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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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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.

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Authors and Affiliations

  1. Clinic of Radiology, Ludwig Maximilians University of Munich, Marchionini Str. 15, 81377, Munich, Germany

    Marco Armbruster, Olaf Dietrich & Martina Brandlhuber

  2. Medical Imaging Department, Mater Dei Hospital, Tal-Qroqq, Msida, MSD 2090, Malta

    Melvin D’Anastasi

  3. Kinderkrankenhaus St.Marien Landshut, Grillparzerstraße 9, 84036, Landshut, Germany

    Veronika Holzner

  4. Department of General-, Visceral- and Vascular Surgery, Charité University Medicine Berlin, Campus Benjamin Franklin Hindenburgdamm 30, 12200, Berlin, Germany

    Martin E. Kreis

  5. Department of Internal Medicine, Klinik Mühldorf am Inn, Krankenhausstraße 1, 84453, Mühldorf am Inn, Germany

    Bernhard Brandlhuber

  6. Gemeinschaftspraxis Radiologie München, Burgstraße 7, 80331, Munich, Germany

    Anno Graser

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  1. Marco Armbruster
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Correspondence to Martina Brandlhuber.

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The authors declare that they have no conflict of interest.

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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.

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

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Armbruster, M., D’Anastasi, M., Holzner, V. et al. Improved detection of a tumorous involvement of the mesorectal fascia and locoregional lymph nodes in locally advanced rectal cancer using DCE-MRI. Int J Colorectal Dis 33, 901–909 (2018). https://doi.org/10.1007/s00384-018-3083-x

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  • DOI: https://doi.org/10.1007/s00384-018-3083-x

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