Improved detection of a tumorous involvement of the mesorectal fascia and locoregional lymph nodes in locally advanced rectal cancer using DCE-MRI

  • Marco Armbruster
  • Melvin D’Anastasi
  • Veronika Holzner
  • Martin E. Kreis
  • Olaf Dietrich
  • Bernhard Brandlhuber
  • Anno Graser
  • Martina Brandlhuber
Original Article
  • 21 Downloads

Abstract

Purpose

The prediction of an infiltration of the mesorectal fascia (MRF) and malignant lymph nodes is essential for treatment planning and prognosis of patients with rectal cancer. The aim of this study was to assess the additional diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the detection of a malignant involvement of the MRF and of mesorectal lymph nodes in patients with locally advanced rectal cancer.

Methods

In this prospective study, 22 patients with locally advanced rectal cancer were examined with 1.5-T MRI between September 2012 and April 2015. Histopathological assessment of tumor size, tumor infiltration to the MRF, and malignant involvement of locoregional lymph nodes served as standard of reference. Sensitivity and specificity of detecting MRF infiltration and malignant nodes (nodal cut-off size [NCO] ≥ 5 and ≥ 10 mm, respectively) was determined by conventional MRI (cMRI; precontrast and postcontrast T1-weighted, T2-weighted, and diffusion-weighted images) and by additional semi-quantitative DCE-MRI maps (cMRI+DCE-MRI).

Results

Compared to cMRI, additional semi-quantitative DCE-MRI maps significantly increased sensitivity (86 vs. 71% [NCO ≥ 5 mm]/29% [NCO ≥ 10 mm]) and specificity (90 vs. 70% [NCO ≥ 5 mm]) of detecting malignant lymph nodes (p < 0.05). Moreover, DCE-MRI significantly augmented specificity (91 vs. 82%) of discovering a MRF infiltration (p < 0.05), while there was no change in sensitivity (83%; p > 0.05).

Conclusion

DCE-MRI considerably increases both sensitivity and specificity for the detection of small mesorectal lymph node metastases (≥ 5 mm but < 10 mm) and sufficiently improves specificity of a suspected MRF infiltration in patients with locally advanced rectal cancer.

Keywords

Rectal cancer DCE-MRI Mesorectal fascia Lymph nodes Perfusion parameters 

Notes

Acknowledgements

The authors are most grateful to Dr. Simone Reu for providing histopathologic images and thank Dres. Ursula and Günther Karpitschka for their profound support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic of RadiologyLudwig Maximilians University of MunichMunichGermany
  2. 2.Medical Imaging DepartmentMater Dei HospitalMsidaMalta
  3. 3.Kinderkrankenhaus St.Marien LandshutLandshutGermany
  4. 4.Department of General-, Visceral- and Vascular SurgeryCharité University Medicine BerlinBerlinGermany
  5. 5.Department of Internal MedicineKlinik Mühldorf am InnMühldorf am InnGermany
  6. 6.Gemeinschaftspraxis Radiologie MünchenMunichGermany

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