Eun Sun Lee1,2,3, Min Ju Kim4, Sung Chan Park5, Bo Yun Hur3, Jong Hee Hyun5, Hee Jin Chang5, Ji Yeon Baek5, Sun Young Kim5,6, Dae Yong Kim5, Jae Hwan Oh5. 1. Department of Radiology, Chung-Ang University Hospital, Seoul, Korea. 2. College of Medicine and Graduate School of Medicine, Chung-Ang University, Seoul, Korea. 3. Department of Radiology, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea. 4. Department of Radiology, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea. kimmj@ncc.re.kr. 5. Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea. 6. Department of Oncology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea.
Abstract
OBJECTIVES: We evaluated the diagnostic performance of magnetic resonance imaging (MRI) in terms of identifying extramural venous invasion (EMVI) in rectal cancer patients with preoperative chemoradiotherapy (CRT) and its prognostic significance. METHODS: During 2008-2010, 200 patients underwent surgery following preoperative CRT for rectal cancer. Two radiologists independently reviewed all pre- and post-CRT MRI retrospectively. We investigated diagnostic performance of pre-CRT MR-EMVI (MR-EMVI) and post-CRT MR-EMVI (yMR-EMVI), based on pathological EMVI as the standard of reference. We assessed correlation between MRI findings and patients' prognosis, such as disease-free survival (DFS) and overall survival (OS). Additionally, subgroup analysis in MR- or yMR-EMVI-positive patients was performed to confirm the significance of the severity of EMVI in MRI on patient's prognosis. RESULTS: The sensitivity and specificity of yMR-EMVI were 76.19% and 79.75% (area under the curve: 0.830), respectively. In univariate analysis, yMR-EMVI was the only significant MRI factor in DFS (P = 0.027). The mean DFS for yMR-EMVI (+) patients was significantly less than for yMR-EMVI (-) patients: 57.56 months versus 72.46 months. CONCLUSION: yMR-EMVI demonstrated good diagnostic performance. yMR-EMVI was the only significant EMVI-related MRI factor that correlated with patients' DFS in univariate analysis; however, it was not significant in multivariate analysis. KEY POINTS: • Diagnostic performance of MRI for EMVI after preoperative chemoradiotherapy is good. • The mean DFS was lower in yMR-EMVI-positive than yMR-EMVI-negative patients. • MRI can facilitate prognosis prediction of rectal cancer patients with preoperative chemoradiotherapy.
OBJECTIVES: We evaluated the diagnostic performance of magnetic resonance imaging (MRI) in terms of identifying extramural venous invasion (EMVI) in rectal cancerpatients with preoperative chemoradiotherapy (CRT) and its prognostic significance. METHODS: During 2008-2010, 200 patients underwent surgery following preoperative CRT for rectal cancer. Two radiologists independently reviewed all pre- and post-CRT MRI retrospectively. We investigated diagnostic performance of pre-CRT MR-EMVI (MR-EMVI) and post-CRT MR-EMVI (yMR-EMVI), based on pathological EMVI as the standard of reference. We assessed correlation between MRI findings and patients' prognosis, such as disease-free survival (DFS) and overall survival (OS). Additionally, subgroup analysis in MR- or yMR-EMVI-positive patients was performed to confirm the significance of the severity of EMVI in MRI on patient's prognosis. RESULTS: The sensitivity and specificity of yMR-EMVI were 76.19% and 79.75% (area under the curve: 0.830), respectively. In univariate analysis, yMR-EMVI was the only significant MRI factor in DFS (P = 0.027). The mean DFS for yMR-EMVI (+) patients was significantly less than for yMR-EMVI (-) patients: 57.56 months versus 72.46 months. CONCLUSION: yMR-EMVI demonstrated good diagnostic performance. yMR-EMVI was the only significant EMVI-related MRI factor that correlated with patients' DFS in univariate analysis; however, it was not significant in multivariate analysis. KEY POINTS: • Diagnostic performance of MRI for EMVI after preoperative chemoradiotherapy is good. • The mean DFS was lower in yMR-EMVI-positive than yMR-EMVI-negative patients. • MRI can facilitate prognosis prediction of rectal cancerpatients with preoperative chemoradiotherapy.
Entities:
Keywords:
Chemoradiotherapy; Disease-free survival; Magnetic resonance imaging; Prognosis; Rectal neoplasms
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