Preoperative diagnosis and staging of rectal cancer using diffusion-weighted and water imaging combined with dynamic contrast-enhanced scanning

Zhao, Qili; Liu, Lijian; Wang, Qiuyan; Ze-xia, Liang; Shi, Guo‐Ming

doi:10.3892/ol.2014.2590

Cited by 12 publications

(8 citation statements)

References 21 publications

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“…Most studies reported significantly higher ADC values (indicating a lower cellular density) for benign nodes than for malignant nodes. [28][29][30][31] Sensitivities and specificities to characterize nodes based on the ADC (using retrospectively determined threshold values) ranged from 67 to 88% and 60 to 97% respectively, which is only slightly higher than previously reported values for morphological MRI. 21,22,24,32 Moreover, reported ADC values vary across studies (using different MR vendors and protocols) and show considerable overlap between malignant and benign nodes.…”

Section: Lymph Node Stagingmentioning

confidence: 53%

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Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Schurink

Lambregts

Beets‐Tan

2019

The British Journal of Radiology

117

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This paper aims to give an overview of the various clinical applications of DWI and discuss their potential role for rectal cancer imaging. PRiMARy RectAl cANceR stAgiNg Rectal tumour detection The main goal of MRI for rectal cancer is staging rather than tumour detection, since typically the presence of tumour has already been established by endoscopy or CT-colonography. 2 It is probably therefore that only a few studies have focused on DWI for the primary detection of rectal cancer. 3-10 Nevertheless, published reports have shown consistently good results for DWI to detect rectal tumours. In a recent meta-analysis, albeit focusing on colorectal tumours in general and not specifically on rectal cancer, pooled sensitivity, specificity and area under the curve (AUC) were 95%, 93% and 0.98, respectively. 11

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Section: Lymph Node Stagingmentioning

confidence: 53%

“…The majority of studies on DWI for characterizing rectal nodes focused on quantitatively measuring nodal ADC values. 23,[28][29][30][31] An overview of these studies is presented in Table 1.…”

Section: Lymph Node Stagingmentioning

confidence: 99%

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Schurink

Lambregts

Beets‐Tan

2019

The British Journal of Radiology

117

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“…The diagnostic sensitivity and specificity of MRI for lymph node metastasis are 77 and 71%, respectively [ 12 ]. Additionally, the usefulness of diffusion-weighted imaging (DWI)-MRI has recently been reported [ 13 – 15 ]. The accuracy of DWI-MRI is better than that of both CT and 18 FDG-PET (86.6 vs. 76.0% and 78.3 vs. 69.9%, respectively) [ 14 , 15 ].…”

Section: Case Presentationmentioning

confidence: 99%

Lateral lymph node metastasis in a patient with T1 upper rectal cancer treated by lateral lymph node dissection: a case report and brief literature review

et al. 2017

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BackgroundLateral lymph node (LLN) metastasis may occur in patients with advanced rectal cancers of which the lower margins are located at or below the peritoneal reflection. However, LLN metastasis from a T1 rectal cancer is rare. Here, we report a case of LLN metastasis from a T1 upper rectal cancer that was successfully treated by sequential LLN dissection.Case presentationA 56-year-old man was referred to our hospital for the treatment of a T1 upper rectal cancer. We performed a laparoscopic low anterior resection. Histological examination showed a moderately differentiated adenocarcinoma with submucosal layer invasion; the invasion depth was classified as head invasion, without vessel or lymph duct invasion. Tumor budding was classified as grade 1. A total of six lymph nodes were harvested, and no lymph node metastases were detected. The postoperative course was uneventful. At 6 months after surgery, however, the serum carcinoembryonic antigen levels were elevated, and abdominal computed tomography (CT) revealed swollen lymph nodes in the right internal and common iliac artery area. Positron emission tomography with CT revealed hot spots in the same lesions. A retrospective re-evaluation of the preoperative CT images revealed no apparent swollen lymph nodes; however, an unusual soft tissue area was detected around the right internal iliac artery. A right LLN dissection was performed. Fifteen lymph nodes were resected, and histologically, metastases of adenocarcinoma were identified in 3 nodes. The postoperative course was again uneventful. The patient was given 12 cycles of adjuvant chemotherapy with FOLFOX (fluorouracil, leucovorin, and oxaliplatin). The patient remains healthy and with no signs of recurrence at 30 months after the second surgery.ConclusionsLLN metastasis occurs very rarely in patients with T1 upper rectal cancer and no risk factors for lymph node metastasis; however, a careful perioperative examination of the LLN should be performed. In cases involving LLN metastasis, a LLN dissection may be a therapeutic option if performed with curative intent.

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“…Several approaches to the assessment of tumour response using MRI have been described. These include morphological changes assessed in terms of MRI tumour regression grade (mrTRG) and volumetry, or functional changes using diffusion‐weighted imaging (DWI) and dynamic contrast‐enhanced MRI. Tumour volume is a strong predictor of tumour response and outcome, especially when combined with DWI.…”

Section: Introductionmentioning

confidence: 99%

Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial

Nougaret

Castan

Forges

et al. 2019

British Journal of Surgery

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Background: Tailored neoadjuvant treatment of locally advanced rectal cancer (LARC) may improve outcomes. The aim of this study was to determine early MRI prognostic parameters with which to stratify neoadjuvant treatment in patients with LARC.Methods: All patients from a prospective, phase II, multicentre randomized study (GRECCAR4; NCT01333709) were included, and underwent rectal MRI before treatment, 4 weeks after induction chemotherapy and after completion of chemoradiotherapy (CRT). Tumour volumetry, MRI tumour regression grade (mrTRG), T and N categories, circumferential resection margin (CRM) status and extramural vascular invasion identified by MRI (mrEMVI) were evaluated.Results: A total of 133 randomized patients were analysed. Median follow-up was 41⋅4 (95 per cent c.i. 36⋅6 to 45⋅2) months. Thirty-one patients (23⋅3 per cent) developed tumour recurrence. In univariable analysis, mrEMVI at baseline was the only prognostic factor associated with poorer outcome (P = 0⋅015). After induction chemotherapy, a larger tumour volume on MRI (P = 0⋅019), tumour volume regression of 60 per cent or less (P = 0⋅002), involvement of the CRM (P = 0⋅037), mrEMVI (P = 0⋅026) and a poor mrTRG (P = 0⋅023) were associated with poor outcome. After completion of CRT, the absence of complete response on MRI (P = 0⋅004), mrEMVI (P = 0⋅038) and a poor mrTRG (P = 0⋅005) were associated with shorter disease-free survival. A final multivariable model including all significant variables (baseline, after induction, after CRT) revealed that Eastern Cooperative Oncology Group performance status (P = 0⋅011), sphincter involvement (P = 0⋅009), mrEMVI at baseline (P = 0⋅002) and early tumour volume regression of 60 per cent or less after induction (P = 0⋅007) were associated with relapse.Conclusion: Baseline and early post-treatment MRI parameters are associated with prognosis in LARC. Future preoperative treatment should stratify treatment according to baseline mrEMVI status and early tumour volume regression.

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Preoperative diagnosis and staging of rectal cancer using diffusion-weighted and water imaging combined with dynamic contrast-enhanced scanning

Cited by 12 publications

References 21 publications

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Lateral lymph node metastasis in a patient with T1 upper rectal cancer treated by lateral lymph node dissection: a case report and brief literature review

Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial

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