CT and 3 Tesla MRI in the TN Staging of Colon Cancer: A Prospective, Blind Study

Abstract

(1) Background: Computer tomography (CT) scanning is currently the standard method for staging of colon cancer; however, the CT based preoperative local staging is far from optimal. The purpose of this study was to investigate the sensitivity and specificity of magnetic resonance imaging (MRI) compared to CT in the T- and N-staging of colon cancer. (2) Methods: Patients underwent a standard contrast-enhanced CT examination. For the abdominal MRI scan, a 3 Tesla unit was used, including diffusion weighted imaging (DWI). Experienced radiologists reported the CT and MRI scans blinded to each other and the endpoint of the pathological report. (3) Results: From 2018 to 2021, 134 patients received CT and MRI scans. CT identified 118 of the 134 tumors, whereas MRI identified all tumors. For discriminating between stage T3ab and T3cd, the sensitivity of CT was 51.1% and of MRI 80.0% (p = 0.02). CT and MRI showed a sensitivity of 21.4% and 46.4% in detecting pT4 tumors and a specificity of 79.0% and 85.0%, respectively. (4) Conclusion: Compared to CT, the sensitivity of MRI was statistically significantly higher in staging advanced T3cd and T4 tumors. MRI has the potential to be used in the treatment planning of colon cancer.

Estimation of colon cancer grade and metastatic lymph node involvement using DWI/ADC sequences

“…In addition, the level of movement disruption of the presence of water at the cellular level correlates with tumor aggressiveness (37) and is different between original tumorous and metastatic tissue. The recently published study provided by Rafaelsen et al (5) has shown that the diffusion restriction was significantly lower in mucin-containing colonic tumors, where the mean primary tumor ADC values tended to be lower in patients with distant metastases than in those without it. Though the data in our study relate to non–mucinous adenocarcinomas, differences in the amount of the mucin component (range = 0%–50%) (38), is a possible clue for unexpected findings related to the tumor grade.…”

“…As the fourth most common form of cancer occurring worldwide, colorectal carcinoma is a central issue requiring better diagnostic and therapeutic options (1,2). Though neoadjuvant chemotherapy (NAC) for rectal cancer has been well established (3), there is still ongoing research in the use of NAC in the setting of colonic cancer (4,5). Several recent studies have shown promising results using NAC in colon cancer before surgery (6)(7)(8)(9)(10).…”

Diagnostic Performance of Diffusion-Weighted Imaging for Colorectal Cancer Detection: An Updated Systematic Review and Meta-Analysis

“…The small number of participants might reduce the credibility and stability of the results. Moreover, the small sample sizes also limited further subgroup analyses or sensitivity analyses, e.g., only a few studies on colon cancer were available, and MRI with DWI was reported to have a better performance in detecting more colonic cancers than CT ( 36 ). Second, some of the studies did not match the participants by age or gender.…”

Current Controversies in the Management of Locally Advanced Colon Cancer

“…Magnetic resonance imaging had significantly higher sensitivity than CT scan in identifying T3 tumors (80% vs 51%). 77 In contrast, Hunter et al prospectively analyzed the accuracy of CT and MRI in 53 patients with T3 colon cancer and reported no significant differences in accuracy. 75 In other studies, CT has accurately identified high-risk colon cancer, with low rates of over-staging.…”

“…[72][73][74] Various studies have been conducted to evaluate the staging accuracy of MRI, as it offers better soft tissue contrast. [75][76][77][78] A retrospective analysis in 2019 by Fernandez et al focused on 150 patients who underwent right colectomy between 2011 and 2016 at two institutions, with the goal of evaluating accuracy of CT staging for proximal colon cancer. The authors found CT failed to recognize the primary cancer in 18% of cases and over-staged tumor and lymph node involvement in 23.7% and 28.7% of cases, respectively.…”