Korean J Radiol.  2014 Feb;15(1):37-44. 10.3348/kjr.2014.15.1.37.

Accuracy of High-Resolution MRI with Lumen Distention in Rectal Cancer Staging and Circumferential Margin Involvement Prediction

• Iannicelli E
• Di Renzo S
• Ferri M
• Pilozzi E
• Di Girolamo M
• Sapori A
• Ziparo V
• David V

• KMID: 1711475
• DOI: http://doi.org/10.3348/kjr.2014.15.1.37

Abstract

OBJECTIVE
To evaluate the accuracy of magnetic resonance imaging (MRI) with lumen distention for rectal cancer staging and circumferential resection margin (CRM) involvement prediction.
MATERIALS AND METHODS
Seventy-three patients with primary rectal cancer underwent high-resolution MRI with a phased-array coil performed using 60-80 mL room air rectal distention, 1-3 weeks before surgery. MRI results were compared to postoperative histopathological findings. The overall MRI T staging accuracy was calculated. CRM involvement prediction and the N staging, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed for each T stage. The agreement between MRI and histological results was assessed using weighted-kappa statistics.
RESULTS
The overall MRI accuracy for T staging was 93.6% (k = 0.85). The accuracy, sensitivity, specificity, PPV and NPV for each T stage were as follows: 91.8%, 86.2%, 95.5%, 92.6% and 91.3% for the group < or = T2; 90.4%, 94.6%, 86.1%, 87.5% and 94% for T3; 98,6%, 85.7%, 100%, 100% and 98.5% for T4, respectively. The predictive CRM accuracy was 94.5% (k = 0.86); the sensitivity, specificity, PPV and NPV were 89.5%, 96.3%, 89.5%, and 96.3% respectively. The N staging accuracy was 68.49% (k = 0.4).
CONCLUSION
MRI performed with rectal lumen distention has proved to be an effective technique both for rectal cancer staging and involved CRM predicting.

Keyword

Rectum MR; Rectum NEOPLASM; Rectum staging

MeSH Terms

Adult
Aged
*Air
Dilatation/methods
Female
Humans
Magnetic Resonance Imaging/*methods/standards
Male
Middle Aged
Neoplasm Staging/*methods
Prospective Studies
Rectal Neoplasms/*pathology/surgery
Rectum/*pathology
Sensitivity and Specificity

Figure

• 

  Fig. 1 Two intramural rectal cancers. High-resolution TSE T2-weighted scans on sagittal (A) and axial plane (B) show intramural rectal cancer: distention of rectal lumen allows good delineation of polipoid lesion with normal aspect of muscular layer (arrow). Histo-pathological specimen detected pT1 lesion. In another patient high-resolution TSE T2-weighted scans on sagittal (C) and axial plane (D) demonstrate tumor confined to muscular layer (arrows) without any involvement of perirectal adipous tissue. Histo-pathological specimen detected pT2 lesion. TSE = Turbo Spin Echo

• 

  Fig. 2 High-resolution Turbo Spin Echo T2-weighted scans on sagittal (A) and axial plane (B) show T2-stage low rectal cancer. Muscular layer appears normal both on sagittal and axial scan and insufflation of rectal lumen does not modify detection of mesorectal fat tissue anteriorly.

• 

  Fig. 3 High-resolution Turbo Spin Echo T2-weighted axial scan of T3 rectal cancer in three different patients. In first patient (A) early T3 lesion is depicted with spiculations spreading through muscular layer into perirectal fat; lymph-node is located in mesorectum on right side. In second patient (B) MRI shows circumferential rectal mass with deep parietal infiltration spreading in perirectal fat tissue, without any involvement of CRM (> 2 mm). In third patient (C) axial scan shows large rectal mass with deep extra-mural neoplastic infiltration that involves mesorectal fascia both on anterior and left lateral side with positive CRM; some metastatic lymph nodes are depicted in mesorectal fat tissue. CRM = circumferential resection margin

• 

  Fig. 4 T3 rectal cancer involving circumferential resection margin. High-resolution Turbo Spin Echo T2-weighted axial scans at two different level show circumferential rectal mass spreading widely into perirectal fat (A). Tumor's deposits in mesorectum are less than 2 mm from mesorectal fascia (B) and involvement of circumferential resection margin was established.

• 

  Fig. 5 Borderline T3 rectal cancer. High-resolution Turbo Spin Echo T2-weighted scans on sagittal (A), axial (B) and coronal plane (C) show borderline T3-stage rectal neoplasm. Hypointense strands into mesorectum are difficult to characterize. Differentiation between mesorectal tumour infiltration and desmoplastic reaction is often unfeasible. Histological specimen detected pT2 neoplasm.

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