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Boraschi P, Donati F, Cervelli R, Bani K, Morganti R, Furbetta N, Morelli L, Neri E. MR staging of rectal cancer: Comparison between the 2012 and 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guidelines. Eur J Radiol 2024; 181:111804. [PMID: 39471550 DOI: 10.1016/j.ejrad.2024.111804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 10/11/2024] [Accepted: 10/22/2024] [Indexed: 11/01/2024]
Abstract
PURPOSE To compare the adherence of the interpretation and reporting staging system, respectively proposed in the 2012 and 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guidelines for Magnetic Resonance Imaging (MRI) staging of rectal cancer, focusing on the improvement offered by the criteria introduced by 2016 ESGAR guidelines. METHOD Fifty-six patients affected by rectal cancer were included; 25/56 patients underwent upfront surgery; 31 underwent to neo-adjuvant chemo-radiotherapy before surgery. All patients underwent 3 T MRI examination for local staging. All MR exams were evaluated by two radiologists with 20- and 4-years' experience, who were blinded to each other; the T and N stages, the Mesorectal Fascia (MRF) status and the Extramural Vascular Invasion (EMVI) were assessed according to both 2012 and 2016 ESGAR guidelines. The correlation between radiological and pathological findings, as well as the MRI staging were evaluated. RESULTS As to the expert reviewer, no significant differences were found by comparing the MR T and N stages, T and N restaging, MRF status and EMVI according to 2012 and 2016 ESGAR guidelines. As to the 4-years' experience radiologist the MR staging agreement between 2012 and 2016 guidelines was "moderate" in N-stage evaluation and "fair" in T-restaging evaluation. No significant discrepancies were found for other parameters. CONCLUSIONS MRI is a reliable method in rectal cancer staging/restaging. The assessment of T-restaging is improved by adopting the 2016 ESGAR guidelines, especially for non-expert readers; this result could be justified by the introduction of diffusion-weighted imaging. On the contrary, the newest guidelines do not improve the diagnostic performance in assessing nodal staging and restaging.
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Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Radiological Nuclear and Laboratory Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy.
| | - Francescamaria Donati
- 2nd Unit of Radiology, Department of Radiological Nuclear and Laboratory Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Rosa Cervelli
- Unit of Interventional Radiology, Department of Radiological Nuclear and Laboratory Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Kathrine Bani
- Academic Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Riccardo Morganti
- Departmental Section of Statistical Support for Clinical Trials, Pisa University Hospital, Via Roma 67, Pisa 56126, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy
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Pupulim LF, Stolz A. Letter to the Editor regarding the article "Rectal cancer lexicon 2023 revised and updated consensus statement from the Society of Abdominal Radiology Colorectal and Anal Cancer Disease‑Focused Panel" by Sonia Lee et al. Abdom Radiol (NY) 2023; 48:3774-3775. [PMID: 37731067 DOI: 10.1007/s00261-023-04057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Lawrence F Pupulim
- Department of Radiology, Réseau Hospitalier Neuchâtelois, Rue de la Maladière, 45, 2000, Neuchâtel, Switzerland.
| | - Alexandre Stolz
- Department of Radiology, Réseau Hospitalier Neuchâtelois, Rue de la Maladière, 45, 2000, Neuchâtel, Switzerland
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Cicero G, Ascenti G, Blandino A, Booz C, Vogl TJ, Trimarchi R, D'Angelo T, Mazziotti S. Overview of the Large Bowel Assessment using Magnetic Resonance Imaging: Different Techniques for Current and Emerging Clinical Applications. Curr Med Imaging 2022; 18:1031-1045. [PMID: 35362386 DOI: 10.2174/1573405618666220331111237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/29/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
Radiological assessments of the small and large bowel are essential in daily clinical practice. Over X-ray plain films and ultrasound, cross-sectional techniques are considered the most comprehensive imaging modalities. "Cross-sectional techniques" refers to CT and MRI, as stated in the following sentence. In fact, computed tomography and magnetic resonance imaging take great advantage of the three-dimensional appraisal and the extensive evaluation of the abdominal cavity, allowing intestinal evaluation as well as detection of extra-intestinal findings. In this context, the chief advantage of computed tomography is the fast scan time, which is crucial for emergency cases. Nonetheless, it is undeniably impaired using ionizing radiation. As the awareness of radiation exposure is a topic of increasing importance, magnetic resonance imaging is not only becoming a mere alternative but also a primary imaging technique used in assessing intestinal diseases. Specifically, the evaluation of the large bowel through MRI can still be considered relatively uncharted territory. Although it has demonstrated superior accuracy in the assessment of some clinical entities from inflammatory bowel disease to rectal carcinoma, its role needs to be consolidated in many other conditions. Moreover, different technical methods can be applied for colonic evaluation depending on the specific disease and segment involved. This article aims to provide a thorough overview of the techniques that can be utilized in the evaluation of the large bowel and a discussion on the major findings in different colonic pathologies of primary interest.
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Affiliation(s)
- Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Division of Experimental and Translational Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Division of Experimental and Translational Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Renato Trimarchi
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
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Bogveradze N, Lambregts DMJ, El Khababi N, Dresen RC, Maas M, Kusters M, Tanis PJ, Beets-Tan RGH. The sigmoid take-off as a landmark to distinguish rectal from sigmoid tumours on MRI: Reproducibility, pitfalls and potential impact on treatment stratification. Eur J Surg Oncol 2021; 48:237-244. [PMID: 34583878 DOI: 10.1016/j.ejso.2021.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The sigmoid take-off (STO) was recently introduced as a preferred landmark, agreed upon by expert consensus recommendation, to discern rectal from sigmoid cancer on imaging. Aim of this study was to assess the reproducibility of the STO, explore its potential treatment impact and identify its main interpretation pitfalls. METHODS Eleven international radiologists (with varying expertise) retrospectively assessed n = 155 patients with previously clinically staged upper rectal/rectosigmoid tumours and re-classified them using the STO as completely below (rectum), straddling the STO (rectosigmoid) or completely above (sigmoid), after which scores were dichotomized as rectum (below/straddling STO) and sigmoid (above STO), being the clinically most relevant distinction. A random subset of n = 48 was assessed likewise by 6 colorectal surgeons. . RESULTS Interobserver agreement (IOA) for the 3-category score ranged from κ0.19-0.82 (radiologists) and κ0.32-0.72 (surgeons), with highest scores for the most experienced radiologists (κ0.69-0.76). Of the 155 cases, 44 (28%) were re-classified by ≥ 80% of radiologists as sigmoid cancers; 36 of these originally received neoadjuvant treatment which in retrospect might have been omitted if the STO had been applied. Main interpretation pitfalls were related to anatomical variations, borderline cases near the STO and angulation of axial imaging planes. CONCLUSIONS Good agreement was reached for experienced radiologists. Despite considerable variation among less-expert readers, use of the STO could have changed treatment in ±1/4 of patients in our cohort. Identified interpretation pitfalls may serve as a basis for teaching and to further optimize MR protocols.
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Affiliation(s)
- Nino Bogveradze
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology & Developmental Biology - University of Maastricht, Maastricht, the Netherlands; Dept. of Radiology, Acad. F. Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Doenja M J Lambregts
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Najim El Khababi
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology & Developmental Biology - University of Maastricht, Maastricht, the Netherlands
| | | | - Monique Maas
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda Kusters
- Dept. of Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, the Netherlands
| | - Pieter J Tanis
- Dept. of Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology & Developmental Biology - University of Maastricht, Maastricht, the Netherlands
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Jayaprakasam VS, Javed-Tayyab S, Gangai N, Zheng J, Capanu M, Bates DDB, Fuqua JL, Paroder V, Golia-Pernicka J, Gollub MJ, Petkovska I. Does microenema administration improve the quality of DWI sequences in rectal MRI? Abdom Radiol (NY) 2021; 46:858-866. [PMID: 32926212 DOI: 10.1007/s00261-020-02718-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine whether the administration of a microenema immediately prior to rectal magnetic resonance imaging (MRI) decreases the level of gas-related artifacts on diffusion-weighted imaging (DWI) sequences. METHODS This retrospective analysis included 492 (183 baseline and 309 post-total neoadjuvant treatment [TNT]) consecutive MRI scans for rectal cancer from January 2019 to January 2020. Scan-related factors were identified including microenema use (yes or no), field of view (FOV) in DWI (b = 800 or b = 1500), and magnet strength (1.5 T or 3 T). Two readers scored DWI studies for gas-related artifacts and T2-weighted sequences for the amount of intraluminal gas on a 5-point scale. Fisher's exact test and the Rao-Scott Chi-squared test were used to examine associations between microenema use and other factors. Generalized estimating equation and multivariable regression models were performed to examine the effect of microenema use in subgroups of scans for each reader. Cohen's κ was used to assess inter-reader agreement. RESULTS Gas-related artifact levels decreased in scans with microenema overall (P < 0.001) as well as when scans were stratified by FOV (P ≤ 0.003). For both readers, post-TNT scans with microenema showed lower artifact levels overall (P < 0.014 and P < 0.001) and in post-TNT subgroups of axial DWI scans (P ≤ 0.006 and P < 0.001) and scans acquired with a 3 T magnet (P ≤ 0.001 for both FOV). No evidence of decreased artifact level was found for baseline studies. Decreased gas was seen with microenema use (P < 0.001 for both readers). Inter-reader agreement on artifact-level and gas-level assessments ranged from slight to substantial (κ = 0.273-0.685). CONCLUSION Microenema use prior to rectal MRI reduces gas-related artifacts on DWI, including both large and small FOV sequences and particularly on post-TNT scans performed at 3 T, and offers a viable solution to improve DWI quality.
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Cianci R, Cristel G, Agostini A, Ambrosini R, Calistri L, Petralia G, Colagrande S. MRI for Rectal Cancer Primary Staging and Restaging After Neoadjuvant Chemoradiation Therapy: How to Do It During Daily Clinical Practice. Eur J Radiol 2020; 131:109238. [PMID: 32905955 DOI: 10.1016/j.ejrad.2020.109238] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/04/2020] [Accepted: 08/12/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To provide a practical overview regarding the state-of-the-art of the magnetic resonance imaging (MRI) protocol for rectal cancer imaging and interpretation during primary staging and restaging after neoadjuvant chemoradiation therapy (CRT), pointing out technical skills and findings that radiologists should consider for their reports during everyday clinical activity. METHOD Both 1.5T and 3.0T scanners can be used for rectal cancer evaluation, using pelvic phased array external coils. The standard MR protocol includes T2-weighted imaging of the pelvis, high-resolution T2-weighted sequences focused on the tumor and diffusion-weighted imaging (DWI). The mnemonic DISTANCE is helpful for the interpretation of MR images: DIS, for distance from the inferior part of the tumor to the anorectal-junction; T, for T staging; A, for anal sphincter complex status; N, for nodal staging; C, for circumferential resection margin status; and E, for extramural venous invasion. RESULTS Primary staging with MRI is a cornerstone in the preoperative workup of patients with rectal cancer, because it provides clue information for decisions on the administration of CRT and surgical treatment. Restaging after CRT is crucial for treatment planning, and findings on post-CRT MRI correlate with the patient's prognosis and survival. It may be useful to remember the mnemonic word "DISTANCE" to check and describe all the relevant MRI findings necessary for an accurate radiological definition of tumor stage and response to CRT. CONCLUSIONS "DISTANCE" assessment for rectal cancer staging and treatment response estimation after CRT may be helpful as a checklist for a structured reporting.
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Affiliation(s)
- Roberta Cianci
- SS Annunziata Hospital, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Via dei Vestini, 66100 Chieti, Italy
| | - Giulia Cristel
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Department of Radiology, University Hospital "Umberto I - G.M. Lancisi - G. Salesi", Via Conca 71, 60126 Ancona, AN, Italy
| | - Roberta Ambrosini
- Radiology Unit Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, P. le Spedali Civili 1, 25123 Brescia, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
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Yamada I, Yamauchi S, Uetake H, Yasuno M, Kinugasa Y, Saida Y, Tateishi U, Kobayashi D. Diffusion tensor imaging of rectal carcinoma: Clinical evaluation and its correlation with histopathological findings. Clin Imaging 2020; 67:177-188. [PMID: 32829150 DOI: 10.1016/j.clinimag.2020.08.005] [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: 05/03/2020] [Revised: 07/12/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to assess the feasibility of diffusion tensor imaging (DTI) to noninvasively evaluate histological grade and lymph node metastasis in patients with rectal carcinoma (RC). METHODS Thirty-seven consecutive patients with histologically confirmed RC were examined by 1.5-T MRI. DTI was performed using a single-shot echo-planar imaging sequence with b values of 0 and 1000 s/mm2 and motion-probing gradients in nine noncollinear directions. Fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) maps were compared with histopathological findings. RESULTS The FA values (0.357 ± 0.047) of the RCs were significantly lower than those of the normal rectal wall, muscle, prostate, and uterus (P < 0.001 for all), while the AD, MD, and RD values (1.221 ± 0.131, 0.804 ± 0.075, and 0.667 ± 0.057 × 10-3 mm2/s, respectively) were also significantly lower than their respective normal values (P < 0.001 for all). The FA, AD, MD, and RD values for RC additionally showed significant inverse correlations with histological grades (r = -0.781, r = -0.750, r = -0.718, and r = -0.682, respectively; P < 0.001 for all). Further, the FA (0.430 vs. 0.611), AD (1.246 vs. 1.608 × 10-3 mm2/s), MD (0.776 vs. 1.036 × 10-3 mm2/s), and RD (0.651 vs. 0.824 × 10-3 mm2/s) (P < 0.001 for all) of the metastatic and nonmetastatic lymph nodes were significantly different. CONCLUSIONS DTI may be clinically useful for the noninvasive evaluation of histological grade and lymph node metastasis in patients with RC.
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Affiliation(s)
- Ichiro Yamada
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Shinichi Yamauchi
- Department of Colorectal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Uetake
- Department of Colorectal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masamichi Yasuno
- Department of Colorectal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Colorectal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yukihisa Saida
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Kobayashi
- Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan
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Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ. MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management. Radiographics 2019; 39:367-387. [PMID: 30768361 DOI: 10.1148/rg.2019180114] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of rectal MRI and increased radiologist awareness of the key rectal cancer TNM staging features, the mortality rate of rectal cancer has been declining over the past few decades in adults over 50 years of age. Currently, rectal MRI plays a key role in the pre- and posttreatment evaluation of rectal cancer, assisting the multidisciplinary team in tailoring the most appropriate treatment option. The benefits achieved with rectal MRI are strictly dependent on obtaining good-quality images, which is important for the characterization of the main anatomic structures and their relationship with the tumor. In primary staging, rectal MRI helps the radiologist (a) describe the tumor location and morphology, (b) provide its T and N categories, (c) detect the presence of extramural vascular invasion, and (d) identify its relationship with surrounding structures, including the sphincter complex and involvement of the mesorectal fascia. These features help diagnose locally advanced rectal tumors (categories T3c-d, T4, N1, and N2), for which neoadjuvant chemoradiotherapy (CRT) is indicated. In restaging after neoadjuvant CRT, in addition to reassessing the features noted during primary staging, rectal MRI can help in the assessment of treatment response, especially with the emergence of nonsurgical approaches such as "watch and wait." ©RSNA, 2019.
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Affiliation(s)
- Natally Horvat
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Camila Carlos Tavares Rocha
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Brunna Clemente Oliveira
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Iva Petkovska
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Marc J Gollub
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
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Cattapan K, Chulroek T, Wancharoenrung D, Kordbacheh H, Harisinghani M. Can MR imaging be useful in differentiating low rectal cancer from anal cancer? Abdom Radiol (NY) 2019; 44:438-445. [PMID: 30171293 DOI: 10.1007/s00261-018-1759-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the role of pelvic MR imaging in differentiating between low rectal and anal cancers using the pathological results as the gold standard. MATERIALS AND METHODS In this study, retrospective analysis of 100 patients with a history of low rectal (n = 50) or anal (n = 50) cancers who underwent staging pelvic MR imaging before treatment was performed. The following parameters were analyzed: distance from the anal verge to the tumor, percentage of tumor above puborectalis muscle, tumor size, T2W signal intensity, sphincter/levator muscles invasion, organ invasion, and MRI diagnosis. Multivariable logistic regression was performed to determine factors associated with low rectal and anal cancers. Distances from the anal verge to the tumor were compared using receiver-operating characteristic (ROC) curves. RESULTS From the ROC curves, the cut-off value for the distance from the anal verge to the tumor in differentiating between low rectal and anal cancers was 2.1 cm and the area under the ROC curve was 0.90 (95% CI 0.84-0.97). Multivariate logistic regression revealed three significant factors in differentiating between low rectal and anal cancers, including T2 mixed hyper- and hyposignal intensity (OR 66.00, 95% CI 4.66-934.81), distance cut-off value (OR 34.72, 95% CI 5.73-210.27), and absence of sphincter invasion (OR 18.75, 95% CI 1.91-183.96), with sensitivity, specificity, PPV, and NPV of 98%, 88%, 89%, and 97%, respectively, and diagnostic accuracy increased from 79% (reader 1) and 82% (reader 2) to 93%. CONCLUSION MR imaging can be useful to differentiating between low rectal and anal cancers which benefits staging and treatment planning.
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Affiliation(s)
- Kamonwon Cattapan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
- Department of Radiology, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thitinan Chulroek
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
- Department of Diagnostic Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Dearada Wancharoenrung
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
- Department of Diagnostic Radiology, Faculty of Medicine, Vajira Hospital, Nawamindradhiraj University, Bangkok, Thailand
| | - Hamed Kordbacheh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Mukesh Harisinghani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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Li F, Zhang W, Li J, Zhu X, Chen H, Wu Y, Wang J. The clinical application value of MR diffusion-weighted imaging in the diagnosis of rectal cancer: A retrospective study. Medicine (Baltimore) 2018; 97:e13732. [PMID: 30572512 PMCID: PMC6319922 DOI: 10.1097/md.0000000000013732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The present study evaluated the clinical potential of magnetic resonance (MR) diffusion-weighted imaging (DWI) in the diagnosis of rectal cancer.A total of 84 patients confirmed with rectal cancer were used as study subjects in the present study. All patients received conventional sequence MR T1WI, T2WI, and DWI examination as well as operative pathological examination. The differences between the MRI results and operative pathological results were analyzed.The diagnosis accordance rates of conventional sequence examination in stage T1, T2, T3, and T4 were 60.00%, 82.75%, 62.85%, and 80.00%, respectively. The diagnosis accordance rates of conventional sequence combined with DWI examination in stages T1, T2, T3, and T4 were 100.00%, 100.00%, 82.85%, and 100.00% respectively. The total diagnosis accordance rates in the T staging of rectal cancer with conventional (Routinely or generally applied) sequence examination and conventional sequence combined with DWI examination were 71.42% and 92.85%, respectively.The analysis on consistency of MR conventional sequence examination suggested that the conventional sequence combined with DWI examination is more consistent with pathological staging when compared with the convention sequence examination alone. MR DWI combined with conventional sequences reveals quite good accuracy in the T staging of rectal cancer.
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Yamada I, Hikishima K, Yoshino N, Sakamoto J, Miyasaka N, Yamauchi S, Uetake H, Yasuno M, Saida Y, Tateishi U, Kobayashi D, Eishi Y. Colorectal carcinoma: Ex vivo evaluation using q-space imaging; Correlation with histopathologic findings. J Magn Reson Imaging 2018; 48:1059-1068. [DOI: 10.1002/jmri.26018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/06/2018] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ichiro Yamada
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School; Tokyo Medical and Dental University; Tokyo Japan
| | - Keigo Hikishima
- Okinawa Institute of Science and Technology Graduate University; Okinawa Japan
| | - Norio Yoshino
- Department of Oral and Maxillofacial Radiology; Tokyo Medical and Dental University; Tokyo Japan
| | - Junichiro Sakamoto
- Department of Oral and Maxillofacial Radiology; Tokyo Medical and Dental University; Tokyo Japan
| | - Naoyuki Miyasaka
- Department of Comprehensive Reproductive Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Shinichi Yamauchi
- Department of Colorectal Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroyuki Uetake
- Department of Colorectal Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Masamichi Yasuno
- Department of Colorectal Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Yukihisa Saida
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School; Tokyo Medical and Dental University; Tokyo Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School; Tokyo Medical and Dental University; Tokyo Japan
| | - Daisuke Kobayashi
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoshinobu Eishi
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
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12
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Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.16801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Engin G, Sharifov R. Magnetic resonance imaging for diagnosis and neoadjuvant treatment evaluation in locally advanced rectal cancer: A pictorial review. World J Clin Oncol 2017; 8:214-229. [PMID: 28638791 PMCID: PMC5465011 DOI: 10.5306/wjco.v8.i3.214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/14/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
High-resolution pelvic magnetic resonance imaging (MRI) is the primary method for staging rectal cancer. MRI is highly accurate in the primary staging of rectal cancer; however, it has not proven to be effective in re-staging, especially in complete response evaluation after neoadjuvant therapy. Neoadjuvant chemoradiotherapy produces many changes in rectal tumors and on adjacent area, as a result, local tumor extent may not be accurately determined. However, adding diffusion-weighted sequences to the standard approach can improve diagnostic accuracy. In this pictorial review, an overview of the situation of MRI in the staging and re-staging of rectal cancer is exhibited as a pictorial assay. An experience- and literature-based discussion of limitations and difficulties in interpretation are also presented.
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14
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Gangadhar K, Mahajan A, Sable N, Bhargava P. Magnetic Resonance Imaging of Pelvic Masses: A Compartmental Approach. Semin Ultrasound CT MR 2017; 38:213-230. [PMID: 28705369 DOI: 10.1053/j.sult.2016.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic mass can arise from any tissue present within the pelvis. Although most masses in the female pelvis arise from the reproductive organs, masses may also arise from the gastrointestinal tract, urinary system, adjacent soft tissues, peritoneum, etc. It may not always be possible to determine the site of origin or distinguish these masses based on imaging characteristics. However, familiarity with the clinicopathologic and MRI features of most common pelvic masses helps in narrowing the differential diagnosis. Diagnosis of these masses needs a holistic approach as required for any tumor including clinical history, laboratory data, and imaging characteristics. We focus on MRI characteristics of commonly encountered pelvic masses. A compartmental imaging approach is discussed in this article that helps in identifying and characterizing these masses.
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Affiliation(s)
- Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Nilesh Sable
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
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15
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Yamada I, Yoshino N, Hikishima K, Miyasaka N, Yamauchi S, Uetake H, Yasuno M, Saida Y, Tateishi U, Kobayashi D, Eishi Y. Colorectal carcinoma: Ex vivo evaluation using 3-T high-spatial-resolution quantitative T2 mapping and its correlation with histopathologic findings. Magn Reson Imaging 2017; 38:174-181. [DOI: 10.1016/j.mri.2016.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/31/2016] [Accepted: 12/31/2016] [Indexed: 01/13/2023]
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16
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Lee CC, Chen PC, Chen HH, Huang CC, Lin LH, Ng SH, Chen MC, Ko SF. Effectiveness of a Tailored Anterior Saturation Band in the Improvement of the Image Quality of Pelvic Magnetic Resonance for Assessing Rectal Cancer. Clin Colorectal Cancer 2017; 16:187-194. [PMID: 28209482 DOI: 10.1016/j.clcc.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/13/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE We sought to test the effectiveness of the application of a tailored anterior saturation band (ASB) to improve the image quality of pelvic magnetic resonance imaging (MRI) for assessing rectal cancer. METHODS A total of 165 patients with MRI assessment of rectal cancer between 2013 and 2015 were included. The image quality scores (4-point scale: 1, nondiagnostic through 4, excellent) of MRI without and with tailored ASBs were compared. Sensitivity, specificity, positive and negative predictive values, and accuracy of pelvic MRIs with and without a tailored ASB for T-staging in 65 patients with direct surgery and 67 patients with chemoradiotherapy before surgery were evaluated. RESULTS Two independent raters exhibited moderate-to-excellent interobserver agreements (κ = 0.529-0.879) in the grading of MRI image quality. Overall, the quality scores of sagittal and axial T2-weighted images with tailored ASBs were significantly improved compared with MRIs without ASBs (3.5 ± 0.3 vs. 2.7 ± 0.8 [mean ± SD]; P < .001, and 3.6 ± 0.3 vs. 2.8 ± 0.8; P < .001, respectively). The application of tailored ASBs in MRIs improved the averaged accuracies for staging of ≤ T2, T3, and T4 tumors from 87.7%, 78.5%, and 90.8% to 93.1%, 86.9%, and 97.7%, respectively. In post-chemoradiotherapy MRI follow-ups, the use of tailored ASBs also improved the average accuracies for staging of yT0, yT1-2, yT3, and yT4 tumors from 80.6%, 73.1%, 73.9%, and 91.0%, to 85.8%, 82.9%, 85.1%, and 94.0%, respectively. CONCLUSIONS Application of a tailored ASB in pelvic MRI is effective in substantially reducing motion artifacts, significantly upgrading image quality, and improving accuracies of rectal tumor staging.
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Affiliation(s)
- Chen-Chang Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Po-Chou Chen
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hong-Hwa Chen
- Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Cheng Huang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li-Han Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Hang Ng
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Chi Chen
- Biostatistics Consulting Center and Department of Public Health, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheung-Fat Ko
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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17
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Essential Items for Structured Reporting of Rectal Cancer MRI: 2016 Consensus Recommendation from the Korean Society of Abdominal Radiology. Korean J Radiol 2017; 18:132-151. [PMID: 28096724 PMCID: PMC5240498 DOI: 10.3348/kjr.2017.18.1.132] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/21/2016] [Indexed: 12/30/2022] Open
Abstract
High-resolution rectal MRI plays a crucial role in evaluating rectal cancer by providing multiple prognostic findings and imaging features that guide proper patient management. Quality reporting is critical for accurate effective communication of the information among multiple disciplines, for which a systematic structured approach is beneficial. Existing guides on reporting of rectal MRI are divergent on some issues, largely reflecting the differences in overall management of rectal cancer patients between the United States and Europe. The Korean Society of Abdominal Radiology (KSAR) study group for rectal cancer has developed an expert consensus recommendation regarding essential items for structured reporting of rectal cancer MRI using a modified Delphi method. This recommendation aims at presenting an up-to-date, evidence-based, practical, structured reporting template that can be readily adopted in daily clinical practice. In addition, a thorough explanation of the clinical and scientific rationale underlying the reporting items and their formats is provided. This KSAR recommendation may serve as a useful tool to help achieve more standardized optimal care for rectal cancer patients using rectal MRI.
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18
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Hassan TA, Abdel-Rahman HM, Ali HY. Utility of high resolution MRI for pre-operative staging of rectal carcinoma, involvement of the mesorectal fascia and circumferential resection margin. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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19
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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.
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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
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20
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Lee DH, Lee JM. Whole-body PET/MRI for colorectal cancer staging: Is it the way forward? J Magn Reson Imaging 2016; 45:21-35. [DOI: 10.1002/jmri.25337] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Dong Ho Lee
- Department of Radiology; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
| | - Jeong Min Lee
- Department of Radiology; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
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21
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Abstract
Magnetic resonance imaging (MRI) with rectal protocol modification is a reliable staging modality which is rapidly replacing transrectal ultrasound for staging. The added information delivered by MRI includes wide circumferential radial margin compromise, distant lymph node metastasis in the pelvis, and level of sphincter compromise in the low rectum. As more information becomes available through ongoing studies, MRI may be able to contribute the decision to treat rectal cancer nonoperatively.
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Affiliation(s)
- Gregory dePrisco
- Department of Radiology, Body MRI Division, Baylor University Medical Center, Dallas, Texas
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22
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Hassan I, Wise PE, Margolin DA, Fleshman JW. The Role of Transanal Surgery in the Management of T1 Rectal Cancers. J Gastrointest Surg 2015; 19:1704-12. [PMID: 26048145 DOI: 10.1007/s11605-015-2866-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/25/2015] [Indexed: 02/06/2023]
Abstract
The management of T1 rectal cancers is based on finding the balance between optimal oncologic outcomes and acceptable functional results for the patient. While radical resection involving a proctectomy is considered the most oncologically adequate option, its adverse effects on patient reported outcomes makes this a less than ideal choice in certain circumstances. While local excision can circumvent some of the adverse functional outcomes, its inadequacy in assessing metastatic lymph node disease and the subsequent negative impact of untreated positive lymph nodes on patient prognosis is a cause for concern. As a result, the therapeutic strategy has to be based on patient and disease-related factors in order to identify the best treatment choice that maximizes survival benefit and preserves health-related quality of life. After adequate preoperative staging work up, in selected patients with favorable pathological features, local excision can be considered. These cancers can be removed by transanal local excision or transanal endoscopic microsurgery, depending on the location of the cancer and expertise available. While perioperative morbidity is minimal, close postoperative follow-up is essential.
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Affiliation(s)
- Imran Hassan
- Department of Surgery, University of Iowa, Iowa City, IA, USA,
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23
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van der Pol CB, Shabana WM, McInnes MD, Schieda N. High-resolution T2-weighted (T2W) oblique plane turbo spin-echo (TSE) MRI for rectal adenocarcinoma staging. Clin Imaging 2015; 39:627-31. [DOI: 10.1016/j.clinimag.2015.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/21/2015] [Indexed: 01/25/2023]
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24
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Guillem JG, Bertelsen C. Total proctocolectomy for rectal cancer in Lynch syndrome: indications and considerations. COLORECTAL CANCER 2015. [DOI: 10.2217/crc.15.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Patients with Lynch syndrome and rectal cancer present a unique clinical challenge. Management of the primary rectal cancer and prophylactic removal of the colon should be considered. In patients requiring a mesorectal excision, a combined prophylactic colon removal can be considered. Although surveillance of the colon with frequent colonoscopies is an alternative, concerns of metachronous colon cancer development support prophylactic removal of the colon as an alternative. Since data are not available to confirm superiority of either approach, the final decision is greatly dependent upon a patient's wishes and preferences. Patients interested in pursuing simultaneous prophylactic colon removal can be offered total proctocolectomy with either ileal pouch anal-anastomosis as a sphincter-preserving alternative or a total proctocolectomy with end ileostomy.
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Affiliation(s)
- Jose G Guillem
- Memorial Sloan Kettering Cancer Center, Department of Surgery, Colorectal Service, 1275 York Avenue, C1077, New York, NY 10065, USA
| | - Corinna Bertelsen
- Memorial Sloan Kettering Cancer Center, Department of Surgery, Colorectal Service, 633 3rd Avenue, 1584A, New York, NY 10017, USA
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25
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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.
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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
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26
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Algebally AM, Mohey N, Szmigielski W, Yousef RRH, Kohla S. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging. Pol J Radiol 2015; 80:115-21. [PMID: 25806096 PMCID: PMC4356185 DOI: 10.12659/pjr.892583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/15/2014] [Indexed: 01/19/2023] Open
Abstract
Background The purpose of the study was to identify the accuracy of high-resolution MRI in the pre-operative assessment of mesorectal fascia involvement, circumfrential resection margin (CRM) and local staging in patients with rectal carcinoma. Material/Methods The study included 56 patients: 32 male and 24 female. All patients underwent high-resolution MRI and had confirmed histopathological diagnosis of rectal cancer located within 15 cm from the anal verge, followed by surgery. MRI findings were compared with pathological and surgical results. Results The overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI-based T-staging were 92.8, 88.8%, 96.5%, 96%, and 90.3%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based assessment of CRM were 94.6%, 84.6%, 97.6%, 91.4, and 94.6%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based N-staging were 82.1%, 75%, 67.3%, 60%, and 86.1%, respectively. Conclusions Preoperative high-resolution rectal MRI is accurate in predicting tumor stage and CRM involvement. MRI is a precise diagnostic tool to select patients who may benefit from neo-adjuvant therapy and to avoid overtreatment in those patients who can proceed directly to surgery.
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Affiliation(s)
| | - Nesreen Mohey
- Department of Diagnostic Imaging and Nuclear Medicine, Zagazig University, Zagazig, Egypt
| | - Wojciech Szmigielski
- Department of Clinical Imaging, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Samah Kohla
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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27
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Synchronous rectal and prostate cancer--the impact of MRI on incidence and imaging findings. Eur J Radiol 2015; 84:563-7. [PMID: 25638578 DOI: 10.1016/j.ejrad.2014.12.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/29/2014] [Accepted: 12/31/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the incidence of synchronous diagnosis of rectal and prostate cancer and to identify how the role of magnetic resonance imaging (MRI) for preoperative staging of rectal cancer has affected the incidence. METHODS Regional data from the Swedish Colorectal Cancer Registry and the Regional Cancer Registry in Stockholm-Gotland area (two million inhabitants) between the years 1995-2011 were used. Patients were included when the rectal cancer was diagnosed prior to the prostate cancer. Medical records and pre-treatment MRI were retrospectively reviewed. RESULTS Of 29,849 patients diagnosed with either disease, synchronous diagnosis was made in 29 patients (0.1%). Two patients were diagnosed in the years 1995-1999, seven patients between the years 2000-2005 and 20 patients between the years 2006-2011. The most common presentation, for the prostate cancer was incidental finding during staging for rectal cancer, n=20, and of those led MRI to the diagnosis in 14 cases. At retrospective review, all patients had focal lesions in the prostate on MRI and patients with higher suspicion of malignancy on MRI had more locally advanced disease. CONCLUSION Synchronous rectal and prostate cancer are a rare entity, but a strong increase in synchronous diagnosis is seen which may be attributed to improved diagnostic methods, including the use of pre-treatment MRI in routine work-up for rectal cancer.
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28
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Kijima S, Sasaki T, Nagata K, Utano K, Lefor AT, Sugimoto H. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol 2014; 20:16964-16975. [PMID: 25493009 PMCID: PMC4258565 DOI: 10.3748/wjg.v20.i45.16964] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/13/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
Imaging studies are a major component in the evaluation of patients for the screening, staging and surveillance of colorectal cancer. This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography (CT) colonography, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT colonography. CT colonography provides important information for the preoperative assessment of T staging. Wall deformities are associated with muscular or subserosal invasion. Lymph node metastases from colorectal cancer often present with calcifications. CT is superior to detect calcified metastases. Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery. T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure. N staging in patients with colorectal cancer is still challenging using any imaging modality. MRI is more accurate than CT for the evaluation of liver metastases. PET/CT colonography is valuable in the evaluation of extra-colonic and hepatic disease. PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically. PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely. However, there is no definite evidence to support the routine clinical use of PET/CT colonography.
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29
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Virmani V, Ramanathan S, Virmani VS, Ryan J, Fasih N. What is hiding in the hindgut sac? Looking beyond rectal carcinoma. Insights Imaging 2014; 5:457-71. [PMID: 25038846 PMCID: PMC4141340 DOI: 10.1007/s13244-014-0347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/14/2014] [Accepted: 07/03/2014] [Indexed: 11/08/2022] Open
Abstract
Objectives Although rectal cancer is by far and large the most common pathology involving the rectum that needs imaging, there are many other important but less common pathological conditions affecting anorectal region. The objective of this pictorial review is to discuss the cross-sectional imaging features of less common anorectal and perirectal diseases. Results Although a specific histological diagnosis cannot usually be made due to considerable overlap in the imaging appearances of anorectal diseases, this review illustrates the cross-sectional imaging findings with emphasis on magnetic resonance imaging (MRI) that can help in narrowing down the differentials to a reasonable extent. Teaching points • Variety of pathology exists in the anorectum apart from common rectal carcinoma • Anorectal diseases present as non-specific wall thickening indistinguishable from rectal carcinoma • Computed tomography (CT) and MRI can help in narrowing down the differentials, although often biopsy is warranted.
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Affiliation(s)
- Vivek Virmani
- Department of Diagnostic Imaging, The Ottawa Hospital, General campus, University of Ottawa, 501 Smyth road, Ottawa, ON, K1S8L6, Canada
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30
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Abtahi SM, Mao Y, Prapruttam D, Elmi A, Hedgire SS. Magnetic resonance imaging of pelvic metastases in male patients. Magn Reson Imaging Clin N Am 2014; 22:201-15, vi. [PMID: 24792678 DOI: 10.1016/j.mric.2014.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Magnetic resonance (MR) imaging offers a noninvasive tool for diagnosis of primary and metastatic pelvic tumors. The diagnosis of a pelvic metastatic lesion implies an adverse prognosis and dictates the management strategies. Knowledge of normal MR imaging anatomy of the pelvis and the signal characteristics of normal and abnormal structures is essential for accurate interpretation of pelvic MR imaging. This article reviews imaging manifestations of nodal, visceral, and musculoskeletal metastatic lesions of the pelvis along with current and evolving MR imaging techniques.
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Affiliation(s)
- Seyed Mahdi Abtahi
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Yun Mao
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Duangkamon Prapruttam
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Azadeh Elmi
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Sandeep S Hedgire
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
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Heo SH, Kim JW, Shin SS, Jeong YY, Kang HK. Multimodal imaging evaluation in staging of rectal cancer. World J Gastroenterol 2014; 20:4244-4255. [PMID: 24764662 PMCID: PMC3989960 DOI: 10.3748/wjg.v20.i15.4244] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/20/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Rectal cancer is a common cancer and a major cause of mortality in Western countries. Accurate staging is essential for determining the optimal treatment strategies and planning appropriate surgical procedures to control rectal cancer. Endorectal ultrasonography (EUS) is suitable for assessing the extent of tumor invasion, particularly in early-stage or superficial rectal cancer cases. In advanced cases with distant metastases, computed tomography (CT) is the primary approach used to evaluate the disease. Magnetic resonance imaging (MRI) is often used to assess preoperative staging and the circumferential resection margin involvement, which assists in evaluating a patient’s risk of recurrence and their optimal therapeutic strategy. Positron emission tomography (PET)-CT may be useful in detecting occult synchronous tumors or metastases at the time of initial presentation. Restaging after neoadjuvant chemoradiotherapy (CRT) remains a challenge with all modalities because it is difficult to reliably differentiate between the tumor mass and other radiation-induced changes in the images. EUS does not appear to have a useful role in post-therapeutic response assessments. Although CT is most commonly used to evaluate treatment responses, its utility for identifying and following-up metastatic lesions is limited. Preoperative high-resolution MRI in combination with diffusion-weighted imaging, and/or PET-CT could provide valuable prognostic information for rectal cancer patients with locally advanced disease receiving preoperative CRT. Based on these results, we conclude that a combination of multimodal imaging methods should be used to precisely assess the restaging of rectal cancer following CRT.
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Partovi S, Kohan A, Rubbert C, Vercher-Conejero JL, Gaeta C, Yuh R, Zipp L, Herrmann KA, Robbin MR, Lee Z, Muzic RF, Faulhaber P, Ros PR. Clinical oncologic applications of PET/MRI: a new horizon. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2014; 4:202-212. [PMID: 24753986 PMCID: PMC3992213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 01/13/2014] [Indexed: 06/03/2023]
Abstract
Positron emission tomography/magnetic resonance imaging (PET/MRI) leverages the high soft-tissue contrast and the functional sequences of MR with the molecular information of PET in one single, hybrid imaging technology. This technology, which was recently introduced into the clinical arena in a few medical centers worldwide, provides information about tumor biology and microenvironment. Studies on indirect PET/MRI (use of positron emission tomography/computed tomography (PET/CT) images software fused with MRI images) have already generated interesting preliminary data to pave the ground for potential applications of PET/MRI. These initial data convey that PET/MRI is promising in neuro-oncology and head & neck cancer applications as well as neoplasms in the abdomen and pelvis. The pediatric and young adult oncology population requiring frequent follow-up studies as well as pregnant woman might benefit from PET/MRI due to its lower ionizing radiation dose. The indication and planning of therapeutic interventions and specifically radiation therapy in individual patients could be and to a certain extent are already facilitated by performing PET/MRI. The objective of this article is to discuss potential clinical oncology indications of PET/MRI.
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Affiliation(s)
- Sasan Partovi
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Andres Kohan
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Christian Rubbert
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Jose Luis Vercher-Conejero
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Chiara Gaeta
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Roger Yuh
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Lisa Zipp
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical CenterCleveland, Ohio
| | - Karin A Herrmann
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Mark R Robbin
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Zhenghong Lee
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Raymond F Muzic
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Peter Faulhaber
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
| | - Pablo R Ros
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve UniversityCleveland, Ohio
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Torkzad MR, Kamel I, Halappa VG, Beets-Tan RGH. Magnetic resonance imaging of rectal and anal cancer. Magn Reson Imaging Clin N Am 2013; 22:85-112. [PMID: 24238134 DOI: 10.1016/j.mric.2013.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Magnetic resonance imaging plays a pivotal role in the imaging and staging of rectal and anal carcinomas. Rectal adenocarcinomas and anal squamous cell carcinomas behave differently, and are staged and treated differently. This article attempts to explain these 2 entities, which share the same regions of interest, in a comprehensive manner.
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Affiliation(s)
- Michael R Torkzad
- Section of Radiology, Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala 75185, Sweden.
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Uçar A, Obuz F, Sökmen S, Terzi C, Sağol O, Sarıoğlu S, Füzün M. Efficacy of high resolution magnetic resonance imaging in preoperative local staging of rectal cancer. Mol Imaging Radionucl Ther 2013; 22:42-8. [PMID: 24003396 PMCID: PMC3759308 DOI: 10.4274/mirt.43153] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/13/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the efficacy of high-resolution magnetic resonance imaging (HRMRI) for preoperative local staging in patients with rectal cancer who did not receive preoperative radiochemotherapy. METHODS In this retrospective study, 30 patients with biopsy proved primary rectal cancer were evaluated by HRMRI. Two observers independently scored the tumour and lymph node stages, and circumferential resection margin (CRM) involvement. The sensitivity, specificity, the negative predictive value and the positive predictive value of HRMRI findings were calculated within the 95% confidence interval. The area under the curve was measured for each result. Agreement between two observers was assessed by means of the Kappa test. RESULTS In T staging the accuracy rate of HRMRI was 47-67%, overstaging was 10-21%, and understaging was 13-43%. In the prediction of extramural invasion with HRMRI, the sensitivity was 79-89%, the specificity was 72-100%, the PPV was 85-100%, the NPV was 73-86%, and the area under the curve was 0.81-0.89. In the prediction of lymph node metastasis, the sensitivity was 58-58%, the specificity was 50-55%, the PPV was 43-46%, and the NPV was 64-66%. The area under the curve was 0.54-0.57. When the cut off value was selected as 1 mm, the sensitivity of HRMRI was 38-42%, the specificity was 73-82%, the PPV was 33-42%, and NPV was 79-81% in the prediction of the CRM involvement. The correlation between the two observers was moderate for tumour staging, substantial for lymph node staging and predicting of CRM involvement. CONCLUSION Preoperative HRMRI provides good predictive data for extramural invasion but poor prediction of lymph node status and CRM involvement. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Aysun Uçar
- Dokuz Eylül University, Department of Radiology, İzmir, Turkey
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