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Value of gadofosveset-enhanced MRI and multiplanar reformatting for selecting good responders after chemoradiation for rectal cancer

  • Gastrointestinal
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Abstract

Objectives

Our primary objective was to evaluate diagnostic performance of gadofosveset T1-weighted magnetic resonance imaging (T1W MRI) for discriminating between ypT0–2 and ypT3–4 tumours after chemoradiation therapy (CRT) for rectal cancer compared with T2W MRI for a general and expert reader. Second objectives included assessing the value of multiplanar reformatting (MPR) and interobserver agreement.

Methods

A general and expert reader evaluated 49 patients for likelihood of ypT0–2 tumour after CRT on T2W, gadofosveset T1W MRI, and gadofosveset T1W MRI + T2W MRI. The general reader scored with and without MPR. Confidence level scores were used to construct receiver-operating characteristic (ROC) curves. Area under the curve (AUC) values and diagnostic parameters were calculated and compared.

Results

Gadofosveset T1W MRI + T2W MRI showed slightly superior sensitivity than T2W MRI for the general but not the expert reader. Specificity was higher for the expert on gadofosveset T1W MRI only compared with T2W MRI only (100 % vs. 82 %). MPR did not increase diagnostic performance. Interobserver agreement was highest for the combination of gadofosveset-enhanced T1W imaging plus T2W MRI.

Conclusions

The sole use or addition of gadofosveset-enhanced T1W MRI to T2W MRI did not increase significantly diagnostic performance for assessing ypT0–2 tumours. Adding gadofosveset-enhanced T1W MRI slightly increased sensitivity for the general reader and specificity for the expert reader, but this increase was not significant for more accurate clinical decision making. MPR did not improve diagnostic performance.

Key Points

• ycT restaging with MRI in rectal cancer is challenging.

• Gadofosveset-enhanced T1W MRI has shown promise for nodal restaging.

• Gadofosveset-enhanced T1W MRI did not significantly increase diagnostic performance for assessing ypT0–2-tumours.

• Addition of the gadofosveset sequence to T2W MRI slightly increased sensitivity for the general reader.

• MPR did not improve diagnostic performance of ycT staging.

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Acknowledgements

The scientific guarantor of this publication is Prof. Dr. RGH Beets-Tan. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients. Some study participants or cohorts have been previously reported in the Annals of Surgery: Lambregts DM, Beets GL, Maas M et al. [18] Accuracy of gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer. Ann Surg 253:539–545. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    Luc A. Heijnen, Monique Maas, Max J. Lahaye, Ulrich Lalji, Doenja M. J. Lambregts, Milou H. Martens & Regina G. H. Beets-Tan

  2. Department of Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    Luc A. Heijnen, Milou H. Martens & Geerard L. Beets

  3. Department of Pathology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    Robert G. Riedl

  4. GROW School for Oncology and Developmental Biology, PO Box 616, 6200 MD, Maastricht, The Netherlands

    Luc A. Heijnen, Milou H. Martens, Geerard L. Beets & Regina G. H. Beets-Tan

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  1. Luc A. Heijnen
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  2. Monique Maas
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  3. Max J. Lahaye
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  5. Doenja M. J. Lambregts
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  8. Geerard L. Beets
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  9. Regina G. H. Beets-Tan
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Corresponding author

Correspondence to Regina G. H. Beets-Tan.

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Heijnen, L.A., Maas, M., Lahaye, M.J. et al. Value of gadofosveset-enhanced MRI and multiplanar reformatting for selecting good responders after chemoradiation for rectal cancer. Eur Radiol 24, 1845–1852 (2014). https://doi.org/10.1007/s00330-014-3231-9

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  • DOI: https://doi.org/10.1007/s00330-014-3231-9

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