Radiologic and Pathological Correlation of Staging of Rectal Cancer with 3 Tesla Magnetic Resonance Imaging

Abstract

French

Purpose

To assess the sensitivity and specificity of 3 Tesla magnetic resonance imaging (MRI) in the prediction of extramural spread and metastatic adenopathy in rectal carcinoma.

Materials and Methods

This was a prospective cohort study that included forty consecutive patients with rectal carcinoma from the Department of Colorectal Surgery. Three Tesla (3T) MRI was performed on these patients after a 4-hour fast and cleansing water enema. TI-weighted and T2-weighted images were obtained with high-resolution images T2-weighted sequences through the pelvis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 3T MRI for prediction of metastatic adenopathy and extramural spread were calculated. The TNM staging based on MRI was compared with histopathology of the resected specimen (taken as the criterion standard).

Results

In our study, sensitivity, specificity, PPV, and NPV of 3T MRI for prediction of metastatic adenopathy were 100%, 78.3%, 77.3%, and 100%, respectively. Sensitivity, specificity, PPV, and NPV of 3T MRI for prediction of extramural tumour spread were 100% and 20%, 89.7% and 100%, respectively (ie, prediction of stages T3 and above).

Conclusion

MRI allows accurate measurement of the depth of extramural tumour spread. In the assessment of metastatic adenopathy, however, MRI has a low specificity. This study shows that MRI is unlikely to miss any significant parameter in staging of rectal carcinoma. However, it has a tendency to overstage extramural spread of tumour.

Keywords

Rectal cancer 3 Tesla Magnetic resonance imaging MRI Staging

Get full access to this article

View all access options for this article.

References

Kapiteijn

Marijnen

C.A.

Nagtegaal

I.D.

Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer

N Engl J Med 2001; 345:638–646.

Kaminsky-Forrett

M.C.

Conroy

Luporsi

Prognostic implications of downstaging following preoperative radiation therapy for operable T3–T4 rectal cancer

Int J Radiat Oncol Biol Phys 1998; 42:935–941.

Brown

Richards

C.J.

Newcombe

R.G.

Rectal carcinoma: thin-section MR imaging for staging in 28 patients

Radiology 1999; 211:215–222.

Blair

Ellenhorn

J.D.

Transanal excision for low rectal cancers is curative in early-stage disease with favorable histology

Am Surg 2000; 66:817–820.

Brown

, Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study Mercury Study Group. BMJ 2006;333:779.

Sagar

P.M.

Pemberton

J.H.

Surgical management of locally recurrent rectal cancer

Br J Surg 1996; 83:293–304.

Gagliardi

Bayar

Smith

Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils

Arch Surg 2002; 137:447–451.

De Lange

E.E.

Fechner

R.E.

Wanebo

H.J.

Suspected recurrent rectosigmoid carcinoma after abdominoperineal resection: MR imaging and histopathologic findings

Radiology 1989; 170:323–328.

Low

R.N.

McCue

Barone

MR staging of primary colorectal carcinoma: comparison with surgical and histopathologic findings

Abdom Imaging 2003; 28:784–793.

10.

Kim

J.H.

Beets

G.L.

Kim

M.J.

High resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size?

Eur J Radiol 2004; 52:78–83.

11.

Iafrate

Laghi

Paolantonio

Preoperative staging of rectal cancer with MR imaging: correlation with surgical and histopathologic findings

RadioGraphics 2006; 26:701–714.

12.

Beets-Tan

R.G.

Beets

G.L.

van der Hoop

A.G.

High-resolution magnetic resonance imaging of the anorectal region without an endocoil

Abdom Imaging 1999; 24:576–581.

13.

Age specific incidence rates, by sex, bowel cancer, UK, 2006. Available at: http://info.cancerresearchuk.org. Accessed October 12, 2009.

14.

Vliegen

R.F.

Beets

Von Meyenfeldt

M.F.

Rectal cancer: MR imaging in local staging—is gadolinium-based contrast material helpful?

Radiology 2005; 234:179–188.

15.

Blomqvist

Holm

Rubio

Rectal tumours: MR imaging with endorectal and/or phased-array coils, and histopathological staging on giant sections. A comparative study

Acta Radiol 1997; 38:437–444.

16.

Kim

C.K.

Kim

S.H.

Chun

H.K.

Preoperative staging of rectal cancer: accuracy of 3-Tesla magnetic resonance imaging

Eur Radiol 2006; 16:972–980.

17.

Kim

Lim

J.S.

Choi

J.Y.

Rectal cancer: comparison of accuracy of local-regional staging with two- and three-dimensional preoperative 3-T MR imaging

Radiology 2010; 254:485–492.