MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience

Abstract

Background Anastomotic leakage (AL) is one of the most serious postoperative complications after colorectal anastomosis. This study aims to evaluate the feasibility and diagnostic accuracy of magnetic resonance imaging (MRI) in the early detection of AL in patients with clinically suspected AL after rectal anterior resection. Methods This was a prospective study including patients who underwent anterior resection and postoperative MRI examination. AL was diagnosed by comprehensive indictors, which were mainly confirmed by clinical signs, symptoms, and retrograde contrast enema (RCE) radiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosing AL with MRI were calculated. Results In total, 347 patients received anterior resection for rectal cancer, and 28 patients were suspected to have AL. Finally, 23 patients were included and received MRI examination. The median time interval from surgery to MRI was 10 days (3–21 days). The median distance from anastomosis to anal verge was 4.0 cm (2.0–10 cm), and 11 patients underwent diverted ileostomy. Eighteen patients had an anastomotic leak, including one patient who had a pelvic abscess and five patients who had no evidence of AL in the MRI examination. The overall sensitivity and specificity were 94.4% (95% CI 70.6% to 99.7%) and 80% (95% CI 29.8% to 98.9%), respectively. The PPV was 0.94 (95% CI 0.71 to 0.99) and the NPV was 0.80 (95% CI 0.29 to 0.99). For patients who had anastomosis less than 5 cm, the diagnostic accuracy of MRI was 93.7% (15/16). T2-weighted imaging with fat suppression can effectively reveal the leak track. Conclusions The accuracy of plain MRI examination in diagnosing AL was favorable for patients with a suspected AL. T2-weighted imaging with fat suppression was the best imaging modality to diagnose AL. A multicenter prospective study with more samples is needed to further determine the safety and feasibility of MRI in the diagnosis of AL.

Computed tomography‐based preoperative muscle measurements as prognostic factors for anastomotic leakage following oncological sigmoid and rectal resections

“…A study shows that the incidence of anastomotic leakage after colorectal surgery is 1%-24%, which can lead to patient death in severe cases and increase the chance of tumor recurrence, reducing the overall 5-year survival rate. 2 Therefore, it is of great significance to comprehensively analyze the risk factors of anastomotic leakage before surgery and reduce the occurrence of anastomotic leakage. Although we believe it is a very interesting topic, we would like to offer the following points for your consideration.…”

Magnetic Resonance Imaging With Contrast Enema in Detecting the Colorectal Anastomosis Failure

“…Недавние исследования Yu и др. с использованием конвенциальной МРТ [7] доказали его высокую эффективность для выявления несостоятельности анастомоза в сравнении с методами компьютерной томографии или проктографии. Чувствительность и специфичность МРТ составили 94,4% и 80% Arrow -level of anastomosis; asterisk -perianastomotic fluid accumulation: a -T2WI in sagittal projection; b -T1WI FS in sagittal projection before contrast enema; c -T1WI FS after contrast enema.…”