Rutger Ch Stijns1, Tom Wj Scheenen1, Johannes Hw de Wilt2, Jurgen J Fütterer1, Regina Gh Beets-Tan3,4. 1. 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands. 2. 2 Department of Surgery, Radboud University Medical Center , Nijmegen , The Netherlands. 3. 3 Department of Radiology, The Netherlands Cancer Institute , Amsterdam , The Netherlands. 4. 4 GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands.
Abstract
OBJECTIVE: To assess the influence of endorectal filling (EF) on rectal cancer staging. METHODS: 47 patients who underwent a staging MRI of rectal cancer in the period from 2011 to 2014 were included. The MRI protocol included T2 weighted fast spin echo sequences without and with EF at 3 T (EF-MRI). Images were scored by two readers for T-stage, distance of the lower pole of the tumour to the anorectal junction, distance to the mesorectal fascia (MRF), and number of (suspicious) lymph nodes. Agreement in T-staging was calculated using the Cohen's κ value. Comparison of continuous variables was performed using Wilcoxon matched pairs signed-rank test. RESULTS: The interobserver agreement for T-staging with and without EF-MRI showed a poor agreement between both readers (weighted κ = 0.156, weighted κ = 0.037, respectively). Tumours tended to be overstaged more prominently with EF-MRI. The accuracy of predicting the pathological T-stage slightly improved from 55% with EF to 64% without EF for Reader 1 and from 59 to 68% for Reader 2, respectively. The distance of the tumour to the anorectal junction increased from 33.9 to 49.3 mm (p < 0.001) after EF for Reader 2. EF-MRI did not significantly influence the number of (suspicious) lymph nodes and distance to the mesorectal fascia. CONCLUSION: EF-MRI did not lead to an improved tumour staging and it has the potential to influence the distance to a key anatomical landmark. EF-MRI is therefore not recommended in primary staging rectal cancer. Advances in knowledge: EF-MRI may not be used as an additional tool to stage rectal cancer patients, as it does not seem to facilitate in locoregionally staging the disease.
OBJECTIVE: To assess the influence of endorectal filling (EF) on rectal cancer staging. METHODS: 47 patients who underwent a staging MRI of rectal cancer in the period from 2011 to 2014 were included. The MRI protocol included T2 weighted fast spin echo sequences without and with EF at 3 T (EF-MRI). Images were scored by two readers for T-stage, distance of the lower pole of the tumour to the anorectal junction, distance to the mesorectal fascia (MRF), and number of (suspicious) lymph nodes. Agreement in T-staging was calculated using the Cohen's κ value. Comparison of continuous variables was performed using Wilcoxon matched pairs signed-rank test. RESULTS: The interobserver agreement for T-staging with and without EF-MRI showed a poor agreement between both readers (weighted κ = 0.156, weighted κ = 0.037, respectively). Tumours tended to be overstaged more prominently with EF-MRI. The accuracy of predicting the pathological T-stage slightly improved from 55% with EF to 64% without EF for Reader 1 and from 59 to 68% for Reader 2, respectively. The distance of the tumour to the anorectal junction increased from 33.9 to 49.3 mm (p < 0.001) after EF for Reader 2. EF-MRI did not significantly influence the number of (suspicious) lymph nodes and distance to the mesorectal fascia. CONCLUSION: EF-MRI did not lead to an improved tumour staging and it has the potential to influence the distance to a key anatomical landmark. EF-MRI is therefore not recommended in primary staging rectal cancer. Advances in knowledge: EF-MRI may not be used as an additional tool to stage rectal cancerpatients, as it does not seem to facilitate in locoregionally staging the disease.
Authors: Regina G H Beets-Tan; Doenja M J Lambregts; Monique Maas; Shandra Bipat; Brunella Barbaro; Filipe Caseiro-Alves; Luís Curvo-Semedo; Helen M Fenlon; Marc J Gollub; Sofia Gourtsoyianni; Steve Halligan; Christine Hoeffel; Seung Ho Kim; Andrea Laghi; Andrea Maier; Søren R Rafaelsen; Jaap Stoker; Stuart A Taylor; Michael R Torkzad; Lennart Blomqvist Journal: Eur Radiol Date: 2013-06-07 Impact factor: 5.315
Authors: Harmeet Kaur; Haesun Choi; Y Nancy You; Gaiane M Rauch; Corey T Jensen; Ping Hou; George J Chang; John M Skibber; Randy D Ernst Journal: Radiographics Date: 2012 Mar-Apr Impact factor: 5.333
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