The Deepest Extent of Acellular Mucin Pools in Resected Locally Advanced Rectal Cancer With Pathological Complete Response After Preoperative Chemoradiotherapy

Chen, Mian; Wang, Chao; Liu, Huashan; Liang, Zhenxing; Ye, F; Luo, Shuangling; Liu, Zhanzhen; Hu, Huanxin; Lai, Sicong; Hou, Yujie; Kang, Liang; Huang, Liang

doi:10.1097/pas.0000000000002055

Cited by 1 publication

(1 citation statement)

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“…Actually in 1 patient with only intramural venous invasion in our study, acellular mucin pools were detected in extramural veins, which was considered as mucinous degeneration of EMVI after neoadjuvant therapy, and viable EMVI could be latent. In addition, the presence of acellular mucin pools has been reported to carry a poor prognosis 28 . Because 2 readers rated this case with acellular mucin pools as positive EMVI only with 1.2-DLR, the prognostic value of 1.2-DLR may be more accurate than the other images.…”

Section: Discussionmentioning

confidence: 86%

Ultra-High-Resolution T2-Weighted PROPELLER MRI of the Rectum With Deep Learning Reconstruction

Matsumoto,

Tsuboyama,

Onishi

et al. 2023

Invest Radiol

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Objective The aim of this study was to evaluate the impact of ultra-high-resolution acquisition and deep learning reconstruction (DLR) on the image quality and diagnostic performance of T2-weighted periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) imaging of the rectum. Materials and Methods This prospective study included 34 patients who underwent magnetic resonance imaging (MRI) for initial staging or restaging of rectal tumors. The following 4 types of oblique axial PROPELLER images perpendicular to the tumor were obtained: a standard 3-mm slice thickness with conventional reconstruction (3-CR) and DLR (3-DLR), and 1.2-mm slice thickness with CR (1.2-CR) and DLR (1.2-DLR). Three radiologists independently evaluated the image quality and tumor extent by using a 5-point scoring system. Diagnostic accuracy was evaluated in 22 patients with rectal cancer who underwent surgery after MRI without additional neoadjuvant therapy (median interval between MRI and surgery, 22 days). The signal-to-noise ratio and tissue contrast were measured on the 4 types of PROPELLER imaging. Results 1.2-DLR imaging showed the best sharpness, overall image quality, and rectal and lesion conspicuity for all readers (P < 0.01). Of the assigned scores for tumor extent, extramural venous invasion (EMVI) scores showed moderate agreement across the 4 types of PROPELLER sequences in all readers (intraclass correlation coefficient, 0.60–0.71). Compared with 3-CR imaging, the number of cases with MRI-detected extramural tumor spread was significantly higher with 1.2-DLR imaging (19.0 ± 2.9 vs 23.3 ± 0.9, P = 0.03), and the number of cases with MRI-detected EMVI was significantly increased with 1.2-CR, 3-DLR, and 1.2-DLR imaging (8.0 ± 0.0 vs 9.7 ± 0.5, 11.0 ± 2.2, and 12.3 ± 1.7, respectively; P = 0.02). For the diagnosis of histopathologic extramural tumor spread, 3-CR and 1.2-CR had significantly higher specificity than 3-DLR and 1.2-DLR imaging (0.75 and 0.78 vs 0.64 and 0.58, respectively; P = 0.02), and only 1.2-CR had significantly higher accuracy than 3-CR imaging (0.83 vs 0.79, P = 0.01). The accuracy of MRI-detected EMVI with reference to pathological EMVI was significantly lower for 3-CR and 3-DLR compared with 1.2-CR (0.77 and 0.74 vs 0.85, respectively; P < 0.01), and was not significantly different between 1.2-CR and 1.2-DLR (0.85 vs 0.80). Using any pathological venous invasion as the reference standard, the accuracy of MRI-detected EMVI was significantly the highest with 1.2-DLR, followed by 1.2-CR, 3-CR, and 3-DLR (0.71 vs 0.67 vs 0.59 vs 0.56, respectively; P < 0.01). The signal-to-noise ratio was significantly highest with 3-DLR imaging (P < 0.05). There were no significant differences in tumor-to-muscle contrast between the 4 types of PROPELLER imaging. Conclusions Ultra-high-resolution PROPELLER T2-weighted imaging of the rectum combined with DLR improved image quality, increased the number of cases with MRI-detected extramural tumor spread and EMVI, but did not improve diagnostic accuracy with respect to pathology in rectal cancer, possibly because of false-positive MRI findings or false-negative pathologic findings.

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Section: Discussionmentioning

confidence: 86%