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Distinguishing mesorectal tumor deposits from metastatic lymph nodes by using diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging in rectal cancer

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to identify whether apparent diffusion coefficient (ADC) values and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters are helpful in distinguishing mesorectal tumor deposits (TD) from metastatic lymph nodes (MLN) in rectal cancer (RC).

Methods

Thirty patients (59 lesions, including 30 TD and 29 MLN) with RC who underwent pretreatment-MRI between February 2016 and August 2018 were enrolled. The morphological features, ADC values, and semi-quantitative parameters of DCE-MRI, including relative enhancement (RE), maximum enhancement (ME), maximum relative enhancement (MRE), time to peak (TTP), wash-in rates (WIR), wash-out rates (WOR), brevity of enhancement (BRE), and area under the curve (AUC) were measured on lesions (TD or MLN) and RC. The parameters were compared between TD and MLN, tumor with and without TD group by using Fisher’s exact test, independent-samples t-test, and Mann-Whitney U test. The ratio (lesion-to-tumor) of the parameters was compared between TD and MLN. Receiver operating characteristic curve analysis and binary logistic regression analysis were used to assess the diagnostic ability of single and combined metrics for distinguishing TD from MLN.

Results

The morphological features, including size, shape, and border, were significantly different between TD and MLN. TD exhibited significantly lower RE, MRE, RE-ratio, MRE-ratio, ADCmin-ratio, and ADCmean-ratio than MLN. RE-ratio showed the highest AUC (0.749) and accuracy (77.97%) among single parameters. The combination of DCE-MRI and DWI parameters together showed higher diagnostic efficiency (AUC = 0.825).

Conclusions

Morphological features, ADC values, and DCE-MRI parameters can preoperatively help distinguish TD from MLN in RC.

Key Points

• DWI and DCE-MRI can facilitate early detection and distinguishing mesorectal TD (tumor deposits) from MLN (metastatic lymph nodes) in rectal cancer preoperatively.

• TD has some specific morphological features, including relatively larger size, lower short- to long-axis ratio, irregular shape, and ill-defined border on T2-weighted MR images in rectal cancer.

• The combination of ADC values and semi-quantitative parameters of DCE-MRI (RE, MRE) can help to improve the diagnostic efficiency of TD in rectal cancer.

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Abbreviations

AJCC:

American Joint Committee on Cancer

BRE:

Brevity of enhancement

EMVI:

Extramural vascular invasion

FOV:

Field of view

ICC:

Intraclass correlation coefficient

LN:

Lymph node

ME:

Maximum enhancement

MLN:

Metastatic lymph nodes

MRE:

Maximum relative enhancement

NAT:

Neoadjuvant therapy

RC:

Rectal cancer

RE:

Relative enhancement

T2WI:

T2-weighted imaging

TD:

Tumor deposits

TE:

Echo time

TIC:

Time-signal intensity curve

TNM:

Tumor-node-metastasis

TR:

Repetition time

TSE:

Turbo spin echo

TTP:

Time to peak

WIR:

Wash-in rates

WOR:

Wash-out rates

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Funding

This work has received funding from Beijing Municipal Natural Science Foundation (No.7222316) and the Fundamental Research Funds for the Central Universities (No. 3332020077).

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Authors and Affiliations

  1. Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, #8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, China

    Qiaoyu Xu

  2. Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China

    Yanyan Xu, Juan Wang, Hongliang Sun & Sheng Xie

  3. Department of Pathology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China

    Jie Lin

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  1. Qiaoyu Xu
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Correspondence to Hongliang Sun.

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Xu, Q., Xu, Y., Wang, J. et al. Distinguishing mesorectal tumor deposits from metastatic lymph nodes by using diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging in rectal cancer. Eur Radiol 33, 4127–4137 (2023). https://doi.org/10.1007/s00330-022-09328-8

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  • DOI: https://doi.org/10.1007/s00330-022-09328-8

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