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Rectal cancer: 3D dynamic contrast-enhanced MRI; correlation with microvascular density and clinicopathological features

Carcinoma del retto: studio dinamico post-contrasto in 3D mediante risonanza magnetica; correlazione con la densità microvascolare e le caratteristiche clinico-patologiche

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

The primary aim of this prospective study was to evaluate the relationship between three-dimensional dynamic contrast-enhanced magnetic resonance (3D-DCE-MR) imaging parameters and clinicopathological features of rectal cancer and assess their potential as new radiological prognostic predictors.

Materials and methods

Three-dimensional DCE-MR was performed on 26 cases of pathologically proved rectal adenocarcinoma 1 week prior to operation. Data were analysed to calculate transfer constant (Ktrans), leakage space (Ve) and rate constant (Kep) of both tumour and normal rectal wall. Microvessel density (MVD) was evaluated by immunohistochemical staining of surgical specimens. All findings were analysed prospectively and correlated with tumour/node/metastasis (TNM) staging, Dukes staging, histological grading, presence of lymph node metastasis, serosal involvement and MVD.

Results

Mean Ktrans, Ve and Kep for tumours were as follows: Ktrans 7.123±3.850/min, Ve 14.2±3.0%, Kep 49.446±20.404/min, revealing the significant difference between the tumour and normal rectal wall (p=0.001). There was a significant difference for Ktrans not only between patients with and without lymphatic involvement (p=0.000), but also among Dukes staging (p=0.04) and pTNM staging (p=0.03). Kep showed moderate correlation with TNM stages (r=0.479, p=0.02). Ve and MVD revealed no significant correlation with the clinicopathological findings described above (p>0.05).

Conclusion

Owing to the moderate and strong relationship between Ktrans and clinicopathological elements, Ktrans might be the prognostic indicator of rectal cancer. Threedimensional DCE high-resolution MR imaging provides a competing opportunity to assess contrast kinetics.

Riassunto

Obiettivo

L’obiettivo principale dello studio è valutare la correlazione tra i parametri ottenuti mediante studio dinamico post-contrasto in risonanza magnetica tridimensionale (3D-DCE-MRI) te le caratteristiche clinico-patologiche del carcinoma rettale e definire le potenzialità di tali parametri di imaging come nuovi fattori prognostici.

Materiali e metodi

Ventisei pazienti affetti da adenocarcinoma del retto, confermato istologicamente, sono stati sottoposti a 3D-DCE-MRI una settimana prima dell’intervento chirurgico. A livello del tessuto tumorale e della parete rettale indenne sono stati calcolati i seguenti parametri: costante di transito (Ktrans), la percentuale dello spazio di distribuzione extravascolare extracellulare — leakage space — (Ve) te la rate constant (Kep). La densità microvascolare è stata stimata mediante analisi immunoistochimica su sezioni del pezzo operatorio. Le analisi sono state condotte in modo prospettico ed i risultati ottenuti correlati alle seguenti caratteristiche clinico-patologiche: stadio di malattia secondo i sistemi TNM e Dukes, grading istologico, presenza di linfonodi metastatici, coinvolgimento della tunica sierosa e densità microvascolare.

Risultati

Dall’analisi del tessuto tumorale sono stati ottenuti i seguenti valori medi di Ktrans, Ve e Kep: Ktrans 7,123±3,850/min, Ve 14,2±3,0 %, Kep 49,446±20,404/min con differenza statisticamente significativa (p=0,001) rispetto ai valori relativi alla parete rettale indenne. Il valore della costante di transito (Ktrans) è risultato significativamente diverso in caso di presenza o meno di coinvolgimento linfonodale di malattia (p=0,000) e nei diversi stadi sia secondo la classificazione di Dukes (p=0.04) che secondo il pTNM (p=0,03). Moderata correlazione è stata dimostrata tra il parametro Kep e gli stadi TNM (r=0,479, p=0,02). Nessuna correlazione statisticamente significativa è stata stabilita per i parametri Ve e MVD (p>0,05).

Conclusioni

La stretta correlazione dimostrata tra i valori di Ktrans e le caratteristiche clinico-patologiche prese in esame rende tale parametro un utile indice prognostico per l’adenocarcinoma del retto. Lo studio dinamico mediante risonanza magnetica 3D rappresenta un valido strumento diagnostico per la valutazione della vascolarizzazione tumorale.

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Authors and Affiliations

  1. Department of Radiology, Shanghai No. 6 People’s Hospital affiliated to Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China

    W. W. Yao

  2. Department of Radiology, Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicne, 197 Ruijin Er Road, 200025, Shanghai, China

    H. Zhang, B. Ding, T. Fu, H. Jia, L. Pang, L. Song, Q. Song, K. Chen & Z. Pan

  3. School of Medicine, Shanghai Jiaotong University, 227 Chong qin Nan Road, Shanghai, 200025, China

    W. Xu

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Correspondence to Z. Pan.

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Yao, W.W., Zhang, H., Ding, B. et al. Rectal cancer: 3D dynamic contrast-enhanced MRI; correlation with microvascular density and clinicopathological features. Radiol med 116, 366–374 (2011). https://doi.org/10.1007/s11547-011-0628-2

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  • DOI: https://doi.org/10.1007/s11547-011-0628-2

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