European Radiology

, Volume 28, Issue 2, pp 496–505 | Cite as

Magnetic Resonance Imaging-Detected Extramural Venous Invasion in Rectal Cancer before and after Preoperative Chemoradiotherapy: Diagnostic Performance and Prognostic Significance

  • Eun Sun Lee
  • Min Ju KimEmail author
  • Sung Chan Park
  • Bo Yun Hur
  • Jong Hee Hyun
  • Hee Jin Chang
  • Ji Yeon Baek
  • Sun Young Kim
  • Dae Yong Kim
  • Jae Hwan Oh



We evaluated the diagnostic performance of magnetic resonance imaging (MRI) in terms of identifying extramural venous invasion (EMVI) in rectal cancer patients with preoperative chemoradiotherapy (CRT) and its prognostic significance.


During 2008–2010, 200 patients underwent surgery following preoperative CRT for rectal cancer. Two radiologists independently reviewed all pre- and post-CRT MRI retrospectively. We investigated diagnostic performance of pre-CRT MR-EMVI (MR-EMVI) and post-CRT MR-EMVI (yMR-EMVI), based on pathological EMVI as the standard of reference. We assessed correlation between MRI findings and patients’ prognosis, such as disease-free survival (DFS) and overall survival (OS). Additionally, subgroup analysis in MR- or yMR-EMVI-positive patients was performed to confirm the significance of the severity of EMVI in MRI on patient’s prognosis.


The sensitivity and specificity of yMR-EMVI were 76.19% and 79.75% (area under the curve: 0.830), respectively. In univariate analysis, yMR-EMVI was the only significant MRI factor in DFS (P = 0.027). The mean DFS for yMR-EMVI (+) patients was significantly less than for yMR-EMVI (−) patients: 57.56 months versus 72.46 months.


yMR-EMVI demonstrated good diagnostic performance. yMR-EMVI was the only significant EMVI-related MRI factor that correlated with patients’ DFS in univariate analysis; however, it was not significant in multivariate analysis.

Key Points

Diagnostic performance of MRI for EMVI after preoperative chemoradiotherapy is good.

The mean DFS was lower in yMR-EMVI-positive than yMR-EMVI-negative patients.

MRI can facilitate prognosis prediction of rectal cancer patients with preoperative chemoradiotherapy.


Rectal neoplasms Magnetic resonance imaging Disease-free survival Chemoradiotherapy Prognosis 



Area under the curve




Disease-free survival


EMVI tumour regression grading assessed by magnetic resonance


Extramural venous invasion


Initial MRI-detected EMVI


Magnetic resonance imaging


Overall survival


Pathologically proven EMVI


Post-chemoradiotherapy MRI-detected EMVI


Receiver operating characteristic


Compliance with ethical standards


The scientific guarantor of this publication is Dr. Min Ju Kim

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.


This study has received funding by a grant from the National Cancer Centre of Korea (NCC-1710880)

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of RadiologyChung-Ang University HospitalSeoulKorea
  2. 2.College of Medicine and Graduate School of MedicineChung-Ang UniversitySeoulKorea
  3. 3.Department of RadiologyNational Cancer CentreGoyang-siKorea
  4. 4.Centre for Colorectal CancerNational Cancer CentreGoyangKorea
  5. 5.Department of Oncology, Asan Medical CentreUniversity of Ulsan College of MedicineSeoulKorea

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