European Radiology

, Volume 27, Issue 5, pp 1840–1847 | Cite as

Prognostic aspects of dynamic contrast-enhanced magnetic resonance imaging in synchronous distant metastatic rectal cancer

  • Jing Yu
  • Qing Xu
  • Dong-Ya Huang
  • Jia-Cheng Song
  • Yan Li
  • Lu-Lu Xu
  • Hai-Bin ShiEmail author



To explore the correlations between DCE-MRI quantitative parameters and synchronous distant metastasis and the clinicopathological factors in rectal cancers.


Sixty-three patients with rectal cancer (synchronous distant metastasis, n = 31; non-metastasis, n = 32) were enrolled in this study. Student’s t test and ANOVA were used to compare DCE-MRI parameters (K trans , K ep and V e ). The receiver operating characteristic (ROC) analysis was used to find the reasonable threshold of DCE-MRI parameters to differentiate lesions with synchronous distant metastasis from those without metastasis.


The K trans , K ep , and V e value were significantly higher in the lesions with distant metastasis than in the lesions without distant metastasis (0.536 ± 0.242 vs. 0.299 ± 0.118 min-1, p < 0.001; 1.598 ± 0.477 vs. 1.341 ± 0.390 min-1, p = 0.022; and 0.324 ± 0.173 vs. 0.249 ± 0.091, p = 0.034; respectively). The K trans showed the highest AUCs of 0.788 (p < 0.001), with sensitivity of 61.29 % and specificity of 87.5 %, respectively.


DCE-MRI parameters may represent a prognostic indicator for synchronous distant metastases in patients with rectal cancer.

Key Points

The K trans , K ep and V e values correlated with synchronous distant metastasis.

Higher K trans , K ep and V e values were noted among patients with metastasis.

DCE-MRI parameters might represent a prognostic indicator for synchronous distant metastases.


DCE-MRI Rectal cancer Synchronous distant metastasis Quantitative parameters Clinicopathological factors 



Area under the curve


Carcinoembryonic antigen


Dynamic contrast-enhanced magnetic resonance imaging


Extravascular-extracellular space


Rate constant from EES to blood plasma (min-1)


Volume transfer constant between EES and blood plasma (min-1)


Lymphovascular invasion


Receiver operating characteristic


EES volume per unit tissue volume



The scientific guarantor of this publication is Hai-Bin Shi. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.


  1. 1.
    Engelen SM, Maas M, Lahaye MJ, Leijtens JW, van Berlo CL, Jansen RL et al (2013) Modern multidisciplinary treatment of rectal cancer based on staging with magnetic resonance imaging leads to excellent local control, but distant control remains a challenge. Eur J Cancer 49:2311–2320CrossRefPubMedGoogle Scholar
  2. 2.
    Meguerditchian AN, Bairati I, Lagace R, Harel F, Kibrite A (2005) Prognostic significance of lymphovascular invasion in surgically cured rectal carcinoma. Am J Surg 189:707–713CrossRefPubMedGoogle Scholar
  3. 3.
    Hong HS, Kim SH, Park HJ, Park MS, Kim KW, Kim WH et al (2013) Correlations of dynamic contrast-enhanced magnetic resonance imaging with morphologic, angiogenic, and molecular prognostic factors in rectal cancer. Yonsei Med J 54:123–130CrossRefPubMedGoogle Scholar
  4. 4.
    Shihab OC, Moran BJ, Heald RJ, Quirke P, Brown G (2009) MRI staging of low rectal cancer. Eur Radiol 19:643–650CrossRefPubMedGoogle Scholar
  5. 5.
    Li L, Wang K, Sun X, Wang K, Sun Y, Zhang G et al (2015) Parameters of dynamic contrast-enhanced MRI as imaging markers for angiogenesis and proliferation in human breast cancer. Med Sci Monit 21:376–382CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lollert A, Junginger T, Schimanski CC, Biesterfeld S, Gockel I, Duber C et al (2014) Rectal cancer: dynamic contrast-enhanced MRI correlates with lymph node status and epidermal growth factor receptor expression. J Magn Reson Imaging 39:1436–1442CrossRefPubMedGoogle Scholar
  7. 7.
    Padhani AR (2002) Dynamic contrast-enhanced MRI in clinical oncology: current status and future directions. J Magn Reson Imaging 16:407–422CrossRefPubMedGoogle Scholar
  8. 8.
    Tofts PS, Brix G, Buckley DL, Evelhoch JL, Henderson E, Knopp MV et al (1999) Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging 10:223–232CrossRefPubMedGoogle Scholar
  9. 9.
    DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRefPubMedGoogle Scholar
  10. 10.
    Schisterman EF, Perkins NJ, Liu A, Bondell H (2005) Optimal cut-point and its corresponding Youden Index to discriminate individual using pooled blood samples. Epidemiology 16:73–81CrossRefPubMedGoogle Scholar
  11. 11.
    Fidler IJ, Ellis LM (1994) The implications of angiogenesis for the biology and therapy of cancer metastasis. Cell 79:185–188CrossRefPubMedGoogle Scholar
  12. 12.
    Koo HR, Cho N, Song IC, Kim H, Chang JM, Yi A et al (2012) Correlation of perfusion parameters on dynamic contrast-enhanced MRI with prognostic factors and subtypes of breast cancers. J Magn Reson Imaging 36:145–151CrossRefPubMedGoogle Scholar
  13. 13.
    Chen J, Qian T, Zhang H, Wei C, Meng F, Yin H (2016) Combining dynamic contrast enhanced magnetic resonance imaging and microvessel density to assess the angiogenesis after PEI in a rabbit VX2 liver tumor model. Magn Reson Imaging 34:177–182CrossRefPubMedGoogle Scholar
  14. 14.
    Yeo DM, Oh SN, Jung CK, Lee MA, Oh ST, Rha SE et al (2015) Correlation of dynamic contrast-enhanced MRI perfusion parameters with angiogenesis and biologic aggressiveness of rectal cancer: preliminary results. J Magn Reson Imaging 41:474–480CrossRefPubMedGoogle Scholar
  15. 15.
    Gollub MJ, Cao K, Gultekin DH, Kuk D, Gonen M, Sohn M et al (2013) Prognostic aspects of DCE-MRI in recurrent rectal cancer. Eur Radiol 23:3336–3344CrossRefPubMedGoogle Scholar
  16. 16.
    Hanahan D, Weinberg RA (2000) The hallmarks of cancer. Cell 100:57–70CrossRefPubMedGoogle Scholar
  17. 17.
    Christofori G, Semb H (1999) The role of the cell-adhesion molecule E-cadherin as a tumour-suppressor gene. Trends Biochem Sci 24:73–76CrossRefPubMedGoogle Scholar
  18. 18.
    Herzig M, Savarese F, Novatchkova M, Semb H, Christofori G (2007) Tumor progression induced by the loss of E-cadherin independent of beta-catenin/Tcf-mediated Wnt signaling. Oncogene 26:2290–2298CrossRefPubMedGoogle Scholar
  19. 19.
    Awasthi R, Rathore RK, Soni P, Sahoo P, Awasthi A, Husain N et al (2012) Discriminant analysis to classify glioma grading using dynamic contrast-enhanced MRI and immunohistochemical markers. Neuroradiology 54:205–213CrossRefPubMedGoogle Scholar
  20. 20.
    Jia Z, Geng D, Xie T, Zhang J, Liu Y (2012) Quantitative analysis of neovascular permeability in glioma by dynamic contrast-enhanced MR imaging. J Clin Neurosci 19:820–823CrossRefPubMedGoogle Scholar
  21. 21.
    Huh JW, Kim CH, Lim SW, Kim HR, Kim YJ (2013) Early recurrence in patients undergoing curative surgery for colorectal cancer: is it a predictor for poor overall survival? Int J Colorectal Dis 28:1143–1149CrossRefPubMedGoogle Scholar
  22. 22.
    Wang L, Zhong XG, Peng YF, Li ZW, Gu J (2014) Prognostic value of pretreatment level of carcinoembryonic antigen on tumour downstaging and early occurring metastasis in locally advanced rectal cancer following neoadjuvant radiotherapy (30 Gy in 10 fractions). Colorectal Dis 16:33–39CrossRefPubMedGoogle Scholar
  23. 23.
    Villeneuve PJ, Sundaresan RS (2009) Surgical management of colorectal lung metastasis. Clin Colon Rectal Surg 22:233–241CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Davenport MS, Heye T, Dale BM, Horvath JJ, Breault SR, Feuerlein S et al (2013) Inter- and intra-rater reproducibility of quantitative dynamic contrast enhanced MRI using TWIST perfusion data in a uterine fibroid model. J Magn Reson Imaging 38:329–335CrossRefPubMedGoogle Scholar
  25. 25.
    Sohn B, Lim JS, Kim H, Myoung S, Choi J, Kim NK et al (2015) MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol 25:1347–1355CrossRefPubMedGoogle Scholar
  26. 26.
    Kim YC, Kim JK, Kim MJ, Lee JH, Kim YB, Shin SJ (2016) Feasibility of mesorectal vascular invasion in predicting early distant metastasis in patients with stage T3 rectal cancer based on rectal MRI. Eur Radiol 26:297–305CrossRefPubMedGoogle Scholar
  27. 27.
    Betge J, Pollheimer MJ, Lindtner RA, Kornprat P, Schlemmer A, Rehak P et al (2012) Intramural and extramural vascular invasion in colorectal cancer: prognostic significance and quality of pathology reporting. Cancer 118:628–638CrossRefPubMedGoogle Scholar
  28. 28.
    Gunther K, Dworak O, Remke S, Pfluger R, Merkel S, Hohenberger W et al (2002) Prediction of distant metastases after curative surgery for rectal cancer. J Surg Res 103:68–78CrossRefPubMedGoogle Scholar
  29. 29.
    Lim SB, Yu CS, Jang SJ, Kim TW, Kim JH, Kim JC (2010) Prognostic significance of lymphovascular invasion in sporadic colorectal cancer. Dis Colon Rectum 53:377–384CrossRefPubMedGoogle Scholar
  30. 30.
    Glynne-Jones R, Anyamene N, Moran B, Harrison M (2012) Neoadjuvant chemotherapy in MRI-staged high-risk rectal cancer in addition to or as an alternative to preoperative chemoradiation? Ann Oncol 23:2517–2526CrossRefPubMedGoogle Scholar
  31. 31.
    Chua YJ, Barbachano Y, Cunningham D, Oates JR, Brown G, Wotherspoon A et al (2010) Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol 11:241–248CrossRefPubMedGoogle Scholar
  32. 32.
    Scharitzer M, Ba-Ssalamah A, Ringl H, Kolblinger C, Grunberger T, Weber M et al (2013) Preoperative evaluation of colorectal liver metastases: comparison between gadoxetic acid-enhanced 3.0-T MRI and contrast-enhanced MDCT with histopathological correlation. Eur Radiol 23:2187–2196CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Jing Yu
    • 1
  • Qing Xu
    • 1
  • Dong-Ya Huang
    • 2
  • Jia-Cheng Song
    • 1
  • Yan Li
    • 1
  • Lu-Lu Xu
    • 1
  • Hai-Bin Shi
    • 1
    Email author
  1. 1.Department of RadiologyFirst Affiliated Hospital of Nanjing Medical UniversityNanjingChina
  2. 2.Department of General SurgeryFirst Affiliated Hospital of Nanjing Medical UniversityNanjingChina

Personalised recommendations