Skip to main content

Advertisement

SpringerLink
Log in

Interobserver variability in MRI measurements of mesorectal invasion depth in rectal cancer

  • Hollow Organ GI
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Propose

To assess the interobserver variability in MRI measurements of mesorectal invasion depth (MID) in rectal adenocarcinomas primarily staged as T3, by determining the level of interobserver agreement in the differentiation of individual T3 substages and of T3a-b vs. T3c-d disease, between readers with different levels of expertise.

Methods

A retrospective analysis of 60 patients classified by MRI as having T3 rectal cancers was performed. Each patient underwent MR examination in a 1.5 T machine and the standard imaging protocol included a high-resolution axial T2-weighted sequence in which the measurements were determined by independent radiologists (readers A and B, with 15 years and 1 year of experience, respectively). The rectum was further divided into quadrants and each reader selected the quadrant where the measurement was taken. The patients were grouped according to the MID (T3a < 1 mm; T3b 1–5 mm; T3c > 5–15 mm; T3d > 15 mm) and the interobserver reliability was tested using Cohen’s kappa.

Results

Population included 40 males and 20 females with a median age of 65.9 years. Interobserver agreement on individual substage differentiation (T3 a, b, c and d) was moderate (K = 0.428) and in the quadrant evaluation the level of agreement was also moderate (K = 0.414). Nevertheless, the interobserver reliability for the differentiation between stages T3a-b vs. T3c-d was substantial (K = 0.697).

Conclusions

There is no considerable interobserver variability when distinguishing T3a-b from T3c-d tumors, regardless of the quadrant where the MID is measured. Therefore, assessment of MID, for that purpose, is a reproducible MR parameter, irrespectively of the readers’ experience.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Guaranteed.

Code availability

Not applicable.

Abbreviations

ALQ:

Anterior left quadrant

ARQ:

Anterior right quadrant

EMVI:

Extramural venous invasion

MID:

Mesorectal invasion depth

MRF:

Mesorectal fascia

PLQ:

Posterior left quadrant

PRQ:

Posterior right quadrant

RT:

Radiation therapy

References

  1. Brown G, Richards CJ, Newcombe RG, Dallimore NS, Radcliffe AG, Carey DP, Bourne MW, Williams GT. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999;211(1):215-22. https://doi.org/10.1148/radiology.211.1.r99ap35215.

    Article  CAS  PubMed  Google Scholar 

  2. Gu C, Yang X, Zhang X, et al. The prognostic significance of MRI-detected extramural venous invasion, mesorectal extension, and lymph node status in clinical T3 mid-low rectal cancer. Sci Rep. 2019;9(1):12523. https://doi.org/10.1038/s41598-019-47466-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333(7572):779. https://doi.org/10.1136/bmj.38937.646400.55.

    Article  PubMed Central  Google Scholar 

  4. Kim CK, Kim SH, Chun HK, et al. Preoperative staging of rectal cancer: accuracy of 3-Tesla magnetic resonance imaging. Eur Radiol. 2006;16(5):972-80. https://doi.org/10.1007/s00330-005-0084-2.

    Article  PubMed  Google Scholar 

  5. Curvo-Semedo L. Rectal Cancer: Staging. Magn Reson Imaging Clin N Am. 2020;28(1):105-115. https://doi.org/10.1016/j.mric.2019.09.003.

    Article  PubMed  Google Scholar 

  6. Blomqvist L, Machado M, Rubio C, Gabrielsson N, Granqvist S, Goldman S, Holm T. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol. 2000;10(4):653-60. https://doi.org/10.1007/s003300050979.

    Article  CAS  PubMed  Google Scholar 

  7. Delli Pizzi A, Basilico R, Cianci R, et al. Rectal cancer MRI: protocols, signs and future perspectives radiologists should consider in everyday clinical practice. Insights Imaging. 2018;9(4):405-412. https://doi.org/10.1007/s13244-018-0606-5.

    Article  Google Scholar 

  8. Pratik T, Guo W, Yang C, Bimal R, Zeng M. Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI, Iran J Radiol. 2018 ; 15(2):e16801. https://doi.org/10.5812/iranjradiol.16801.

    Article  Google Scholar 

  9. Lino-Silva LS, Loaeza-Belmont R, Gómez Álvarez MA, et al. Mesorectal Invasion Depth in Rectal Carcinoma Is Associated With Low Survival. Clin Colorectal Cancer. 2017;16(1):73-77. https://doi.org/10.1016/j.clcc.2016.05.001.

    Article  PubMed  Google Scholar 

  10. Glimelius B. Neo-adjuvant radiotherapy in rectal cancer. World J Gastroenterol. 2013;19(46):8489-501. https://doi.org/10.3748/wjg.v19.i46.8489.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cho SH, Kim SH, Bae JH, Jang YJ, Kim HJ, Lee D, Park JS; Society of North America (RSNA). Prognostic stratification by extramural depth of tumor invasion of primary rectal cancer based on the Radiological Society of North America proposal. AJR Am J Roentgenol. 2014;202(6):1238–44. https://doi.org/10.2214/AJR.13.11311.

  12. Cho SH, Choi GS, Kim GC, et al. Long-term outcomes of surgery alone versus surgery following preoperative chemoradiotherapy for early T3 rectal cancer: A propensity score analysis. Medicine (Baltimore). 2017;96(12):e6362. https://doi.org/10.1097/MD.0000000000006362.

    Article  Google Scholar 

  13. Beets-Tan RGH, Lambregts DMJ, Maas M, et al. Correction to: Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2018;28(6):2711. https://doi.org/10.1007/s00330-017-5204-2. Erratum for: Eur Radiol. 2018 Apr;28(4):1465-1475.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kaur H, Choi H, You YN, et al. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. Radiographics. 2012;32(2):389–409. https://doi.org/10.1148/rg.322115122.

  15. Li Y, Wang J, Ma X, et al. A Review of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer. Int J Biol Sci. 2016;12(8):1022-31. https://doi.org/10.7150/ijbs.15438.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Park H, Kim KA, Jung J, et al (2020) MRI features and texture analysis for the early prediction of therapeutic response to neoadjuvant chemoradiotherapy and tumor recurrence of locally advanced rectal cancer. Eur Radiol. 2020;30(8):4201-4211. https://doi.org/10.1007/s00330-020-06835-4.

    Article  PubMed  Google Scholar 

  17. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74. PMID: 843571.

    Article  CAS  Google Scholar 

  18. Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet. 2001;357(9255):497-504. https://doi.org/10.1016/s0140-6736(00)04040-x.

    Article  CAS  PubMed  Google Scholar 

  19. Shin R, Jeong SY, Yoo HY, Park KJ, Heo SC, Kang GH, Kim WH, Park JG. Depth of mesorectal extension has prognostic significance in patients with T3 rectal cancer. Dis Colon Rectum. 2012;55(12):1220-8. https://doi.org/10.1097/DCR.0b013e31826fea6a.

    Article  PubMed  Google Scholar 

  20. Pedersen BG, Moran B, Brown G, Blomqvist L, Fenger-Grøn M, Laurberg S. Reproducibility of depth of extramural tumor spread and distance to circumferential resection margin at rectal MRI: enhancement of clinical guidelines for neoadjuvant therapy. AJR Am J Roentgenol. 2011;197(6):1360-6. https://doi.org/10.2214/AJR.11.6508.

    Article  PubMed  Google Scholar 

  21. MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243(1):132-9. https://doi.org/10.1148/radiol.2431051825.

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Hospital do Divino Espírito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal

    Mariana M. Chaves & David Silva

  2. Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Henrique Donato, Nuno Campos & Luís Curvo-Semedo

  3. Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Luís Curvo-Semedo

Authors
  1. Mariana M. Chaves
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henrique Donato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nuno Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luís Curvo-Semedo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MMC developed the concept, performed the data acquisition, captured the images and wrote the manuscript with input from all authors; HD performed the analysis and interpretation of data and revised the manuscript; NC and DS critically revised the manuscript; and LCS captured the images, performed the data acquisition, gave expert opinion and critically revised the manuscript. All authors approved the final version of the manuscript for submission.

Corresponding author

Correspondence to Mariana M. Chaves.

Ethics declarations

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical approval

This is a retrospective, institutional review board-approved.

Consent to participate

Obtained.

Consent for publication

All authors approved the final version of the manuscript for submission and approve publication.

Research involving humans and/or animals

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaves, M.M., Donato, H., Campos, N. et al. Interobserver variability in MRI measurements of mesorectal invasion depth in rectal cancer. Abdom Radiol 47, 907–914 (2022). https://doi.org/10.1007/s00261-021-03363-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-021-03363-7

Keywords

Search

Navigation