The Value of High-Resolution MRI Technique in Patients with Rectal Carcinoma: Pre-Operative Assessment of Mesorectal Fascia Involvement, Circumferential Resection Margin and Local Staging

Abstract

SummaryBackgroundThe purpose of the study was to identify the accuracy of high-resolution MRI in the pre-operative assessment of mesorectal fascia involvement, circumfrential resection margin (CRM) and local staging in patients with rectal carcinoma.Material/MethodsThe study included 56 patients: 32 male and 24 female. All patients underwent high-resolution MRI and had confirmed histopathological diagnosis of rectal cancer located within 15 cm from the anal verge, followed by surgery. MRI findings were compared with pathological and surgical results.ResultsThe overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI-based T-staging were 92.8, 88.8%, 96.5%, 96%, and 90.3%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based assessment of CRM were 94.6%, 84.6%, 97.6%, 91.4, and 94.6%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based N-staging were 82.1%, 75%, 67.3%, 60%, and 86.1%, respectively.ConclusionsPreoperative high-resolution rectal MRI is accurate in predicting tumor stage and CRM involvement. MRI is a precise diagnostic tool to select patients who may benefit from neo-adjuvant therapy and to avoid overtreatment in those patients who can proceed directly to surgery.

Magnetic Resonance Imaging Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-Analysis

“…The characteristics of the studies are presented in Table 1. The reference standards were divided into the following five categories according to different morphological criteria: (A) a short-axis diameter of 5 mm (22-34), (B) morphological standard, including an irregular border and mixed-signal intensity within the lymph node (35)(36)(37)(38)(39)(40), (C) a short-axis diameter of 5 mm with the morphological standard (11,(41)(42)(43)(44)(45)(46)(47)(48), (D) a short-axis diameter of 8 mm with the morphological standard (49)(50)(51)(52), and (E) a short-axis diameter of 10 mm with the morphological standard (11,45,53,54). In all of the included articles, 36 indirectly evaluated the lymph node stage of patients through histopathology and 5 (9,41,42,55,56) identified the node-by-node correspondence between lymph node MRI scans and histopathologic results.…”

Application of ultrasound in the diagnosis of gastrointestinal tumors

“…49 The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based assessment of CRM were 94.6%, 84.6%, 97.6%, 91.4, and 94.6%, respectively. 50…”

Neoadjuvant chemotherapy in the treatment of rectal cancer without mesorectal fascia involvement but with negative prognostic factors

“…Общая точность, чувствительность, специфичность, положительная прогностическая ценность и отрицательная прогностическая ценность МРТ при определении критерия T в работе A. M. Algebally и соавт. составили 92,8; 88,8; 96,5; 96 и 90,3 % соответственно, для оценки циркулярной границы резекции на основе данных МРТ -94,6; 84,6; 97,6; 91,4 и 94,6 % соответственно, для определения статуса N -82,1; 75; 67,3; 60 и 86,1 % соответственно [21].…”