European Radiology

, Volume 27, Issue 12, pp 4960–4969 | Cite as

MRI surveillance for the detection of local recurrence in rectal cancer after transanal endoscopic microsurgery

  • Britt J. P. Hupkens
  • Monique MaasEmail author
  • Milou H. Martens
  • Willem M. L. L. G. Deserno
  • Jeroen W. A. Leijtens
  • Patty J. Nelemans
  • Frans C. H. Bakers
  • Doenja M. J. Lambregts
  • Geerard L. Beets
  • Regina G. H. Beets-Tan



To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM).


Between January 2006 and February 2014, 81 patients who underwent TEM were included. Two expert readers (R1 and R2), independently evaluated T2-weighted (T2W) MRI and diffusion-weighted (DWI) MRI for the detection of local recurrence, retrospectively, and recorded confidence on a five-point scale. Diagnostic performance of follow-up MRI was assessed using ROC-curve analysis and kappa statistics for the reproducibility between readers.


293 MRIs were performed, 203 included DWI. 18 (22%) patients developed a local recurrence: luminal 11, nodal two and both five. Areas under the curve (AUCs) for local recurrence detection were 0.72 (R1) and 0.80 (R2) for T2W-MRI. For DWI, AUCs were 0.70 (R1) and 0.89 (R2). For nodal recurrence AUCs were 0.72 (R1) and 0.80 (R2) for T2W-MRI. Reproducibility was good for T2W-MRI (κ0.68 for luminal and κ0.71 for nodal recurrence) and moderate for DWI (κ0.57). AUCs and reproducibility for recurrence detection increased during follow-up.


Follow-up with MRI after TEM for rectal cancer is feasible. Postoperative changes can be confusing at the first postoperative MRI, but during follow-up diagnostic performance and reproducibility increase.

Key Points

• Follow-up with MRI is feasible for follow-up after TEM for rectal cancer.

• DWI-MRI is a useful addition to detect recurrences after TEM.

• Postoperative changes can be confusing and can lead to underestimation of recurrence.

• Appearance of intermediate signal at T2W-MRI is suspicious for recurrence.

• Nodal staging remains challenging.


Magnetic resonance imaging Rectal neoplasms Transanal endoscopic microsurgery Follow-up Diffusion-weighted magnetic resonance imaging 



Apparent diffusion coefficient


Area under the curve


Confidence interval


Confidence level


Chemoradiation therapy


Diffusion-weighted imaging


Endorectal ultrasound


Magnetic resonance imaging

ROC curve

Receiver operating characteristic curve


T2-weighted MRI


Transanal endoscopic microsurgery


Compliance with ethical standards


The scientific guarantor of this publication is M. Maas.

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.


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

Statistics and biometry

Patty J. Nelemans kindly provided statistical advice for this manuscript.

Informed consent

According to our country’s national law, informed consent is not required for this study because of its retrospective nature.

Ethical approval

According to our country’s national law, institutional review board approval is not required for this study because of its retrospective nature.


  • Retrospective

  • Multicentre study

Supplementary material

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ESM 1 (DOCX 15 kb)
330_2017_4853_MOESM2_ESM.docx (41 kb)
ESM 2 (DOCX 41 kb)
330_2017_4853_MOESM3_ESM.docx (16 kb)
ESM 3 (DOCX 15 kb)


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Britt J. P. Hupkens
    • 1
    • 2
    • 3
  • Monique Maas
    • 1
    • 4
    Email author
  • Milou H. Martens
    • 1
    • 2
    • 3
  • Willem M. L. L. G. Deserno
    • 5
  • Jeroen W. A. Leijtens
    • 6
  • Patty J. Nelemans
    • 7
  • Frans C. H. Bakers
    • 1
    • 8
  • Doenja M. J. Lambregts
    • 9
  • Geerard L. Beets
    • 3
    • 10
  • Regina G. H. Beets-Tan
    • 3
    • 9
  1. 1.Department of RadiologyMaastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  3. 3.GROW School for Oncology and Developmental BiologyMaastrichtThe Netherlands
  4. 4.Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  5. 5.Department of RadiologyLaurentius HospitalRoermondThe Netherlands
  6. 6.Department of SurgeryLaurentius HospitalRoermondThe Netherlands
  7. 7.Department of EpidemiologyMaastricht UniversityMaastrichtThe Netherlands
  8. 8.Maastricht University Medical CentreMaastrichtThe Netherlands
  9. 9.Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  10. 10.Department of SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands

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