Comparison between magnetic resonance imaging and rigid rectoscopy in the preoperative identification of intra‐ and extraperitoneal rectal cancer

Paparo, Francesco; Puppo, Cristina; Montale, Amedeo; Bacigalupo, Lorenzo; Pascariello, A.; Clavarezza, Matteo; Binda, Cecilia; Rollandi, G. A.; Binda, Gian Andrea

doi:10.1111/codi.12698

Cited by 19 publications

(13 citation statements)

References 27 publications

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“…The direct methods achieved the least bias, the highest precision, and the best correlation with rigid sigmoidoscopy among the three methods groups. The majority of previous studies have measured the tumor distance using multiple lines that reflect the anorectal curvature [2,6,[18][19][20][21][22][23][24]29]. However, in our study, the direct methods using a straight line demonstrated the best results; this corroborates the findings by Meylemans et al, who compared measurement methods using a straight line or multiple straight lines [19].…”

Section: Discussionsupporting

confidence: 90%

“…In the recent study, different methods were used to measure the tumor distance from the anal verge on sagittal MRI. Although the majority of research groups have used multiple straight lines from the anal verge along [6,18,19] or not along [2,[20][21][22][23][24] the anorectal centerline, others have used a single straight line [19,25]. Thus, there is no clear consensus on the measurement of tumor distance, and no prospective study has compared these methods.…”

Section: Introductionmentioning

confidence: 99%

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How to accurately measure the distance from the anal verge to rectal cancer on MRI: a prospective study using anal verge markers

et al. 2020

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Purpose To determine an accurate method for localizing rectal cancer using the distance from the anal verge on preoperative MRI. Methods This prospective study included 50 patients scheduled for MRI evaluation of rectal cancer. After rectal filling with gel, MRI was performed with two markers attached at the anal verge. The distance between the tumor and the anal verge on a sagittal T2-weighted image (T2WI) was measured independently by two radiologists using six methods divided into three groups of similar measurement approaches, and compared to those obtained on rigid sigmoidoscopy. The anal verge location relative to the external anal sphincter was assessed on oblique coronal T2WI in reference to the markers. Correlation analysis was performed using the intraclass correlation coefficient (ICC) for verification, and a paired t test was used to evaluate the mean differences. Results The highest correlation (ICC 0.797-0.815) and the least mean difference (0.74-0.85 cm) with rigid sigmoidoscopy, and the least standard deviation (3.12-3.17 cm) were obtained in the direct methods group using a straight line from the anal verge to the tumor. The anal verge was localized within a range of − 1.4 to 1.5 cm (mean − 0.31 cm and − 0.22 cm) from the lower end of the external anal sphincter. ConclusionThe direct methods group provided the most accurate tumor distance among the groups. Among the direct methods, we recommend the direct mass method for its simplicity. Despite minor differences in location, the lower end of the external anal sphincter was a reliable anatomical landmark for the anal verge.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

How to accurately measure the distance from the anal verge to rectal cancer on MRI: a prospective study using anal verge markers

et al. 2020

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“…These authors used the anal verge as a landmark and their levels of agreement were –15.7 cm to 4.7 cm, clearly showing a large variability between the measurements. 19 In regular clinical practice, flexible endoscopes are used that may bend and thereby add a few centimeters to the true distance. Furthermore, the distance hallmarks on the endoscopes are spaced 5 cm apart, which may lead to mistakes in measuring distances.…”

Section: Discussionmentioning

confidence: 99%

“…Only one small study by Paparo et al, including 66 patients, concluded that MRI measurements of rectal tumor height correlated well with rigid proctosigmoidoscopy. These authors used the anal verge as a landmark and their levels of agreement were –15.7 cm to 4.7 cm, clearly showing a large variability between the measurements 19 . In regular clinical practice, flexible endoscopes are used that may bend and thereby add a few centimeters to the true distance.…”

Section: Discussionmentioning

confidence: 99%

Comparison of MRI and colonoscopy in determining tumor height in rectal cancer

Jacobs

Meek

Heukelom

et al. 2017

United European Gastroenterology Journal

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Background and aimEndoscopy and magnetic resonance imaging (MRI) are used routinely in the diagnostic and preoperative work-up of rectal cancer. We aimed to compare colonoscopy and MRI in determining rectal tumor height.MethodsBetween 2002 and 2012, all patients with rectal cancer with available MRIs and endoscopy reports were included. All MRIs were reassessed for tumor height by two abdominal radiologists. To obtain insight in techniques used for endoscopic determination of tumor height, a survey among regional endoscopists was conducted.ResultsA total of 211 patients with rectal cancer were included. Tumor height was significantly lower when assessed by MRI than by endoscopy with a mean difference of 2.5 cm (95% CI: 2.1–2.8). Although the agreement between tumor height as measured by MRI and endoscopy was good (intraclass correlation coefficient (ICC) 0.7 (95% CI: 0.7–0.8)), the 95% limits of agreement varied from –3.0 cm to 8.0 cm. In 45 patients (21.3%), tumors were regarded as low by MRI and middle–high by endoscopy. MRI inter- and intraobserver agreements were excellent with an ICC of 0.8 (95% CI: 0.7–0.9) and 0.9 (95% CI: 0.9–1.0), respectively. The survey showed no consensus among endoscopists as to how to technically measure tumor height.ConclusionThis study showed large variability in rectal tumor height as measured by colonoscopy and MRI. Since MRI measurements showed excellent inter- and intraobserver agreement, we suggest using tumor height measurement by MRI for diagnostic purposes and treatment allocation.

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“…On the sagittal T2W images, APR was identi ed as a thin hypointense linear structure noted along with the superior bladder (men) or uterus (women), which extended inferiorly and posteriorly to the tip of the seminal vesicles in men and to the cul-de-sac in women, after which the posterior extension attached to the anterior rectal wall (Fig. 1A, B) [20]. Unfortunately, not all APRs can be visualized on MRI in clinical practice [4].…”

Section: Introductionmentioning

confidence: 99%

MRI-Based Nomogram Analysis: Recognization of Anterior Peritoneal Reflection and Its Relationship to Rectal Cancers

Zhang

Chen

et al. 2021

Preprint

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Background: This study is aimed to explore the factors influencing the visualization of the APR and evaluated the feasibility of measuring the distance from the anal verge to APR (AV-APR), the tumor height on MRI and the accuracy of determining the tumor location with regard to APR. Methods: We retrospectively analyzed 110 patients with rectal cancer. A univariate and multivariate logistic regression was performed to identify the independent factors (age, gender, T stage, the degree of bladder filling, pelvic effusion, intraoperative tumor location, BMI, uterine orientation, the distance from seminal vesicle/uterus to rectum) associated with the visualization of the APR on MRI. The nomogram diagram and receiver operating characteristic curve (ROC curve) were established. Intraclass correlation coefficient (ICC) was used to evaluate the consistency of the distance of AV-APR. The Pearson correlation coefficient was used to characterize the agreement between measurements of the tumor height by colonoscopy and MRI. The Kappa statistics was used to evaluate the value of MRI in the diagnosis of the tumor location with regard to the APR. Results: Multivariate logistic regression showed that BMI (P=0.031, odds ratio, OR=0.835), pelvic effusion (P=0.020, OR=7.107) and the distance from seminal vesicle/uterus to the rectum (P=0.001, OR=0.276) were correlated with the visualization of APR. The cut-off point of BMI and the distance from seminal vesicle/uterus to the rectum is 25.845kg/m2 and 1.15cm. The area under curve (AUC) （95% Confidence Interval, 95%CI）of the combined model is 0.840 (0.750-0.930). The favorable calibration of the nomogram showed a non-significant Hosmer-Lemeshow test statistic (P=0.195). The ICC value (95%CI) of the distance of AV-APR measured by two radiologists was 0.981 (0.969-0.989). The height measured by MRI and colonoscopy were correlated with each other (r=0.699, P＜0.001). The Kappa value was 0.854. Conclusions: BMI, pelvic effusion, and the distance from seminal vesicle/uterus to rectum could affect the visualization of APR on MRI. Also, it’s feasible to measure the distance of AV-APR, the tumor height, and to evaluate the tumor location with regard to APR using MRI.

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Comparison between magnetic resonance imaging and rigid rectoscopy in the preoperative identification of intra‐ and extraperitoneal rectal cancer

Abstract: RRS is still the main means of assessing the level of a rectal tumour from the anal verge, but MRI has value in determining the level of the tumour in relation to the PR, which cannot be seen on endoscopy.

Cited by 19 publications

References 27 publications

How to accurately measure the distance from the anal verge to rectal cancer on MRI: a prospective study using anal verge markers

How to accurately measure the distance from the anal verge to rectal cancer on MRI: a prospective study using anal verge markers

Comparison of MRI and colonoscopy in determining tumor height in rectal cancer

MRI-Based Nomogram Analysis: Recognization of Anterior Peritoneal Reflection and Its Relationship to Rectal Cancers

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