Abstract
Purpose
To evaluate whether the addition of gadolinium-enhanced MRI and diffusion-weighted imaging (DWI) improves T2 sequence performance for the diagnosis of local recurrence (LR) from rectal cancer and to assess which approach is better at formulating this diagnosis among readers with different experience.
Methods
Forty-three patients with suspected LR underwent pelvic MRI with T2 weighted (T2) sequences, gadolinium fat-suppressed T1 weighted sequences (post-contrast T1), and DWI sequences. Three readers (expert: G, intermediate: E, resident: V) scored the likelihood of LR on T2, T2 + post-contrast T1, T2 + DWI, and T2 + post-contrast T1 + DWI.
Results
In total, 18/43 patients had LR; on T2 images, the expert reader achieved an area under the ROC curve (AUC) of 0.916, sensitivity of 88.9%, and specificity of 76%; the intermediate reader achieved values of 0.890, 88.9%, and 48%, respectively, and the resident achieved values of 0.852, 88.9%, and 48%, respectively. DWI significantly improved the AUC value for the expert radiologist by up to 0.999 (p = 0.04), while post-contrast T1 significantly improved the AUC for the resident by up to 0.950 (p = 0.04). For the intermediate reader, both the T2 + DWI AUC and T2 + post-contrast T1 AUC were better than the T2 AUC (0.976 and 0.980, respectively), but with no statistically significant difference. No statistically significant difference was achieved by any of the three readers by comparing either the T2 + DWI AUCs to the T2 + post-contrast T1 AUCs or the AUCs of the two pairs of sequences to those of the combined three sequences.
Furthermore, using the T2 sequences alone, all of the readers achieved a fair number of “equivocal” cases: they decreased with the addition of either DWI or post-contrast T1 sequences and, for the two less experienced readers, they decreased even more with the three combined sequences.
Conclusions
Both DWI and T1 post-contrast MRI increased diagnostic performance for LR diagnosis compared to T2; however, no significant difference was observed by comparing the two different pairs of sequences with the three combined sequences.
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References
Weinstein S, Osei-Bonsu S, Aslam R, Yee J (2013) Multidetector CT of the postoperative colon: review of normal appearances and common complications. RadioGraphics 33:515–532
Colosio A, Forne P, Soyer P, et al. (2013) Local colorectal cancer recurrence: pelvic MRI evaluation. Abdom Imaging 38:72–81
Abulafi AM, William NS (1994) The local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg 81:7–19
Cai Y, Li Z, Gu X, et al. (2014) Prognostic factors associated with locally recurrent rectal cancer following primary surgery (review). Oncol Lett 7:10–16
Hoffel C, Marcus C, Arrivè L, et al. (2009) Imagerie post-opératoire de chirurgie colorectale. J Radiol 90:954–968
Tan PL, Chan CLH, Moore NR (2005) Radiological appearances in the pelvis following rectal cancer surgery. Clin Radiol 60:846–855
Nural SM, Danaci M, Soyucoket A, et al. (2013) Efficiency of apparent diffusion coefficients in differentiation of colorectal tumor recurrences and post therapeutical soft-tissue changes. Eur J Radiol 82:1702–1709
Nishie A, Stolpen AH, Obuchi M, et al. (2008) Evaluation of locally recurrent pelvic malignancy: performance of T2- and diffusion-weighted MRI with image fusion. J Magn Reson Imaging 28:705–713
Torricelli P, Pecchi A, Luppi G, Romagnoli R (2003) Gadolinium-enhanced MRI with dynamic evaluation in diagnosing the local recurrence of rectal cancer. Abdom Imaging 28:19–27
Blomqvist L, Fransson P, Hindmarsh T (1998) The pelvis after surgery and radio-chemotherapy for rectal cancer studied with Gd-DTPA-enhanced fast dynamic MR imaging. Eur Radiol 8:781–787
Sinha R, Rajiah P, Ramachandran I, et al. (2013) Diffusion-weighted MR imaging of the gastrointestinal tract: technique, indications, and imaging findings. RadioGraphics 33:655–676
Lambregts DMJ, Cappendijk VC, Maas M, et al. (2011) Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer. Eur Radiol 21:1250–1258
Grosu S, Schäfer AO, Baumann T, et al. (2016) Differentiating locally recurrent rectal cancer from scar tissue: value of diffusion-weighted MRI. Eur J Radiol 85(7):1265–1270
Colosio A, Soyer P, Rousset P, et al. (2014) Value of diffusion-weighted and gadolinium-enhanced MRI for the diagnosis of pelvic recurrence from colorectal cancer. J Magn Reson Imaging 40:306–313
Hoeffel C, Arrivé L, Mourra M, et al. (2006) Anatomic and pathologic findings at external phased-array pelvic MR imaging after surgery for anorectal disease. RadioGraphics 26:1391–1407
DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3):837–845
Müller-Schimpfle M, Brix G, Layer G, et al. (1993) Recurrent rectal cancer: diagnosis with dynamic MR imaging. Radiology 189(3):881–889
Kuang F, Ren J, Zhong Q, et al. (2013) The value of apparent diffusion coefficient in the assessment of cervical cancer. Eur Radiol 23(4):1050–1058
Roy C, Foudi F, Charton J, et al. (2013) Comparative sensitivities of functional MRI sequences in detection of local recurrence of prostate carcinoma after radical prostatectomy or external-beam radiotherapy. AJR 200(4):W361–W368
Lambregts DMJ, Vandecaveye V, Barbaro B, et al. (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18:2224–2231
Park MJ, Kim SH, Lee SJ, et al. (2011) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology 260(3):771–780
Lambregts DMJ, Lahaye MJ, Heijnen LA, et al. (2016) MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy. Eur Radiol 26:2118–2125
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Molinelli, V., Angeretti, M.G., Duka, E. et al. Role of MRI and added value of diffusion-weighted and gadolinium-enhanced MRI for the diagnosis of local recurrence from rectal cancer. Abdom Radiol 43, 2903–2912 (2018). https://doi.org/10.1007/s00261-018-1518-z
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DOI: https://doi.org/10.1007/s00261-018-1518-z