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Primary and post-chemoradiotherapy staging using MRI in rectal cancer: the role of diffusion imaging in the assessment of perirectal infiltration

  • Special Section: Rectal Cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To analyze changes in MRI diagnostic accuracy in main rectal tumor (T) evaluation resulting from the use of diffusion-weighted imaging (DWI), according to the degree of experience of the radiologist.

Methods

This is a cross-sectional study of a database including one hundred 1.5 T MRI records (2011–2016) from patients with biopsy-proven rectal cancer, including primary staging and post-chemoradiotherapy follow-up. All cases were individually blindedly reviewed by ten radiologists: three experienced in rectal cancer, three specialized in other areas, and four residents. Each case was assessed twice to detect perirectal infiltration: first, evaluating just high-resolution T2-weighted sequences (HRT2w); second, evaluation of DWI plus HRT2w sequences. Results were pooled by experience, calculating accuracy (area under ROC curve), sensitivity and specificity, predictive values, likelihood ratios, and overstaging/understaging. Histology of surgical specimens provided the reference standard.

Results

DWI significantly improved specificity by experienced radiologists in primary staging (63.2% to 75.9%) and, to a lesser extent, positive likelihood ratio (2.06 to 2.87); minimal changes were observed post-chemoradiotherapy, with a slight decrease of accuracy (0.657 to 0.626). Inexperienced radiologists showed a similar pattern, but with slight enhancement post-chemoradiotherapy (accuracy 0.604 to 0.621). Residents experienced small changes, with increased sensitivity/decreased specificity in both primary (69% to 72%/67.2% to 64.7%) and post-chemoradiotherapy (68.1% to 73.6%/47.3% to 44.6%) staging.

Conclusions

Adding DWI to HRT2w significantly improved specificity for the detection of perirectal infiltration at primary staging by experienced radiologists and also by inexperienced ones, although to a lesser extent. In the post-neoadjuvant treatment subgroup, only minimal changes were observed.

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Abbreviations

DWI:

Diffusion-weighted imaging

HRT2w:

High-resolution T2-weighted imaging

CRT:

Chemoradiotherapy

ER:

Radiologists with previous experience in rectal cancer staging using MRI

NER:

Radiologists without experience in rectal cancer staging using MRI

RR:

Radiology residents

AUC:

Area under the ROC curve

PPV/NPV:

Positive/negative predictive values

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Acknowledgements

We would like to thank Christopher Evans for his support with the translation of this work.

Funding

This work was partially supported by the Medical College of Las Palmas Foundation [research grant, year 2018].

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Authors and Affiliations

  1. Clinical Sciences Department, Faculty of Medicine, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n. 35016, Las Palmas de Gran Canaria, Spain

    Roberto Fornell-Perez, Esteban Perez-Alonso & Juan Francisco Loro-Ferrer

  2. Department of General Surgery, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n. 35016, Las Palmas de Gran Canaria, Spain

    Esteban Perez-Alonso

  3. Department of Radiology, Complejo Hospitalario Universitario Insular Materno-Infantil, Av. Marítima, s/n. 35016, Las Palmas de Gran Canaria, Spain

    Gabriela Porcel-de-Peralta, Alfonso Duran-Castellon, Valentina Vivas-Escalona, Joel Aranda-Sanchez, Maria Carmen Gonzalez-Dominguez, Jano Rubio-Garcia, Patricia Aleman-Flores, Alvaro Lozano-Rodriguez & Maria Elena Orihuela-de-la-Cal

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  1. Roberto Fornell-Perez
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Correspondence to Roberto Fornell-Perez.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was obtained in our center.

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Fornell-Perez, R., Perez-Alonso, E., Porcel-de-Peralta, G. et al. Primary and post-chemoradiotherapy staging using MRI in rectal cancer: the role of diffusion imaging in the assessment of perirectal infiltration. Abdom Radiol 44, 3674–3682 (2019). https://doi.org/10.1007/s00261-019-02139-4

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  • DOI: https://doi.org/10.1007/s00261-019-02139-4

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