Association between high-resolution MRI-detected extramural vascular invasion and tumour microcirculation estimated by dynamic contrast-enhanced MRI in rectal cancer: preliminary results

Abstract

Background To determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) status is associated with quantitative perfusion parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) in rectal cancer. Methods Seventy-two patients with rectal adenocarcinoma who underwent curative surgery alone within 2 weeks following rectal MRI were enrolled in this retrospective study. mrEMVI status was determined based on high-resolution MRI. The quantitative perfusion parameters ( K trans , k ep and v e ) derived from DCE-MRI were calculated from all sections containing tumours. DCE-MRI parameters and clinicopathological variables in patients with different mrEMVI statuses were compared. Results For patients who were mrEMVI positive, the tumours demonstrated significantly lower k ep values ( P = 0.012) and higher v e values ( P = 0.021) than tumours of patients who were mrEMVI negative, while the K trans value displayed no significant difference ( P = 0.390). The patients who were mrEMVI positive had larger tumour size, higher pathological tumour stage and increased regional nodal metastases compared to those who were mrEMVI negative (2.9 cm vs. 3.5 cm, P = 0.011; 63.8% vs. 92.0%, P = 0.010; 36.2% vs. 76.0%, P = 0.001; respectively). Conclusions This study demonstrated for the first time that tumour microcirculation is altered in mrEMVI-positive patients with rectal adenocarcinoma, as evidenced by significantly lower k ep and higher v e values. In addition, these patients were more likely to have a larger tumour size, a higher pathological tumour stage and regional nodal metastases than mrEMVI-negative patients.

Preoperative Prediction of Extramural Venous Invasion in Rectal Cancer: Comparison of the Diagnostic Efficacy of Radiomics Models and Quantitative Dynamic Contrast-Enhanced Magnetic Resonance Imaging

“…During tumor progression, tumor cells secrete vascular endothelial factors that increase the permeability of tumor blood vessels and loss of function of cell-cell adhesion molecules, leading to a large interstitial space and resulting in an enlarged EES (35,36); thus, it was not surprising that the Ve value was significantly higher in the EMVI-positive group than in the EMVI-negative group. This result was in agreement with those of Chen et al (23), who reported that MRI-detected EMVI-positive patients exhibited an increased Ve value. Regarding the K trans value, our finding was consistent with a recent study that showed that LVI was correlated with a high K trans value in patients with rectal cancer (35) but contrary to that of Chen et al (23).…”

“…This result was in agreement with those of Chen et al (23), who reported that MRI-detected EMVI-positive patients exhibited an increased Ve value. Regarding the K trans value, our finding was consistent with a recent study that showed that LVI was correlated with a high K trans value in patients with rectal cancer (35) but contrary to that of Chen et al (23). This may be explained by the different inclusion criteria between our studies.…”

“…According to previous studies, risk factors for EMVI include a large tumor size, a high T stage and lymph node stage. In this study, we confirmed that T stage and histological grade were independent predictors of EMVI, which was partly in agreement with the findings of previous studies (23,32). However, the tumor size and N stage did not correlate with EMVI in our study.…”

“…To our knowledge, there are few studies on DCE-MRI for the evaluation of EMVI in rectal cancer. Recently, Chen et al reported an association between MRI-detected EMVI and DCE-MRI parameters in rectal adenocarcinoma and demonstrated that mrEMVI-positive patients had significantly lower Kep and higher Ve values than mrEMVI-negative patients (23). However, the diagnostic efficacy of DCE-MRI quantitative parameters is still unclear.…”

Magnetic resonance imaging-based artificial intelligence model in rectal cancer

“…High-resolution magnetic resonance imaging (MRI) is the preferred clinical imaging method to evaluate lymph node metastasis of rectal cancer[ 5 ]. Rectal MRI can accurately evaluate the tumor location, tumor stage, invasion depth, extramural vascular invasion (EMVI), and circumferential resection margin[ 6 - 8 ]. Accurate MRI assessment is of great significance to patients with rectal cancer, as it is related to the patients' prognosis[ 9 ].…”