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MRI features of signet ring rectal cancer

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Abstract

Purpose

Signet Ring Rectal Cancer (SRRC) of rectum is rare high-grade subtype with poor prognosis and characteristic histopathology. We evaluated its imaging appearance and correlated its outcomes.

Materials and methods

We conducted a retrospective review of the rectal MRIs of 97 patients with rectal SRRC, evaluating tumor morphology, T2 signal, length, location, pattern of tumor growth, nodal status and location, EMVI (extramural vascular invasion), site of metastases, and response to chemotherapy. The tumor signal on T2W images was categorized into intermediate, T2 hyperintense, and fluid/mucin bright. Imaging findings were correlated with risk of metastatic/ recurrent disease, disease-free survival, and overall survival.

Results

The median age of patients of SRRC in our study was 35 years and more frequently found in male patients. The common imaging features of SRRC were T2-hyperintense signal (63%), infiltrative growth pattern (76%), positive MR CRM (Circumferential Resection Margin on MRI) (84%), presence of EMVI (51%), and advanced T and N stage (97% and 84%, respectively). Peritoneum and nodes were the most common sites of metastases. Raised serum CEA (Carcino-embryonic Antigen) levels, positive MR CRM status, extramesorectal adenopathy, and advanced N stage had statistically significant predictive value for recurrence or metastases. Elevated serum CEA levels (p = 0.019) and intermediate T2 signal (p = 0.012) demonstrated significant independent association with poor overall survival, while advanced N stage (p = 0.033) demonstrated significant independent association with worse disease-free survival in multivariate analysis.

Conclusion

SRRC affected young patients and demonstrated T2-hyperintense signal and subepithelial spread in an infiltrative pattern. Elevated CEA levels and T2-intermediate signal intensity are independent predictors for worse overall survival and advanced nodal stage is independent prognostic factor of poor disease-free survival. MRI rectum can pinpoint the pathology given the distinct MRI morphology and age of presentation.

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Acknowledgements

Mrs. Pallavi Rane, Scientific Assistant, Tata Memorial Hospital Mumbai, for providing statistical analysis for the manuscript.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, India

    Meena Suthar, Akshay D. Baheti, Suman K. Ankathi, Amit Choudhari & Purvi D. Haria

  2. Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Mumbai, Maharashtra, 400012, India

    Meena Suthar, Akshay D. Baheti, Suman K. Ankathi, Amit Choudhari, Purvi D. Haria, Reena Engineer, Vikas Ostwal, Mukta S. Ramadwar, Ashwin Desouza & Avanish Saklani

  3. Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India

    Reena Engineer

  4. Department of Medical Oncology, Tata Memorial Centre, Mumbai, India

    Vikas Ostwal

  5. Department of Pathology, Tata Memorial Centre, Mumbai, India

    Mukta S. Ramadwar

  6. Department of GI Surgical Oncology, Tata Memorial Centre, Mumbai, India

    Ashwin Desouza & Avanish Saklani

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  1. Meena Suthar
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Correspondence to Akshay D. Baheti.

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Appendix

Appendix

See Tables 5, 6, and 7.

Table 5 Imaging protocol for MRI rectum
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Table 6 Univariate analysis for disease-free survival
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Table 7 Univariate analysis for overall survival
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Suthar, M., Baheti, A.D., Ankathi, S.K. et al. MRI features of signet ring rectal cancer. Abdom Radiol 46, 5536–5549 (2021). https://doi.org/10.1007/s00261-021-03250-1

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