Prospective comparison of 3T MRI with diffusion‐weighted imaging and MDCT for the preoperative TNM staging of gastric cancer

ObjectiveTo investigate the role of apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) when applied to the 7th TNM classification in the staging and prognosis of gastric cancer (GC).MethodsBetween October 2009 and May 2014, a total of 89 patients with non-metastatic, biopsy proven GC underwent 1.5T DW-MRI, and then treated with radical surgery. Tumor ADC was measured retrospectively and compared with final histology following the 7th TNM staging (local invasion, nodal involvement and according to the different groups — stage I, II and III). Kaplan-Meier curves were also generated. The follow-up period is updated to May 2016.ResultsMedian follow-up period was 33 months and 45/89 (51%) deaths from GC were observed. ADC was significantly different both for local invasion and nodal involvement (P<0.001). Considering final histology as the reference standard, a preoperative ADC cut-off of 1.80×10–3 mm2/s could distinguish between stages I and II and an ADC value of ≤1.36×10–3 mm2/s was associated with stage III (P<0.001). Kaplan-Meier curves demonstrated that the survival rates for the three prognostic groups were significantly different according to final histology and ADC cut-offs (P<0.001). ConclusionsADC is different according to local invasion, nodal involvement and the 7th TNM stage groups for GC, representing a potential, additional prognostic biomarker. The addition of DW-MRI could aid in the staging and risk stratification of GC.

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“…Some studies have previously determined the ability of DW-MRI to detect, stage and assess tumor response in oncology (32,33,39,40). Liu et al .…”

Section: Discussionmentioning

confidence: 99%

Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer

Giganti

Ambrosi

Chiari

et al. 2017

Chinese Journal of Cancer Research

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“…Some recent studies have demonstrated that DWI could perform well in the diagnosis and preoperative TNM staging of gastric cancer as well as that DWI could clearly show the border of gastric cancer and metastatic lymph nodes. Therefore, we could draw ROIs on DWI according to the staging criteria reported in previous published articles . More specifically, the signal intensity on DWI was low in normal and high in malignant muscle; as a result, we could exclude muscle in the case of T2 stage tumors.…”

Section: Methodsmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) has also been extensively employed in diagnosing gastric cancer. Diffusion‐weighted imaging (DWI), which reflects the Brownian movement of water molecules, can qualitatively and quantitatively provide morphologic and functional information about gastric cancers …”

mentioning

confidence: 99%

“…Previous studies have confirmed the value of DWI in detecting and characterizing gastric cancers. MRI with DWI can increase the sensitivity and accuracy of TNM staging for gastric cancer, especially T staging . In quantitative terms, the apparent diffusion coefficient (ADC) values could help differentiate between gastric cancers and normal gastric mucosa as well as between gastric adenocarcinoma and lymphoma .…”

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confidence: 99%

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Assessment of histological differentiation in gastric cancers using whole-volume histogram analysis of apparent diffusion coefficient maps

Zhang

Chen

Liu

et al. 2016

J. Magn. Reson. Imaging

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“…There was only one outlying study with a low specificity of MRI for T4 staging. 21 A sensitivity analysis was performed to investigate the influence of excluding the study on MRI specificity for T4 staging. We found that this analysis produced a higher estimate of specificity, and statistical heterogeneity of specificity in T4 stage tumour was diminished.…”

Section: Diagnostic Accuracy Of Primary Tumour Depth (T Stage)mentioning

confidence: 99%

The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

Huang¹,

Xie²,

Guo³

et al. 2015

BJR

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Objective: To perform a meta-analysis and literature review regarding the diagnostic accuracy of MRI for pre-operative tumour depth invasion (T) and regional lymph node invasion (N) staging of gastric carcinoma (GC). Methods: Articles were identified through systematic search of Medline, PubMed, Cochrane Library, Web of Science, Springerlink and several Chinese databases. The study quality was assessed by the quality assessment for studies of diagnostic accuracy. 2 reviewers independently extracted and assessed the data from 11 eligible studies. A meta-analysis was then carried out. Subgroup and sensitivity analyses were also performed. Results: 11 studies (439 patients) were finally included in the current review. Among these studies, the significant evidence of heterogeneity was only discovered for Subgroup analyses showed that diffusion-weighted imaging was more helpful for T staging. Conclusion:The present systematic review suggests that MRI has a good diagnostic accuracy for pre-operative T staging of GC and should be widely used in clinical work. However, the ability for N staging is relatively poor on MRI. Advances in knowledge:In the pre-operative staging of GC, MRI was a useful tool and may enhance accuracy for the T staging of advanced GC.Gastric carcinoma (GC) is the fourth most common cancer and the second leading cause of cancer-related death with a 5-year survival rate of ,20% around the world. 1 The disease is more common in Asian countries, especially China, Japan and Republic of Korea.2,3 Accurate assessment of local tumour depth invasion (T) and regional lymph node invasion (N) plays an essential role in predicting prognosis and determining the most appropriate treatment planning. 4,5The pre-operative staging of GC has been based on a multimodality approach, such as endoscopic ultrasonography (EUS), CT, MRI and positron emission tomography (PET).6,7 EUS and CT have been widely used for GC staging in previous years.8 Of course, different imaging modalities have themselves relative merits. CT with ionized radiation requires the injection of iodine contrast medium.9 EUS is an invasive technique requiring sedation 1 and is highly operator dependent.10 PET highly depends upon the standardized uptake value and the pathological subtype of the cancer. 11MRI is a powerful imaging method with high soft-tissue contrast, with technical versatility for sequence selection and modification, and without ionizing radiation. However, it was unsuitable for the staging of GC owing to its long acquisition time and susceptibility to motion artefacts in previous years. With technology improved and shorter imaging time, these limitations have recently been partially overcome. 12Recently, there has been much research using MRI to assess pre-operative staging of GC. Nevertheless, the number of patients in each study has been insufficient, and the results varied among the articles. Also, the limited imaging field of view of MRI in a single session makes it difficult to stage the distant metastasis (M). 13Therefore, the o...

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Prospective comparison of 3T MRI with diffusion‐weighted imaging and MDCT for the preoperative TNM staging of gastric cancer

Abstract: The diagnostic accuracy of 3T MRI is comparable to that of MDCT for the preoperative TNM staging of gastric cancer, and for assessing LN metastasis, the addition of DWI to conventional MRI may increase the sensitivity.

Cited by 67 publications

References 52 publications

Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer

Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer

Assessment of histological differentiation in gastric cancers using whole-volume histogram analysis of apparent diffusion coefficient maps

The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

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