Nodal staging in the rectal cancer follow-up MRI after chemoradiotherapy: use of morphology, size, and diffusion criteria

Pérez, R. Fornell; Perez-Alonso, Esteban; Alemán‐Flores, Patricia; Lozano-Rodriguez, Alvaro; Loro-Ferrer, Juan Francisco

doi:10.1016/j.crad.2019.08.003

Cited by 7 publications

(7 citation statements)

References 43 publications

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“…Additionally, the cDWI b1,000 and aDWI b1,000 images showed similar moderate sensitivity and high specificity in identifying patients without metastatic nodes. Our results may approve the conclusions of Fornell-Perez et al (29). They reported adding diffusion criteria did not demonstrate a clear advantage over the mixed morphology-size criteria.…”

Section: Discussionsupporting

confidence: 91%

“…For N staging, N0 represents no regional lymph node metastasis; N1 for metastases of 1 to 3 regional lymph nodes occurred, and N2 means metastases of no less than 4 regional lymph nodes occurred. Morphological criteria for suspicion of positive lymph node included a short-axis diameter of ≥5 mm, an irregular border, mixed-signal intensity or a round shape, and diffusion criteria (high signal intensity on images of high b-values) (28,29).…”

Section: Assessment Of Local Preoperative Tn Staging and Tumor Locationmentioning

confidence: 99%

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Comparison of Computed and Acquired DWI in the Assessment of Rectal Cancer: Image Quality and Preoperative Staging

Xia

Wang

et al. 2022

Front. Oncol.

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ObjectiveThe aim of the study was to evaluate the computed diffusion-weighted images (DWI) in image quality and diagnostic performance of rectal cancer by comparing with the acquired DWI.MethodsA total of 103 consecutive patients with primary rectal cancer were enrolled in this study. All patients underwent two DWI sequences, namely, conventional acquisition with b = 0 and 1,000 s/mm2 (aDWIb1,000) and another with b = 0 and 700 s/mm2 on a 3.0T MR scanner (MAGNETOM Prisma; Siemens Healthcare, Germany). The images (b = 0 and 700 s/mm2) were used to compute the diffusion images with b value of 1,000 s/mm2 (cDWIb1,000). Qualitative and quantitative analysis of both computed and acquired DWI images was performed, namely, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and signal intensity ratio (SIR), and also diagnostic staging performance. Interclass correlation coefficients, weighted κ coefficient, Friedman test, Wilcoxon paired test, and McNemar or Fisher test were used for repeatability and comparison assessment.ResultsCompared with the aDWIb1,000 images, the cDWIb1,000 ones exhibited significant higher scores of subjective image quality (all P <0.050). SNR, SIR, and CNR of the cDWIb1,000 images were superior to those of the aDWIb1,000 ones (P <0.001). The overall diagnostic accuracy of computed images was higher than that of the aDWIb1,000 images in T stage (P <0.001), with markedly better sensitivity and specificity in distinguishing T1–2 tumors from the T3–4 ones (P <0.050).ConclusioncDWIb1,000 images from lower b values might be a useful alternative option and comparable to the acquired DWI, providing better image quality and diagnostic performance in preoperative rectal cancer staging.

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Section: Discussionsupporting

confidence: 91%

Section: Assessment Of Local Preoperative Tn Staging and Tumor Locationmentioning

confidence: 99%

Comparison of Computed and Acquired DWI in the Assessment of Rectal Cancer: Image Quality and Preoperative Staging

Xia

Wang

et al. 2022

Front. Oncol.

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“…The morphological criteria of malignancy including 1) intranodal signal heterogeneity, 2) a round shape, and 3) irregular outer margins. At least two of the above morphological criteria plus diffusion criteria (hyperintensity signal on images of high b values) had to be met to consider a node as malignant 29,30 …”

Section: Methodsmentioning

confidence: 99%

Computed Diffusion‐Weighted Images of Rectal Cancer: Image Quality, Restaging, and Treatment Response after Neoadjuvant Therapy

Xia

Zhu

Cai

et al. 2023

Magnetic Resonance Imaging

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BackgroundComputed diffusion‐weighted images (cDWI) of random b value could be derived from acquired DWI (aDWI) with at least two different b values. However, its comparison between aDWI and cDWI images in locally advanced rectal cancer (LARC) patients after neoadjuvant therapy (NT) is needed.PurposeTo compare the cDWI and aDWI in image quality, restaging, and treatment response of LARC after NT.Study TypeRetrospective.PopulationEighty‐seven consecutive patients.Field Strength/Sequence3.0 T/DWI.AssessmentAll patients underwent two DWI sequences, including conventional acquisition with b = 0 and 1000 s/mm2 (aDWIb1000) and another with b = 0 and 700 s/mm2 on a 3.0‐T MR scanner. The images of the latter were used to compute the diffusion images with b = 1000 s/mm2 (cDWIb1000). Four radiologists with 3, 4, 14, and 25 years of experience evaluated the images to compare the image quality, TN restaging performance, and treatment response between aDWIb1000 and cDWIb1000.Statistical TestsInterclass correlation coefficients, weighted κ coefficient, paired Wilcoxon, and McNemar or Fisher test were used. A significance level of 0.05 was used.ResultsThe cDWIb1000 images were superior to the aDWIb1000 ones in both subjective and objective image quality. In T restaging, the overall diagnostic accuracy of cDWIb1000 images was higher than that of aDWIb1000 images (57.47% vs. 49.43%, P = 0.289 for the inexperienced radiologist; 77.01% vs. 63.22%, significant for the experienced radiologist), with better sensitivity in determining ypT0‐Tis tumors. Additionally, it increased the sensitivity in detecting ypT2 tumors for the inexperienced radiologist and ypT3 tumors for the experienced radiologist. N restaging and treatment response were found to be similar between two sequences for both radiologists.Data ConclusionCompared to aDWIb1000 images, the computed ones might serve as a wise approach, providing comparable or better image quality, restaging performance, and treatment response assessment for LARC after NT.Level of Evidence3Technical Efficacy Stage2

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“…In the case of rectal cancer, locoregional lymph nodes are considered to be the obturator lymph nodes, internal iliac lymph nodes and the ones located in the mesorectum [49][50][51]. Therefore, the correct assessment of the existence of lymph node metastases in patients with rectal cancer is of particular importance in the preoperative assessment of these patients, the experience of the examining physician having a particularly important role in these cases [52,53] (Figure 3).…”

Section: Detection Of Lymph Node Metastases Using Mri In Patients With Rectal Cancermentioning

confidence: 99%

The Utility of Magnetic Resonance Imaging in the Multidisciplinary Treatment of Patients with Rectal Cancer

Hălmaciu¹,

Andrei²,

Russu³

et al. 2023

Current Topics in Colorectal Surgery

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Rectal cancer is one of the most common types of cancer in both men and women. In recent years, the importance of magnetic resonance imaging (MRI) has greatly increased in the multidisciplinary treatment of patients with rectal cancer. MRI has a particularly important role in the most accurate preoperative staging of these patients, both in terms of assessing the local invasion of the tumor and in terms of assessing the status of pelvic lymph nodes. Many patients with rectal cancer, especially those in the advanced stage of the disease, in the preoperative period undergo neoadjuvant radio chemotherapy. The evaluation of the clinical response of these patients to neoadjuvant therapy is of crucial importance both in terms of personalized treatment and in terms of their prognosis. In this regard, MRI has its clearly defined role at present in evaluating the efficacy of neoadjuvant therapy, as well as in postoperative follow-up.

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Nodal staging in the rectal cancer follow-up MRI after chemoradiotherapy: use of morphology, size, and diffusion criteria

Cited by 7 publications

References 43 publications

Comparison of Computed and Acquired DWI in the Assessment of Rectal Cancer: Image Quality and Preoperative Staging

Comparison of Computed and Acquired DWI in the Assessment of Rectal Cancer: Image Quality and Preoperative Staging

Computed Diffusion‐Weighted Images of Rectal Cancer: Image Quality, Restaging, and Treatment Response after Neoadjuvant Therapy

The Utility of Magnetic Resonance Imaging in the Multidisciplinary Treatment of Patients with Rectal Cancer

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