Comparison of CT and MRI in the pre‐operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI

Mathur, Pawan; Smith, Julius; Ramsey, C; Owen, MA; Thorpe, A.; Karim, Shakir; Burke, Colin; Ramesh, Subburaman; Dawson, Peter

doi:10.1046/j.1463-1318.2003.00537.x

Cited by 99 publications

(75 citation statements)

References 20 publications

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“…This high accuracy rate has not been achieved by EUS, conventional CT or multidetector CT (32). In a comparative study by Mathur et al (42), CT correctly staged patients with T1/T2 rectal cancers more often than MRI (77% vs. 43%, respectively, P = 0.226), and these patients were overstaged more often by MRI compared to CT (54% vs. 23%, respectively, P = 0.226). In this study, the majority of patients with T3 tumors were correctly staged by MRI compared to CT (76% vs. 41%, respectively, P = 0.08), and more T3 disease was understaged by CT than MRI (54% vs. 18%, respectively, P = 0.032).…”

Section: Discussionmentioning

confidence: 96%

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Karatağ

Karatağ²,

Özkurt³

et al. 2011

Diagn Interv Radiol

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20T he prognosis and treatment of rectal carcinoma depends on the tumor stage at presentation (1). Local tumor extent, involved lymph nodes, and the presence of distant metastases are the main factors that influence prognosis (1-5). A poor prognosis of rectal cancer is associated with a high risk of metastases and local recurrence (6). Incomplete removal of the tumor is the major cause of local recurrence, which varies from 3% to 32% (7,8). Total mesorectal excision (TME) is the standard surgical approach in primary rectal cancer. TME involves the removal of the mesorectum, which contains the rectal tumor, all local draining nodes and the mesorectal fat by sharp dissection along the mesorectal fascia (9-12). This minimizes the chance of any tumor being left behind and results in a substantial reduction of the high local recurrence rate to less than 10% (8, 13) even without adjunctive treatment (13,14). When performing TME, knowledge of the relationship of the tumor to the circumferential resection margin (CRM) is important. When the CRM is involved with the tumor, the risk of local recurrence is high (9,(15)(16)(17).Chemoradiation therapy is the standard adjunctive preoperative treatment for patients with a high likelihood of curative resection failure (14,18). According to the recent literature, patients who received preoperative chemoradiation therapy had a lower rate of local recurrence compared to patients who received postoperative chemotherapy and radiation therapy (1,19). Therefore, there is a need for preoperative imaging methods to aid in the identification of patients with extrarectal spread who may benefit from preoperative chemoradiation therapy (20).Magnetic resonance imaging (MRI) is the most promising diagnostic method for the preoperative local staging of rectal cancer (8,21). Spatial resolution has dramatically improved with advances in MRI techniques, such as the use of endorectal and phased-array coils (22,23). Current evidence suggests that MRI is the most accurate technique for predicting tumor stage (24) because it provides an assessment of the local prognostic factors, including the extent of extramural tumor spread, the involvement of the lateral resection margin, the involvement of neighboring organs in the pelvis, the presence of local lymph node metastases, extramural lymphovascular infiltration and peritoneal involvement (9,25,26).The purposes of this study were to evaluate the accuracy of MRI performed with phased-array coil for preoperative local tumor staging in patients with rectal cancer and emphasize the importance of the preoperative differentiation of T2 tumors from T3 so the appropriate treatment plan can be applied. Materials and methods PatientsTwenty-four patients with histopathologically proven primary rectal cancer were prospectively examined using MRI with a phased-array PURPOSEThis study evaluated the accuracy of phased-array magnetic resonance imaging (MRI) for preoperative local tumor staging in primary rectal cancer and emphasized the importance of the preoperativ...

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Section: Discussionmentioning

confidence: 96%

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Karatağ

Karatağ²,

Özkurt³

et al. 2011

Diagn Interv Radiol

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“…The lack of positive CRM in this series may be a reflection of the small sample size in this trial or because of initial clinical over-staging particularly as MRI was not routinely used preoperatively. It has been recognised that a degree of inaccuracy in clinical staging can occur comparing the reporting of preoperative radiological imaging to pathological staging [23]. Another possible explanation is that an element of down-staging occurred.…”

Section: Discussionmentioning

confidence: 99%

Short course continuous, hyperfractionated, accelerated radiation therapy (CHART) as preoperative treatment for rectal cancer

Brooks¹,

Glynne‐Jones²,

Novell³

et al. 2006

Acta Oncologica

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“…The role of circumferential resection margin as an important prognostic indicator of local recurrence is evident and several MRI studies have shown a high accuracy in this regard [12,25,26] . BeetsTan et al [12] used contrast-enhanced thin section MRI on a 1.5 tesla scanner with a quadrature phased-array spine coil and reported that the depth of transmural tumor invasion and mesorectal fascia involvement were predicted correctly in 83% and 100% of their patients, respectively.…”

Section: C B Amentioning

confidence: 99%

Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer

Halefoğlu¹,

Yıldırım²,

Avlanmis³

et al. 2008

WJG

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AIM:To compare the diagnostic accuracy of pelvic phased-array magnetic resonance imaging (MRI) and endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. METHODS: Thirty-four patients (15 males, 19 females) with ages ranging between 29 and 75 who have biopsy proven rectal tumor underwent both MRI and ERUS examinations before surgery. All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases. Imaging results were correlated with histopathological findings regarded as the gold standard and both modalities were compared in terms of predicting preoperative local staging of rectal carcinoma. RESULTS: The pathological T stage of the tumors was: pT1 in 1 patient, pT2 in 9 patients, pT3 in 21 patients and pT4 in 3 patients. The pathological N stage of the tumors was: pN0 in 19 patients, pN1 in 9 patients and pN2 in 6 patients. The accuracy of T staging for MRI was 89.70% (27 out of 34). The sensitivity was 79.41% and the specificity was 93.14%. The accuracy of T staging for ERUS was 85.29% (24 out of 34). The sensitivity was 70.59% and the specificity was 90.20%. Detection of lymph node metastases using phased-array MRI gave an accuracy of 74.50% (21 out of 34). The sensitivity and specificity was found to be 61.76% and 80.88%, respectively. By using ERUS in the detection of lymph node metastases, an accuracy of 76.47% (18 out of 34) was obtained. The sensitivity and specificity were found to be 52.94% and 84.31%, respectively. CONCLUSION: ERUS and phased-array MRI are complementary methods in the accurate preoperative staging of rectal cancer. In conclusion, we can state that phased-array MRI was observed to be slightly superior in determining the depth of transmural invasion (T stage) and has same value in detecting lymph node metastases (N stage) as compared to ERUS.

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Comparison of CT and MRI in the pre‐operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI

Cited by 99 publications

References 20 publications

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Short course continuous, hyperfractionated, accelerated radiation therapy (CHART) as preoperative treatment for rectal cancer

Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer

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