Diagnostic accuracy of state-of-the-art rectal MRI sequences for the diagnosis of extramural vascular invasion in locally advanced rectal cancer after preoperative chemoradiotherapy: dos or maybes?
Diffusion weighted MRI
Magnetic resonance imaging
Multiparametric magnetic resonance imaging
Neoadjuvant chemoradiation therapy
Rectal cancer
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
16
11
2022
accepted:
26
03
2023
revised:
12
03
2023
medline:
21
9
2023
pubmed:
28
4
2023
entrez:
28
4
2023
Statut:
ppublish
Résumé
The aim of this study was to determine the accuracy of three state-of-the-art MRI sequences for the detection of extramural venous invasion (EMVI) in locally advanced rectal cancer (LARC) patients after preoperative chemoradiotherapy (pCRT). This retrospective study included 103 patients (median age 66 years old [43-84]) surgically treated with pCRT for LARC and submitted to preoperative contrast-enhanced pelvic MRI after pCRT. T2-weighted, DWI, and contrast-enhanced sequences were evaluated by two radiologists with expertise in abdominal imaging, blinded to clinical and histopathological data. Patients were scored according to the probability of EMVI presence on each sequence using a grading score ranging from 0 (no evidence of EMVI) to 4 (strong evidence of EMVI). Results from 0 to 2 were ranked as EMVI negative and from 3 to 4 as EMVI positive. ROC curves were drawn for each technique, using histopathological results as reference standard. T2-weighted, DWI, and contrast-enhanced sequences demonstrated an area under the ROC curve (AUC) respectively of 0.610 (95% CI: 0.509-0.704), 0.729 (95% CI: 0.633-0.812), and 0.624 (95% CI: 0.523-0.718). The AUC of DWI sequence was significantly higher than that of T2-weighted (p = 0.0494) and contrast-enhanced (p = 0.0315) sequences. DWI is more accurate than T2-weighted and contrast-enhanced sequences for the identification of EMVI following pCRT in LARC patients. MRI protocol for restaging locally advanced rectal cancer after preoperative chemoradiotherapy should routinely include DWI due to its higher accuracy for the diagnosis of extramural venous invasion compared to high-resolution T2-weighted and contrast-enhanced T1-weighted sequences. • MRI has a moderately high accuracy for the diagnosis of extramural venous invasion in locally advanced rectal cancer after preoperative chemoradiotherapy. • DWI is more accurate than T2-weighted and contrast-enhanced T1-weighted sequences in the detection of extramural venous invasion after preoperative chemoradiotherapy of locally advanced rectal cancer. • DWI should be routinely included in the MRI protocol for restaging locally advanced rectal cancer after preoperative chemoradiotherapy.
Identifiants
pubmed: 37115215
doi: 10.1007/s00330-023-09655-4
pii: 10.1007/s00330-023-09655-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
6852-6860Informations de copyright
© 2023. The Author(s), under exclusive licence to European Society of Radiology.
Références
Rodríguez-Luna MR, Guarneros-Zárate JE, Tueme-Izaguirre J (2015) Total mesorectal excision, an erroneous anatomical term for the gold standard in rectal cancer treatment. Int J Surg 23:97–100. https://doi.org/10.1016/j.ijsu.2015.09.047
doi: 10.1016/j.ijsu.2015.09.047
pubmed: 26409653
Sohn B, Lim JS, Kim H et al (2015) MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol 25(5):1347–1355. https://doi.org/10.1007/s00330-014-3527-9
doi: 10.1007/s00330-014-3527-9
pubmed: 25500963
Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G (2008) Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 95(2):229–236. https://doi.org/10.1002/bjs.5917
doi: 10.1002/bjs.5917
pubmed: 17932879
Smith NJ, Shihab O, Arnaout A, Swift RI, Brown G (2008) MRI for detection of extramural vascular invasion in rectal cancer. AJR Am J Roentgenol 191(5):1517–1522. https://doi.org/10.2214/AJR.08.1298
doi: 10.2214/AJR.08.1298
Rouleau Fournier F, Motamedi MAK, Brown CJ et al (2022) Oncologic outcomes associated with MRI-detected extramural venous invasion (mrEMVI) in rectal cancer: a systematic review and meta-analysis. Ann Surg 275(2):303–314. https://doi.org/10.1097/SLA.0000000000004636
doi: 10.1097/SLA.0000000000004636
pubmed: 33491979
Kim TH, Woo S, Han S, Suh CH, Vargas HA (2019) The diagnostic performance of MRI for detection of extramural venous invasion in colorectal cancer: a systematic review and meta-analysis of the literature. AJR Am J Roentgenol 213(3):575–585. https://doi.org/10.2214/AJR.19.21112
doi: 10.2214/AJR.19.21112
Beets-Tan RGH, Lambregts DMJ, Maas M et al (2018) Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 28(4):1465–1475. https://doi.org/10.1007/s00330-017-5026-2
doi: 10.1007/s00330-017-5026-2
pubmed: 29043428
Taylor FGM, Swift RI, Blomqvist L, Brown G (2008) A systematic approach to the interpretation of preoperative staging MRI for rectal cancer. AJR Am J Roentgenol 191(6):1827–1835. https://doi.org/10.2214/AJR.08.1004
doi: 10.2214/AJR.08.1004
Vliegen RFA, Beets GL, Von Meyenfeldt MF et al (2005) Rectal cancer: MR imaging in local staging - is gadolinium-based contrast material helpful? Radiology 234(1):179–188. https://doi.org/10.1148/radiol.2341031403
doi: 10.1148/radiol.2341031403
pubmed: 15550372
Bossuyt PM, Reitsma JB, Bruns DE et al (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Radiology 277(3):826–832. https://doi.org/10.1148/radiol.2015151516
doi: 10.1148/radiol.2015151516
pubmed: 26509226
Beets-Tan RGH, Lambregts DMJ, Maas M et al (2018) Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 28:1465–1475. https://doi.org/10.1007/s00330-017-5026-2
doi: 10.1007/s00330-017-5026-2
pubmed: 29043428
Ahn JH, Kim SH, Son JH, Jo SJ (2019) Added value of diffusion-weighted imaging for evaluation of extramural venous invasion in patients with primary rectal cancer. Br J Radiol 92(1096). https://doi.org/10.1259/bjr.20180821
Yang SX, Yao X, Song XH, Cui YC, Ye YJ, Wang Y (2017) Extramural vascular invasion detected by contrast-enhanced multiple-row detectors computed tomography (ceMDCT) as a predictor of synchronous metastases in colon cancer. Oncotarget 8(55):1–10. https://doi.org/10.18632/oncotarget.22034
doi: 10.18632/oncotarget.22034
Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ (2019) MRI of rectal cancer: tumor staging, imaging techniques, and management. Radiographics 39(2):367–387. https://doi.org/10.1148/rg.2019180114
doi: 10.1148/rg.2019180114
pubmed: 30768361
Chen S, Li N, Tang Y et al (2021) The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy: a meta-analysis. Eur Radiol 31(12):8827–8837. https://doi.org/10.1007/s00330-021-07981-z
doi: 10.1007/s00330-021-07981-z
pubmed: 33993333
Sohn B, Lim JS, Kim H et al (2015) MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol 25(5):1347–1355
doi: 10.1007/s00330-014-3527-9
pubmed: 25500963
Massucco P, Fontana AP, Balbo Mussetto A et al (2022) MRI-detected extramural vascular invasion (mrEMVI) as the best predictive factor to identify candidates to total neoadjuvant therapy in locally advanced rectal cancer. J Surg Oncol 125(6):1024–1031. https://doi.org/10.1002/jso.26818
doi: 10.1002/jso.26818
pubmed: 35165905
Sofic A, Husic-Selimovic A, Efendic A, et al (2021) MRI evaluation of extramural venous invasion (EMVI) with rectal carcinoma using high resolution T2 and combination of high resolution T2 and contrast enhanced T1 weighted imaging. Acta Inform Med 113–117. https://doi.org/10.5455/aim.2021.29.113-117
Inoue A, Sheedy SP, Heiken JP et al (2021) MRI-detected extramural venous invasion of rectal cancer: multimodality performance and implications at baseline imaging and after neoadjuvant therapy. Insights Imaging 9;12(1):110. https://doi.org/10.1186/s13244-021-01023-4
Fornell-Perez R, Vivas-Escalona V, Aranda-Sanchez J et al (2020) Primary and post-chemoradiotherapy MRI detection of extramural venous invasion in rectal cancer: the role of diffusion-weighted imaging. Radiol Med 125(6):522–530. https://doi.org/10.1007/s11547-020-01137-7
doi: 10.1007/s11547-020-01137-7
pubmed: 32020526