Magnetic Resonance Imaging-Detected Extramural Venous Invasion in Rectal Cancer before and after Preoperative Chemoradiotherapy: Diagnostic Performance and Prognostic Significance
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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.
• 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.
KeywordsRectal neoplasms Magnetic resonance imaging Disease-free survival Chemoradiotherapy Prognosis
Area under the curve
EMVI tumour regression grading assessed by magnetic resonance
Extramural venous invasion
Initial MRI-detected EMVI
Magnetic resonance imaging
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.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution