUSIONS We discuss the diagnosis, evaluation, and management of locally recurrent rectal cancer. Locally recurrent rectal cancer can be successfully managed with multimodal therapy leading to successful palliation and often cure.
Collapse
Affiliation(s)
- Philippe Bouchard
- Division of Colorectal Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | |
Collapse
|
|
34
|
Cho YB, Chun HK, Kim MJ, Choi JY, Park CM, Kim BT, Lee SJ, Yun SH, Kim HC, Lee WY. Accuracy of MRI and 18F-FDG PET/CT for Restaging After Preoperative Concurrent Chemoradiotherapy for Rectal Cancer. World J Surg 2009; 33:2688-94. [DOI: 10.1007/s00268-009-0248-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
|
35
|
Larsen SG, Wiig JN, Emblemsvaag HL, Grøholt KK, Hole KH, Bentsen A, Dueland S, Vetrhus T, Giercksky KE. Extended total mesorectal excision in locally advanced rectal cancer (T4a) and the clinical role of MRI-evaluated neo-adjuvant downstaging. Colorectal Dis 2009; 11:759-67. [PMID: 18662240 DOI: 10.1111/j.1463-1318.2008.01649.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the clinical ability of MRl taken before and after neo-adjuvant treatment in locally advanced rectal cancer (LARC) to predict the necessary extension of TME (ETME) and the possibility to achieve a R0 resection. METHOD Prospective registration of 92 MRI evaluated T4a cancers undergoing elective surgery between 2002 and 2007 in a tertiary referral centre for multimodal treatment of rectal cancer. RESULTS MRI identified patients in need of neo-adjuvant treatment and predicted T-downstaging in 10% and N-downstaging in 59%. Seventy-nine percent R0 resections, 18% R1 and 3% R2 were obtained after ETME in 95% of the patients and TME in the rest. Higher tumour regression grade (TRG) was achieved in higher ypT-stage (P < 0.01). Preoperative chemo radiotherapy resulted in that more patients obtained TRG1-3 compared to those receiving radiotherapy (79% vs. 57%, P = 0.02). The pelvic wall was the area of failure in 70% of the R1 resections. Tumour cells outside the mesorectal fascia scattered within fibrosis was found in 18 TRG2-3 among 33 ypT4 tumours (55%). CONCLUSION MRl cannot discriminate tumour within fibrosis. Therefore, if a R0 resection is the goal, we advocate optimal surgery in accordance with the pre-treatment MRI. Post treatment MRI is a poor predictor of final histology and should not be relied upon to guide the extent of surgical resection. The study has initiated a new approach to histopathological classification of the removed specimen where we introduce a MRI assisted technique for investigating the areas at risk outside the mesorectal fascia in the specimen.
Collapse
Affiliation(s)
- S G Larsen
- Department of Surgical Oncology, the Norwegian Radium Hospital, Rikshospitalet University Hospital, Oslo, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
36
|
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.
Collapse
Affiliation(s)
- Colm J McMahon
- Department of Radiology, Beth israel Deaconess Medical Center, Boston, MA 02215, USA
| | | |
Collapse
|
|
37
|
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.
Collapse
Affiliation(s)
- U Piippo
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | | | | | | |
Collapse
|
|
38
|
Low G, Tho L, Leen E, Wiebe E, Kakumanu S, McDonald A, Poon F. The role of imaging in the pre-operative staging and post-operative follow-up of rectal cancer. Surgeon 2008; 6:222-31. [DOI: 10.1016/s1479-666x(08)80032-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
|
39
|
Zhang XM, Yu D, Zhang HL, Dai Y, Bi D, Liu Z, Prince MR, Li C. 3D dynamic contrast-enhanced MRI of rectal carcinoma at 3T: correlation with microvascular density and vascular endothelial growth factor markers of tumor angiogenesis. J Magn Reson Imaging 2008; 27:1309-1316. [PMID: 18504761 DOI: 10.1002/jmri.21378] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine how dynamic contrast-enhanced (DCE) MRI at 3T correlates with rectal carcinoma angiogenesis. MATERIALS AND METHODS Three-dimensional (3D) DCE MRI was performed in 38 patients (23 males, 15 females, mean age 60 years) with histologically-confirmed rectal carcinoma at 3T. Time-intensity curves (TICs) were used to measure peak enhancement ratio (ER(peak)), time to peak enhancement (T(peak)), first enhancement time (T(first-enhance)), and uptake rate for rectal tumor, normal rectal wall, and gluteal muscle. After tumor resection, microvascular density (MVD) and vascular endothelial growth factor (VEGF) expression were determined using immunohistochemistry (IHC) stains on available specimens (N = 24) to correlate with DCE MRI. RESULTS Rectal carcinoma showed higher ER(peak) (3.0 +/- 0.9 vs. 1.9 +/- 0.9, P < 0.001), higher uptake rate (2.8 +/- 1.5/minute vs. 1.2 +/- 0.9/minute, P < 0.001), earlier T(peak) (88 +/- 56 seconds vs. 124 +/- 72 seconds, P = 0.027), and earlier T(first-enhance) (34 +/- 6 seconds vs. 40 +/- 7 seconds, P = 0.008) than normal rectal wall. Adenocarcinoma had shorter T(peak) compared to signet cell carcinoma (77 +/- 48 seconds vs. 160 +/- 62 seconds, P = 0.004). T(peak) was negatively correlated with MVD (r = -0.516, P = 0.01) and the mean T(peak) was significantly earlier for the VEGF-positive group compared to the VEGF-negative group (57 +/- 17 seconds vs. 107 +/- 64 seconds, P = 0.021). CONCLUSION DCE MRI parameters help predict rectal tumor angiogenesis measured by MVD and VEGF expression and discriminate malignant from normal tissue.
Collapse
Affiliation(s)
- Xiao Ming Zhang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, PR China
| | | | | | | | | | | | | | | |
Collapse
|
|
40
|
Penna C. [Rectal adenocarcinoma: appropriate pretherapeutic explorations by tumor type]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:S126-S132. [PMID: 18467051 DOI: 10.1016/j.gcb.2008.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- C Penna
- Fédération des spécialités digestives, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| |
Collapse
|
|
41
|
Zhang XM, Zhang HL, Yu D, Dai Y, Bi D, Prince MR, Li C. 3-T MRI of rectal carcinoma: preoperative diagnosis, staging, and planning of sphincter-sparing surgery. AJR Am J Roentgenol 2008; 190:1271-1278. [PMID: 18430843 DOI: 10.2214/ajr.07.2505] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
Collapse
Affiliation(s)
- Xiao Ming Zhang
- Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Rd., Jinan, Shandong, China 250012
| | | | | | | | | | | | | |
Collapse
|
|
42
|
Bader FG, Bouchard R, Lubienski A, Keller R, Mirow L, Czymek R, Habermann JK, Bruch HP, Roblick UJ. [Progress in diagnostics of anorectal disorders. Part II: radiology]. Chirurg 2008; 79:410-7. [PMID: 18418564 DOI: 10.1007/s00104-008-1544-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Diagnostics and therapy of anorectal disorders remain a surgical question. In close cooperation between different departments (radiology and gastroenterology, urology and gynecology, dermatology and psychology), the role of radiologic imaging is of growing importance. Exact knowledge of functional anatomy and precise clinical examination constitute the basis of the according therapeutic strategies. In this context radiology has contributed decisively. Developments in imaging techniques, e.g. dynamic MRI, highly contributed to better understanding of complex functional pelvic floor disorders. The combination of nanotechnology and high-resolution imaging allows precise staging, especially in rectal cancer. Furthermore, advances in virtual colonoscopy could lead to widely acceptable and patient-friendly screening for colorectal malignancies.
Collapse
Affiliation(s)
- F G Bader
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburgerallee 160, 23538 Lübeck
| | | | | | | | | | | | | | | | | |
Collapse
|
|
43
|
Jacques AET, Rockall AG, Alijani M, Hughes J, Babar S, Aleong JAC, Cottrill C, Dorudi S, Reznek RH. MRI demonstration of the effect of neoadjuvant radiotherapy on rectal carcinoma. Acta Oncol 2008; 46:989-95. [PMID: 17851843 DOI: 10.1080/02841860701317865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE In patients with locally advanced rectal cancer, neoadjuvant long course (45-54 Gy in 25-30 fractions) chemoradiotherapy (CRT) may reduce tumour size and result in downstaging. In patients with primary resectable tumour short course (25 Gy in 5 fractions) radiotherapy (SCRT) reduces local recurrence but downstaging the disease or altering tumour size has not been described. We aimed to assess change in tumour size on MRI after SCRT or CRT. MATERIALS AND METHODS Nineteen patients with rectal carcinoma underwent MRI before and after SCRT or CRT. In each case, tumour length and width were documented and number of locoregional lymph nodes recorded. Total mesorectal excision was performed in 15 patients and MR findings correlated with histopathology. RESULTS Ten patients received SCRT and nine CRT. Tumour length reduced by 19% overall (15% following SCRT, 23% following CRT). Greater than 30% reduction (partial response) in maximum tumour thickness was seen in 4/10 (40%) following SCRT and 5/9 (56%) following CRT. CONCLUSIONS Significant reduction in tumour size can be achieved with preoperative long course CRT and SCRT. This unexpected finding following SCRT has not been previously described.
Collapse
Affiliation(s)
- Audrey E T Jacques
- Academic Department of Radiology, St. Bartholomews' Hospital, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
44
|
Tytherleigh MG, Ng VV, Pittathankal AA, Wilson MJ, Farouk R. PREOPERATIVE STAGING OF RECTAL CANCER BY MAGNETIC RESONANCE IMAGING REMAINS AN IMPRECISE TOOL. ANZ J Surg 2008; 78:194-8. [DOI: 10.1111/j.1445-2197.2007.04402.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
|
45
|
Laurent V, Olivier P. Imagerie et TEP scanner dans les cancersdu tube digestif. ACTA ACUST UNITED AC 2008; 89:413-35; quiz 436-7. [DOI: 10.1016/s0221-0363(08)89018-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
|
46
|
Vliegen RFA, Beets GL, Lammering G, Dresen RC, Rutten HJ, Kessels AG, Oei TK, de Bruïne AP, van Engelshoven JMA, Beets-Tan RGH. Mesorectal fascia invasion after neoadjuvant chemotherapy and radiation therapy for locally advanced rectal cancer: accuracy of MR imaging for prediction. Radiology 2008; 246:454-62. [PMID: 18227541 DOI: 10.1148/radiol.2462070042] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To retrospectively assess sensitivity and specificity of magnetic resonance (MR) imaging after chemotherapy and radiation therapy for predicting tumor invasion of the mesorectal fascia (MRF) in locally advanced primary rectal cancer, by using results of histologic examination and surgery as the reference standard, and to determine morphologic MR imaging criteria for MRF invasion. MATERIALS AND METHODS The Ethical Committee of University Hospital Maastricht approved this study and waived informed consent. Two observers independently scored postchemoradiation MR images in 64 patients with rectal cancer (38 male [mean age, 60 years] and 26 female [mean age, 64 years] patients) for MRF tumor invasion with a confidence level scoring system defined by subjective criteria. In a subsequent consensus reading session, morphologic MR criteria for invasion were defined by comparing morphologic changes with histologic findings. These criteria were evaluated and compared with the subjective criteria by comparing areas under the receiver operating characteristic curves (AUCs). RESULTS AUCs of postchemoradiation MR imaging for predicting MRF tumor invasion were 0.81 and 0.82 for observers 1 and 2, respectively. The following four types of morphologic tissue patterns at MR imaging were associated with whether or not MRF invasion was present at histologic examination: (a) development of fat pad larger than 2 mm (seen in no quadrants with and in four quadrants without invasion), (b) development or persistence of spiculations (seen in no quadrants with and in 22 quadrants without invasion), (c) development of diffuse hypointense "fibrotic" tissue (seen in 21 quadrants with and in 32 quadrants without invasion), and (d) persistence of diffuse iso- or hyperintense tissue (seen in 19 quadrants with and in two quadrants without invasion). AUC of postchemoradiation MR imaging for predicting MRF invasion on the basis of morphologic criteria was 0.80. There was no significant difference between the performance of subjective and morphologic criteria (P = .73-.76). CONCLUSION Postchemoradiation MR imaging findings have moderate accuracy for predicting tumor invasion of the MRF related to the limitation in differentiating between diffuse "fibrotic" tissue with and that without small tumor foci. Specific other types of morphologic patterns at MR imaging can highly predict a tumor-free or invaded MRF.
Collapse
Affiliation(s)
- Roy F A Vliegen
- Department of Radiology, University Hospital Maastricht, P. Debyelaan 25, 6202 AZ, Maastricht, the Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
47
|
Baeten CIM, Castermans K, Lammering G, Hillen F, Wouters BG, Hillen HFP, Griffioen AW, Baeten CGMI. Effects of radiotherapy and chemotherapy on angiogenesis and leukocyte infiltration in rectal cancer. Int J Radiat Oncol Biol Phys 2007; 66:1219-27. [PMID: 17145537 DOI: 10.1016/j.ijrobp.2006.07.1362] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Revised: 07/11/2006] [Accepted: 07/26/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND We and others have shown that angiogenesis and leukocyte infiltration are important prognostic factors in rectal cancer. However, little is known about its possible changes in response to radiotherapy (RTX), which is frequently given to rectal tumors as a neoadjuvant treatment to improve the prognosis. We therefore investigated the biologic effects of RTX on these parameters using fresh-frozen biopsy samples of tumor and normal mucosa tissue before and after RTX. METHODS Biopsy samples were taken from a total of 34 patients before and after either a short course or long course of RTX combined with chemotherapy. The following parameters were analyzed by immunohistochemistry, flow cytometry, or quantitative real-time polymerase chain reaction: Microvessel density, leukocyte infiltration, proliferating epithelial and tumor cells, proliferating endothelial cells, adhesion molecule expression on endothelial cells, and the angiogenic mRNA profile. RESULTS The tumor biopsy samples taken after RTX treatment demonstrated a significant decrease in microvessel density and the number of proliferating tumor cells and proliferating endothelial cells (p < 0.001). In contrast, the leukocyte infiltration, the levels of basic fibroblast growth factor in carcinoma tissue, and the adhesion molecule expression on endothelial cells in normal as well as carcinoma tissue increased significantly (p < 0.05). CONCLUSION Our data show that together with an overall decrease in tumor cell and endothelial cell proliferation, RTX results in an increase in the expression of adhesion molecules that stimulate leukocyte infiltration. This suggests the possibility that, in addition to its direct cytotoxic effect, radiation may also stimulate an immunologic tumor response that could contribute to the documented improvement in local tumor control and distal failure rate of rectal cancers.
Collapse
Affiliation(s)
- Coen I M Baeten
- Angiogenesis Laboratory, Research Institute for Growth and Development (GROW), Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
|
48
|
Abstract
Rectal cancer is common and nodal disease is an independent adverse prognostic factor for patient survival. Accurate demonstration of the presence and location of nodal disease preoperatively may influence management strategies. In this article we review the pathways of nodal spread in rectal cancer and assessment of nodal disease using sonography, CT, and MRI. The use of morphological criteria instead of size criteria has been shown to improve nodal staging by MRI. The potential role of magnetic resonance lymphography and PET imaging in further improving nodal staging accuracy is discussed.
Collapse
Affiliation(s)
- D M Koh
- Academic Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK.
| | | | | |
Collapse
|
|
49
|
Abstract
The management of colon and rectal cancer has changed dramatically over the last 25 years. The use of adjuvant therapies has become standard practice in locally advanced (stage III and selected stage II) colorectal cancer. Improved surgical techniques, chemotherapeutics and radiotherapy are resulting in higher cure rates and the development of agents targeting proliferative and angiogenic pathways offer further promise. Here we explore risk factors for local and distant recurrence after resection of colon and rectal cancer, and the role of adjuvant treatments. Discussion will focus on the evidence base for adjuvant therapies utilised in colorectal cancer, and the treatment of sub-groups such as the elderly and stage II disease. The role of adjuvant radiotherapy in rectal cancer in reduction of recurrence will be explored and the role and optimal methods for surveillance post-curative resection with or without adjuvant therapy will also be addressed.
Collapse
Affiliation(s)
- Suzanne Kosmider
- Department of Medical Oncology and Clinical Haematology, Western Hospital, Footscray 3011, Victoria, Australia
| | | |
Collapse
|
|
50
|
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: 0.4] [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.
Collapse
Affiliation(s)
- C Hoeffel
- Université Paris-Descartes, Faculté de médecine Cochin-Port-Royal, 24 rue du Faubourg St-Jacques, 75014 Paris.
| | | | | | | | | | | | | | | |
Collapse
|