J Korean Soc Radiol.  2014 Feb;70(2):123-132. 10.3348/jksr.2014.70.2.123.

Diagnostic Accuracy of Computed Tomography and Magnetic Resonance Imaging Obtained after Neoadjuvant Chemoradiotherapy in Predicting the Local Tumor Stage and Circumferential Resection Margin Status of Rectal Cancer

• Park JH
• Kim YH
• Lee SM
• Lee YJ
• Lee KH
• Kang SB
• Kim DW
• Kim JH
• Kim JS
• Lee HS

• KMID: 1839421
• DOI: http://doi.org/10.3348/jksr.2014.70.2.123

Abstract

PURPOSE
To measure the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) obtained after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer for a prediction of the local tumor stage and circumferential resection margin (CRM).
MATERIALS AND METHODS
Two independent radiologists reviewed CT and MRI obtained after neoadjuvant CRT. The accuracy of the local tumor staging and the diagnostic performance for the prediction of CRM involvement were calculated. The agreement between the measurements of the distance to potential CRM on both imaging modalities and the histopathology findings was assessed using Bland-Altman plots.
RESULTS
57 patients (mean age, 59.2 years; 24 females) were included. The accuracy of T and N staging were 43.9% (95% confidence interval, 30.8-57.7%) and 77.2% (64.2-87.3%) on CT and 63.2% (49.4-75.6%) and 77.2% (64.2-87.3%) on MRI for Observer 1. The accuracy of T and N staging were 54.4% (40.7-67.7%) and 77.2% (64.2-87.3%) on CT and 68.4% (54.7-80.1%) and 80.7% (68.1-90.0%) on MRI for Observer 2. Sensitivity and specificity on CRM involvement were 83.3% (43.7-97.0%) and 88.2% (76.6-94.5%) on CT and 100% (61.0-100%) and 90.2% (79.0-95.7%) on MRI for Observer 1. Sensitivity and specificity on CRM involvement were 66.7% (30.0-90.3%) and 88.2% (76.7-94.5%) on CT and 100% (61.0-100%) and 90.2% (79.0-95.7%) on MRI for Observer 2. Bland-Altman plots showed wide discrepancies between measurements of the distance to CRM on each CT and MRI and those on histopathology findings.
CONCLUSION
CT and MRI showed limited performance in predicting the local tumor staging and CRM involvement in patients with neoadjuvant CRT although MRI tended to show a better performance than CT

MeSH Terms

Chemoradiotherapy*
Humans
Magnetic Resonance Imaging*
Multidetector Computed Tomography
Neoplasm Staging
Rectal Neoplasms*
Sensitivity and Specificity

Figure

• 

  Fig. 1 CT image of a 51-year-old male with T3 rectal cancer and clear circumferencial resection margin. The mesorectal fascia is shown as a linear soft tissue-density structure surrounding the mesorectum (arrows). The distance was measured as the shortest distance from the outermost part of the tumor to the adjacent mesorectal fascia at the level of the maximum depth of penetration through the rectal wall.

• 

  Fig. 2 MR image of a 59-year-old female with T3 rectal cancer and involved circumferential resection margin. The mesorectal fascia is shown as a hypo-intense linear structure (arrows). The distance from tumor to mesorectal fascia was 0 mm, and it was 1 mm on histopathology.

• 

  Fig. 3 Bland-Altman plot of differences between post-chemoradiotherapy CT and histopathology in distance measurements from the tumor to circumferential resection margin (CRM) for Observer 1. The limits of agreement (-5.5 mm and 7.7 mm) are not small enough to use CT and histopathology interchangeably in the assessment of distance to CRM. Note.-X-axis = distance from the tumor and the CRM measured on histopathology, Y-axis = difference between the distances measured on CT and histopathology, solid line = mean difference, dashed line = limit of agreement

• 

  Fig. 4 Bland-Altman plot of differences between post-chemoradiotherapy CT and histopathology in distance measurements from the tumor to the circumferential resection margin (CRM) for Observer 2. The limits of agreement (-6.1 mm and 10.5 mm) are not small enough to use CT and histopathology interchangeably in the assessment of distance to CRM. Note.-X-axis = distance from the tumor and the CRM measured on histopathology, Y-axis = difference between the distances measured on CT and histopathology, solid line = mean difference, dashed line = limit of agreement

• 

  Fig. 5 Bland-Altman plot of difference between post-chemoradiotherapy MRI and histopathology in distance measurements from the tumor to the circumferential resection margin (CRM) for Observer 1. The limits of agreement (-3.8 mm and 6.2 mm) are not small enough to use MRI and histopathology interchangeably in the assessment of distance to CRM. Note.-X-axis = distance from the tumor and the CRM measured on histopathology, Y-axis = difference between the distances measured on MRI and histopathology, solid line = mean difference, dashed line = limit of agreement

• 

  Fig. 6 Bland-Altman plot of difference between post-chemoradiotherapy MRI and histopathology in distance measurements from the tumor to the circumferential resection margin (CRM) for Observer 2. The limits of agreement (-4.2 mm and 7.3 mm) are not small enough to use CT and histopathology interchangeably in the assessment of distance to CRM. Note.-X-axis = distance from the tumor and the CRM measured on histopathology, Y-axis = difference between the distances measured on MRI and histopathology, solid line = mean difference, dashed line = limit of agreement

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