Abstract
Purpose
To determine the most accurate measurement technique to assess rectal tumor height on MRI using two different anatomic landmarks for the anal verge.
Introduction
Accurate measurements and standardized reporting of MRI for rectal cancer staging is essential. It is not known whether measurements starting from the internal anal sphincter (IAS) or external anal sphincter (EAS) more closely correlate with tumor height from the anal verge on endoscopy.
Methods
This retrospective study included baseline staging MRI examinations for 85 patients after exclusions. Two radiologists blinded to endoscopic results measured the distance of rectal tumors from the internal anal sphincter and external anal sphincter on sagittal T2 images. The reference standard was endoscopic measurement of tumor height; descriptive statistics were performed.
Results
For reader 1, the mean difference in measurement of tumor height between MRI and endoscopy was − 0.45 cm (SD ± 1.76 cm, range − 6.0 to 3.9 cm) for the IAS and 0.51 cm (SD ± 1.75 cm range − 4.7 to 4.8 cm) for the EAS. For reader 2, the mean difference in measurement of tumor height between MRI and endoscopy was − 0.57 (STD ± 1.81, range − 5.9 to 4.8 cm) for the IAS and 0.52 cm (STD ± 1.85, range − 4.3 to 5.6 cm) for the EAS. Interobserver ICC was excellent between reader 1 and reader 2 for measurements from both the IAS (0.955 95% CI 0.931–0.97) and EAS (0.952, 95% CI 0.928, 0.969).
Conclusion
Measurement of tumor height on MRI was highly reproducible between readers; beginning measurements from the EAS tends to slightly overestimate tumor height on average and from the IAS tends to slightly underestimate tumor height on average.
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This research was funded in part through the National Institute of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.
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Bates, D.D.B., Fuqua, J.L., Zheng, J. et al. Measurement of rectal tumor height from the anal verge on MRI: a comparison of internal versus external anal sphincter. Abdom Radiol 46, 867–872 (2021). https://doi.org/10.1007/s00261-020-02757-3
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DOI: https://doi.org/10.1007/s00261-020-02757-3