Evaluation of Extramural Venous Invasion by Diffusion-Weighted Magnetic Resonance Imaging and Computed Tomography in Rectal Adenocarcinoma

Abstract

Purpose The aim of this study is to evaluate the diagnostic contribution of diffusion-weighted magnetic resonance imaging (MRI) and computed tomography (CT) to distinguish extramural venous invasion (EMVI) in rectal adenocarcinoma. Materials and Methods Fifty-eight patients who had been diagnosed with rectal adenocarcinoma (30 patients with EMVI and 28 patients without EMVI) were enrolled in the study. Apparent diffusion coefficient (ADC) values of the tumour and the EMVI (+) vein, the lengths of the tumours were measured on MRI. The diameters of the superior rectal vein (SRV)-inferior mesenteric vein (IMV) and distant metastatic spread were evaluated on CT. The ability of these findings to detect EMVI was assessed using receiver operating characteristic (ROC) analysis. Pathology was accepted as the reference test for EMVI. Results Mean diameters of the SRV (4.9 ± 0.9 mm vs 3.7 ± 0.8 mm) and IMV (6.9 ± 0.8 mm vs 5.4 ± 0.9 mm) were significantly larger ( P < .001) and tumour ADC values were significantly lower (0.926 ± 0.281 × 10−3 mm2/s vs 1.026 ± 0.246 × 10−3 mm2/s; P = .032) in EMVI (+) patients. Diameters of 3.95 mm for the SRV (area under the curve [AUC] ± standard error [SE]: 0.851 ± 0.051, P < .001, sensitivity: 93.3%, specificity: 67.9%) and 5.95 mm for the IMV (AUC ± SE: 0.893 ± 0.040, P < .001, sensitivity: 93.3%, specificity: 71.4%) and an ADC value of 0.929 × 10−3 mm2/s (AUC ± SE: 0.664 ± 0.072, P = .032 sensitivity: 76.7%, specificity: 57.1%) were found to be cutoff values, determined by ROC analysis, for detection of EMVI. Distant metastases were significantly more prevalent in EMVI (+) patients ( P < .001). Conclusion The measurement of ADC values and SRV-IMV diameters seems to have contribution for diagnosis of EMVI in rectal adenocarcinoma. EMVI (+) patients appear to have higher risks of distant metastases at diagnosis.

Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer

“…Only 3 studies were prospective in nature, 8,24,25 with the remaining 14 being retrospective cohorts 26–39 . A total of 3821 patients were involved in this review and the entire cohort spanned from 2000 to 2017.…”

“…Only 3 studies were prospective in nature, 8,24,25 with the remaining 14 being retrospective cohorts. [26][27][28][29][30][31][32][33][34][35][36][37][38][39] A total of 3821 patients were involved in this review and the entire cohort spanned from 2000 to 2017. Table 1 summarizes the characteristics of included studies.…”

The Preoperative Diagnostic Performance of Multi-Parametric Quantitative Assessment in Rectal Carcinoma: A Preliminary Study Using Synthetic Magnetic Resonance Imaging

“…Gursoy et al. ( 50 ) had suggested that the ADC value was associated with EMVI diagnosis of rectal adenocarcinoma. We conducted further inter-group comparison of patients in 5 groups with different EMVI scores.…”

Machine Learning-Based Radiomics Nomogram for Detecting Extramural Venous Invasion in Rectal Cancer

“…However, compared with CT radiation damage, nomogram may be more suitable for clinical practice. Aysegul et al Used changes in dimensions of superior recurrent vein (SRV) and inferior median vein (IMV) and ADC values were used to predict EMVI (39), and the AUC values were 0.851.0.893 and 0.664, respectively. Although the diagnostic efficiency of IMV was higher than that of the nomogram, but these indexes were based on CT examination, while the ADC value based on MRI examination was significantly lower than that of our nomogram.…”