Diagnostic performance of magnetic resonance to assess treatment response after neoadjuvant therapy in patients with locally advanced rectal cancer

  • Sergio Carlos Nahas
  • Caio Sergio Rizkallah Nahas
  • Gerson Montoya Cama
  • Rodrigo Lautert de Azambuja
  • Natally HorvatEmail author
  • Carlos Frederico Sparapan Marques
  • Marcos Roberto Menezes
  • Ulysses Ribeiro Junior
  • Ivan Cecconello
Special Section: Rectal Cancer



Our study aimed to evaluate the diagnostic performance of rectal magnetic resonance imaging (MRI) for local restaging in patients with non-metastatic locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT) using surgical histopathology of total mesorectal excision as the reference standard.


Ninety-five patients with LARC who underwent rectal MRI after CRT between January 2014 and December 2016 were included. Accuracy, sensitivity, specificity, positive, and negative predictive value for local staging regarding T-stage, N-stage, circumferential resection margin, and MRI tumor regression grade (ymriTRG) were calculated, and inter-test agreements were assessed.


22/95 (23.2%) patients had radiological complete response (rCR), whereas 20/95 (21.1%) had pathological complete response (pCR). Among the patients with pCR, 11/20 (55%) had rCR. Fair agreement was demonstrated between ymriTRG and pathological TRG (ypTRG) (κ = 0.255). The sensitivity and specificity for detection of pCR were 61.1% (95% CI 35.7–82.7) and 89.6% (95% CI 80.6–95.4). For the detection of ypTRG grades 1 and 2, the corresponding values were 67.2% (95% CI 54.3–78.4) and 51.6 (95% CI 33.1–69.8). The accuracy of ymriTRG was 24.2% (95% CI 15.6–32.8). Inter-test agreement in TRG between MRI and pathology was overall fair (κ = 0.255) and slight (κ = 0.179), if TRG 1 + 2.


Qualitative assessment on MRI for diagnosing pCR showed moderate sensitivity and high specificity, whereas the diagnosis of TRG had moderate sensitivity and low specificity with slight to fair inter-test agreement when compared with pathological specimens.


Rectal neoplasms Magnetic resonance Neoadjuvant therapy 



The authors have no support or funding to report.

Compliance with ethical standards

Conflict of interest

The authors have declared that no competing interests exist.

Ethical approval

For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sergio Carlos Nahas
    • 1
    • 2
  • Caio Sergio Rizkallah Nahas
    • 1
    • 2
  • Gerson Montoya Cama
    • 1
  • Rodrigo Lautert de Azambuja
    • 3
    • 4
  • Natally Horvat
    • 3
    • 4
    Email author
  • Carlos Frederico Sparapan Marques
    • 1
    • 2
  • Marcos Roberto Menezes
    • 3
    • 4
  • Ulysses Ribeiro Junior
    • 1
  • Ivan Cecconello
    • 1
    • 2
  1. 1.Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP)Instituto do Câncer do Estado de São Paulo (ICESP)São PauloBrazil
  2. 2.Department of SurgeryHospital Sírio-LibanêsSão PauloBrazil
  3. 3.Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP)Instituto do Câncer do Estado de São Paulo (ICESP)São PauloBrazil
  4. 4.Department of RadiologyHospital Sírio-LibanêsSão PauloBrazil

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