Rectal Carcinoma: Thin-Section MR Imaging for Staging in 28 Patients

Brown, Gina; Richards, C. J.; Newcombe, Robert G.; Dallimore, N S; Radcliffe, A. G.; Carey, Declan; Bourne, Michael W.; Williams, Geraint T.

doi:10.1148/radiology.211.1.r99ap35215

Cited by 417 publications

(285 citation statements)

References 28 publications

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“…Many studies have shown that the depth of extramural invasion, nodal involvement and CRM involvement are independent markers of poor prognosis (Cawthorn et al, 1986;Jass and Love, 1989;Adam et al, 1994;Hall et al, 1998) and selection for neoadjuvant therapy is being increasingly based on these. MRI performs particularly well over other modalities in the assessment of these parameters and studies have prospectively validated the technique for accuracy of depth of extramural spread and its ability to predict CRM involvement (Brown et al, 1999(Brown et al, , 2003a. By contrast, DRE (which depends on the subjective appreciation of tumour mobility or fixity) performs poorly, understaging 47% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…T2-weighted MRI was performed (Brown et al, 1999). The tumour was staged according to the TNM classification and the maximum depth of extramural spread was recorded using criteria developed previously (Brown et al, 1999(Brown et al, , 2003b.…”

Section: Imaging Techniquementioning

confidence: 99%

“…The tumour was staged according to the TNM classification and the maximum depth of extramural spread was recorded using criteria developed previously (Brown et al, 1999(Brown et al, , 2003b. In addition, note was made of the relationship of tumour (either in continuity with the primary mass or as a separate mesorectal deposit (Brown et al, 2003b) with an irregular border or a mixed intensity signal) to the mesorectal fascia.…”

Section: Imaging Techniquementioning

confidence: 99%

“…It has previously been shown that using a high-resolution technique, thin slice magnetic resonance imaging (MRI) can be used to measure the depth of extramural spread accurately with good correlation with corresponding pathology measurements in resection specimens (Brown et al, 1999). Furthermore, the relationship of tumour to the mesorectal fascia can be seen so that CRM positive status is predicted when tumour is imaged within 1 mm of the mesorectal fascia (Brown et al, 2003a).…”

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confidence: 99%

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Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?

et al. 2004

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In rectal cancer, preoperative staging should identify early tumours suitable for treatment by surgery alone and locally advanced tumours that require therapy to induce tumour regression from the potential resection margin. Currently, local staging can be performed by digital rectal examination (DRE), endoluminal ultrasound (EUS) or magnetic resonance imaging (MRI). Each staging method was compared for clinical benefit and cost-effectiveness. The accuracy of high-resolution MRI, DRE and EUS in identifying favourable, unfavourable and locally advanced rectal carcinomas in 98 patients undergoing total mesorectal excision was compared prospectively against the resection specimen pathological as the gold standard. Agreement between each staging modality with pathology assessment of tumour favourability was calculated with the chance-corrected agreement given as the kappa statistic, based on marginal homogenised data. Differences in effectiveness of the staging modalities were compared with differences in costs of the staging modalities to generate cost effectiveness ratios. Agreement between staging and histologic assessment of tumour favourability was 94% for MRI (k ¼ 0.81, s.e. ¼ 0.05; k W ¼ 0.83), compared with very poor agreements of 65% for DRE (k ¼ 0.08, s.e. ¼ 0.068, k W ¼ 0.16) and 69% for EUS (k ¼ 0.17, s.e. ¼ 0.065, k W ¼ 0.17). The resource benefits resulting from the use of MRI rather than DRE was d67164 and d92244 when MRI was used rather than EUS. Magnetic resonance imaging dominated both DRE and EUS on cost and clinical effectiveness by selecting appropriate patients for neoadjuvant therapy and justifies its use for local staging of rectal cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Imaging Techniquementioning

confidence: 99%

Section: Imaging Techniquementioning

confidence: 99%

mentioning

confidence: 99%

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Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?

et al. 2004

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“…The rational for this is that MRI can predict the T and N stage of a rectal tumour more accurately than CT and is superior at identifying contiguous organ involvement, a threatened CRM or the presence of extra-mural vascular invasion, which may influence the decision to use neoadjuvant treatment [16][17][18].…”

Section: Magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

Paradigm Shift in the Management of Rectal Cancer

Rawat

Evans

2014

Indian J Surg

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Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).

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Preoperative Staging of Rectal Cancer Using Magnetic Resonance Imaging With External Phase-Arrayed Coils

Gagliardi

Bayar²,

Smith³

et al. 2002

Arch Surg

111

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Hypothesis: Rectal cancer can be accurately staged preoperatively by magnetic resonance imaging (MRI) with external phase-arrayed coils. Design: Comparison of MRIs with pathologic staging. Setting: University hospital. Patients: Twenty-eight consecutive patients with biopsyproven rectal cancer who did not undergo irradiation. Intervention: Patients underwent imaging using a 1.5-T MRI scanner with external phase-arrayed surface coils. Streaking of the perirectal fat and disruption of the bowel wall margin were interpreted as transmural invasion. Lymph nodes were defined as metastatic when they had a diameter of at least 0.5 cm. Tumors were staged according to the TNM staging system (American Joint Committee on Cancer guidelines) as confined to the bowel wall (T1-T2) and invading through the bowel wall (T3-T4). Patients underwent anterior resection (n = 15), abdominoperineal resection (n = 11), or local excision (n = 2). Main Outcome Measures: Calculation of sensitivity, specificity, and accuracy for invasion through the bowel wall and lymph node status. Results: Sensitivity of MRI in detecting invasion through the bowel wall was 89% (16/18), specificity was 80% (8/10), and accuracy was 86% (24/28). Sensitivity for malignant lymphadenopathy was 67% (8/12), specificity was 71% (10/14), and accuracy 69% (18/26). Conclusion: Although more costly and not as accurate as endoscopic ultrasound, MRI with phase-arrayed coils had excellent sensitivity at detecting transmural penetration of rectal cancer.

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Rectal Carcinoma: Thin-Section MR Imaging for Staging in 28 Patients

Cited by 417 publications

References 28 publications

Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?

Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?

Paradigm Shift in the Management of Rectal Cancer

Preoperative Staging of Rectal Cancer Using Magnetic Resonance Imaging With External Phase-Arrayed Coils

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