Preoperative Staging of Rectal Cancer With MRI: Accuracy and Clinical Usefulness

Kim, Nam Kyu; Kim, Do Young; Park, Jea Kun; Park, Sung Il; Min, Jin Sik

doi:10.1007/s10434-000-0732-3

Cited by 130 publications

(70 citation statements)

References 13 publications

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“…The application of DWI to the head region and its clinical significance has been established (Basser et al 2000;Rovira et al 2002). Now, body DWI can also be used for detecting tumor extension (Kim et al 2000;Beets-Tan et al 2001). Recently therapeutic effects have been evaluated based on the changes in ADC values after chemotherapy and/or irradiation therapy (Harry et al 2008).…”

Section: Discussionmentioning

confidence: 99%

Diffusion-Weighted Imaging in the Detection of Lymph Node Metastasis in Colorectal Cancer

Yasui¹,

Sato²,

Kamada³

2009

Tohoku J. Exp. Med.

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Section: Discussionmentioning

confidence: 99%

Diffusion-Weighted Imaging in the Detection of Lymph Node Metastasis in Colorectal Cancer

Yasui¹,

Sato²,

Kamada³

2009

Tohoku J. Exp. Med.

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“…Although only a handful of patients have LLN metastasis, LLA is unavoidable for some patients with advanced lower rectal cancer, because an accurate diagnosis for LLN metastasis cannot be made, even though using computed tomography and magnetic resonance imaging. Although Tada reported a unique and highly accurate diagnostic method for LLN metastasis using ultrasound [39], the accuracy is usually at 60-80% [40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Total Mesorectal Excision, Lateral Lymphadenectomy and Autonomic Nerve Preservation for Lower Rectal Cancer: Significance in the Long-term Follow-up Study.

et al. 2001

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Summary: We clarify the significance of total mesorectal excision (TME), lateral lymphadenectomy (LLA), and of autonomic nerve preservation (ANP) compared to conventional surgery (CVS), for lower rectal cancer. All 458 patients curatively resected between 1962 and 1997 were retrospectively investigated. In Period I from 1962-1974, when CVS only was performed, in Period II from 1975-1984, THE or THE+LLA was performed, and in Period III from 1985-1997, THE+ANP, THE+ANP+LLA, or THE+LLA was performed. In Dukes A+B disease, there was no significant difference among the three periods, regardless of operation methods. In Dukes C disease, in Period I, CVS (42 patients: pts) had a local recurrence (LR) rate of 45.2% and 5-year disease-free survival (5YDFS) rate of 33.3%. In Period II, THE+LLA (82 pts) had a lower LR rate of 26.8% (p=0.0628) and higher 5YDFS 51.0% (p<0.05) vs CVS. In Period III, THE+ANP (12 pts) had LR 25.0% and 5YDFS 55.6%, TME+ANP+LLA (45 pts) had LR 13.3% (p<0.005, vs CVS) and 5YDFS 56.1 % (p<0.01, vs CVS), and THE+LLA (18 pts) had LR 16.7% (p<0.05, vs CVS) and 5YDFS 20.8%. Also, CVS had the lowest curability rate 64.8% and the highest mortality rate 7.2%. THE and/or LLA was significant for reducing LR and improving survival in patients with Dukes C lower rectal cancer, compared to CVS. ANP was beneficial with LLA. THE+ANP was suitable for Dukes A or B disease.

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“…Mesorectal nodes are often first to be involved (44), however, rarely skip metastases to obturator or iliac chain can occur (45). In normal individuals, there should be no nodes within the mesorectal fascia and any node larger than 5 mm is considered to be involved, although size is not a good criterion to identify involvement as smaller nodes can be involved with metastatic disease (27,(46)(47)(48). In addition to size, borders and signal intensity of nodes should be evaluated, and nodes with irregular borders and mixed signal intensity should be considered suspicious (46)(47)(48).…”

Section: Accuracy Of Mrimentioning

confidence: 99%

“…In normal individuals, there should be no nodes within the mesorectal fascia and any node larger than 5 mm is considered to be involved, although size is not a good criterion to identify involvement as smaller nodes can be involved with metastatic disease (27,(46)(47)(48). In addition to size, borders and signal intensity of nodes should be evaluated, and nodes with irregular borders and mixed signal intensity should be considered suspicious (46)(47)(48). Current literature reveals a wide range of accuracy (39%-95%) in detection of metastatic lymph nodes by MRI (14, 49-51).…”

Section: Accuracy Of Mrimentioning

confidence: 99%

MRI in local staging of rectal cancer: an update

Tapan

Ozbayrak²,

Tatlı³

2014

Diagn Interv Radiol

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Preoperative imaging for staging of rectal cancer has become an important aspect of current approach to rectal cancer management, because it helps to select suitable patients for neoadjuvant chemoradiotherapy and determine the appropriate surgical technique. Imaging modalities such as endoscopic ultrasonography, computed tomography, and magnetic resonance imaging (MRI) play an important role in assessing the depth of tumor penetration, lymph node involvement, mesorectal fascia and anal sphincter invasion, and presence of distant metastatic diseases. Currently, there is no consensus on a preferred imaging technique for preoperative staging of rectal cancer. However, high-resolution phased-array MRI is recommended as a standard imaging modality for preoperative local staging of rectal cancer, with excellent soft tissue contrast, multiplanar capability, and absence of ionizing radiation. This review will mainly focus on the role of MRI in preoperative local staging of rectal cancer and discuss recent advancements in MRI technique such as diffusion-weighted imaging and dynamic contrast-enhanced MRI. Colorectal cancer is the second most common cancer in women and the third most common cancer in men with 570 100 and 663 600 estimated new cases per year worldwide, respectively (1). Rectal cancer accounts for approximately 42% of colorectal cancers with 45 000 estimated new cases per year in the United States (2). Prognosis of rectal cancer is determined by depth of invasion, number of involved lymph nodes, and involvement of circumferential resection margin. Management of rectal cancer has evolved over the years with preoperative imaging playing an increasingly prominent role. Initial strategy of clinical diagnosis followed by surgery and postoperative chemotherapy had a high local recurrence rate (27%) and poor survival (48% 5-year survival) (3). Later studies showed that neoadjuvant chemoradiation improves survival and decreases local recurrence rates significantly (4). In addition, it reduces tumor size, facilitates curative resection (5), and may enable sphincter sparing surgery in cancers close to the anorectal junction (6). Neoadjuvant chemoradiotherapy is not indicated in stage I tumors (confined to rectal wall with no nodal involvement), but is recommended for stage II (extends beyond the rectal wall, no nodal involvement) and stage III tumors (regional lymph node involvement). Therefore, in order to avoid unnecessary chemoradiation in stage I cancers, a reliable imaging modality is crucial to precisely define depth of invasion and to identify lymph node involvement (7). Current approach in the management of rectal cancer includes preoperative staging with different imaging modalities followed by neoadjuvant chemoradiotherapy (for stage II/III cancers). This approach has lowered the local recurrence rate (11%) and improved survival (58% 5-year survival) (3).Preoperative imaging for rectal cancer staging is also useful to determine which surgical technique would be more appropriate: recently-developed lo...

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Preoperative Staging of Rectal Cancer With MRI: Accuracy and Clinical Usefulness

Cited by 130 publications

References 13 publications

Diffusion-Weighted Imaging in the Detection of Lymph Node Metastasis in Colorectal Cancer

Diffusion-Weighted Imaging in the Detection of Lymph Node Metastasis in Colorectal Cancer

Total Mesorectal Excision, Lateral Lymphadenectomy and Autonomic Nerve Preservation for Lower Rectal Cancer: Significance in the Long-term Follow-up Study.

MRI in local staging of rectal cancer: an update

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