Top

International Journal of Colorectal Disease

Published in:

01-07-2018 | Original Article

Improved detection of a tumorous involvement of the mesorectal fascia and locoregional lymph nodes in locally advanced rectal cancer using DCE-MRI

Authors: Marco Armbruster, Melvin D’Anastasi, Veronika Holzner, Martin E. Kreis, Olaf Dietrich, Bernhard Brandlhuber, Anno Graser, Martina Brandlhuber

Published in: International Journal of Colorectal Disease | Issue 7/2018

Abstract

Purpose

The prediction of an infiltration of the mesorectal fascia (MRF) and malignant lymph nodes is essential for treatment planning and prognosis of patients with rectal cancer. The aim of this study was to assess the additional diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the detection of a malignant involvement of the MRF and of mesorectal lymph nodes in patients with locally advanced rectal cancer.

Methods

In this prospective study, 22 patients with locally advanced rectal cancer were examined with 1.5-T MRI between September 2012 and April 2015. Histopathological assessment of tumor size, tumor infiltration to the MRF, and malignant involvement of locoregional lymph nodes served as standard of reference. Sensitivity and specificity of detecting MRF infiltration and malignant nodes (nodal cut-off size [NCO] ≥ 5 and ≥ 10 mm, respectively) was determined by conventional MRI (cMRI; precontrast and postcontrast T1-weighted, T2-weighted, and diffusion-weighted images) and by additional semi-quantitative DCE-MRI maps (cMRI+DCE-MRI).

Results

Compared to cMRI, additional semi-quantitative DCE-MRI maps significantly increased sensitivity (86 vs. 71% [NCO ≥ 5 mm]/29% [NCO ≥ 10 mm]) and specificity (90 vs. 70% [NCO ≥ 5 mm]) of detecting malignant lymph nodes (p < 0.05). Moreover, DCE-MRI significantly augmented specificity (91 vs. 82%) of discovering a MRF infiltration (p < 0.05), while there was no change in sensitivity (83%; p > 0.05).

Conclusion

DCE-MRI considerably increases both sensitivity and specificity for the detection of small mesorectal lymph node metastases (≥ 5 mm but < 10 mm) and sufficiently improves specificity of a suspected MRF infiltration in patients with locally advanced rectal cancer.

Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30CrossRefPubMed

Pox CP, Schmiegel W (2013) German S3-guideline colorectal carcinoma. Dtsch Med Wochenschr 138:2545CrossRefPubMed

Marijnen CA et al (2005) Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23:1847–1858CrossRefPubMed

Patel UB, Blomqvist LK, Taylor F, George C, Guthrie A, Bees N, Brown G (2012) MRI after treatment of locally advanced rectal cancer: how to report tumor response—the MERCURY experience. AJR Am J Roentgenol 199:W486–W495CrossRefPubMed

Patel UB, Taylor F, Blomqvist L, George C, Evans H, Tekkis P, Quirke P, Sebag-Montefiore D, Moran B, Heald R, Guthrie A, Bees N, Swift I, Pennert K, Brown G (2011) Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 29:3753–3760CrossRefPubMed

Taylor FG, Quirke P, Heald RJ, Moran BJ, Blomqvist L, Swift IR, Sebag-Montefiore D, Tekkis P, Brown G, Magnetic Resonance Imaging in Rectal Cancer European Equivalence Study Study Group (2014) Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol 32:34–43CrossRefPubMed

Garcia-Aguilar J, Shi Q, Thomas CR, Chan E, Cataldo P, Marcet J, Medich D, Pigazzi A, Oommen S, Posner MC (2012) A phase II trial of neoadjuvant chemoradiation and local excision for T2N0 rectal cancer: preliminary results of the ACOSOG Z6041 trial. Ann Surg Oncol 19:384–391CrossRefPubMed

Yu CS, Yun HR, Shin EJ, Lee KY, Kim NK, Lim SB, Oh ST, Kang SB, Choi WJ, Lee WY, Colorectal Cancer Study Group, Korean Society of Coloproctology (2013) Local excision after neoadjuvant chemoradiation therapy in advanced rectal cancer: a national multicenter analysis. Am J Surg 206:482–487CrossRefPubMed

Shin YS, Yu CS, Park JH, Kim JC, Lim SB, Park IJ, Kim TW, Hong YS, Kim KP, Yoon SM, Joo JH, Kim JH (2017) Total mesorectal excision versus local excision after favorable response to preoperative chemoradiotherapy in “early” clinical T3 rectal cancer: a propensity score analysis. Int J Radiat Oncol Biol Phys 99:136–144CrossRefPubMed

10.

Beets-Tan RG et al (2013) Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 23:2522–2531CrossRefPubMed

11.

Quaia E, Gennari AG, de Paoli L, Angileri R, Ukmar M, Cova MA (2014) Predictors of mesorectal fascia invasion after gadolinium injection in rectal carcinoma after neoadjuvant therapy. Clin Imaging 38:698–703CrossRefPubMed

12.

Nougaret S, Reinhold C, Mikhael HW, Rouanet P, Bibeau F, Brown G (2013) The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the “DISTANCE”? Radiology 268:330–344CrossRefPubMed

13.

Kono Y, Togashi K, Utano K, Horie H, Miyakura Y, Fukushima N, Lefor AT, Yasuda Y (2015) Lymph node size alone is not an accurate predictor of metastases in rectal cancer: a node-for-node comparative study of specimens and histology. Am Surg 81:1263–1271PubMed

14.

Langman G, Patel A, Bowley DM (2015) Size and distribution of lymph nodes in rectal cancer resection specimens. Dis Colon Rectum 58:406–414CrossRefPubMed

15.

Kim IK, Kang J, Lim BJ, Sohn SK, Lee KY (2015) The impact of lymph node size to predict nodal metastasis in patients with rectal cancer after preoperative chemoradiotherapy. Int J Color Dis 30:459–464CrossRef

16.

Grone J, Loch FN, Taupitz M, Schmidt C, Kreis ME (2018) Accuracy of various lymph node staging criteria in rectal cancer with magnetic resonance imaging. J Gastrointest Surg 22:146–153CrossRefPubMed

17.

Heijnen LA, Maas M, Beets-Tan RG, Berkhof M, Lambregts DM, Nelemans PJ, Riedl R, Beets GL (2016) Nodal staging in rectal cancer: why is restaging after chemoradiation more accurate than primary nodal staging? Int J Color Dis 31:1157–1162CrossRef

18.

Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, Williams GT (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377CrossRefPubMed

19.

Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PMM, Stoker J (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 232:773–783CrossRefPubMed

20.

Brix G, Semmler W, Port R, Schad LR, Layer G, Lorenz WJ (1991) Pharmacokinetic parameters in CNS Gd-DTPA enhanced MR imaging. J Comput Assist Tomogr 15:621–628CrossRefPubMed

21.

Gaa T, Neumann W, Sudarski S, Attenberger UI, Schönberg SO, Schad LR, Zöllner FG (2017) Comparison of perfusion models for quantitative T1 weighted DCE-MRI of rectal cancer. Sci Rep 7:12036CrossRefPubMedPubMedCentral

22.

Koh TS, Bisdas S, Koh DM, Thng CH (2011) Fundamentals of tracer kinetics for dynamic contrast-enhanced MRI. J Magn Reson Imaging 34:1262–1276CrossRefPubMed

23.

Alberda WJ, Dassen HPN, Dwarkasing RS, Willemssen FEJA, van der Pool AEM, de Wilt JHW, Burger JWA, Verhoef C (2013) Prediction of tumor stage and lymph node involvement with dynamic contrast-enhanced MRI after chemoradiotherapy for locally advanced rectal cancer. Int J Color Dis 28:573–580CrossRef

24.

Yao WW, Zhang H, Ding B, Fu T, Jia H, Pang L, Song L, Xu W, Song Q, Chen K, Pan Z (2011) Rectal cancer: 3D dynamic contrast-enhanced MRI; correlation with microvascular density and clinicopathological features. Radiol Med 116:366–374CrossRefPubMed

25.

Do RK, Rusinek H, Taouli B (2009) Dynamic contrast-enhanced MR imaging of the liver: current status and future directions. Magn Reson Imaging Clin N Am 17:339–349CrossRefPubMed

26.

Sourbron S, Sommer WH, Reiser MF, Zech CJ (2012) Combined quantification of liver perfusion and function with dynamic gadoxetic acid-enhanced MR imaging. Radiology 263:874–883CrossRefPubMed

27.

Taylor FG et al (2011) One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. Br J Surg 98:872–879CrossRefPubMed

28.

Ma X et al (2015) Characteristics and prognostic significance of preoperative magnetic resonance imaging-assessed circumferential margin in rectal cancer. Gastroenterol Res Pract 410150:2015

29.

Yu XP, Wen L, Hou J, Wang H, Lu Q (2016) Discrimination of metastatic from non-metastatic mesorectal lymph nodes in rectal cancer using quantitative dynamic contrast-enhanced magnetic resonance imaging. J Huazhong Univ Sci Technolog Med Sci 36:594–600CrossRefPubMed

30.

Grovik E et al (2017) Dynamic multi-echo DCE- and DSC-MRI in rectal cancer: low primary tumor Ktrans and DeltaR2* peak are significantly associated with lymph node metastasis. J Magn Reson Imaging 46:194–206CrossRefPubMed

31.

Lollert A, Junginger T, Schimanski CC, Biesterfeld S, Gockel I, Düber C, Oberholzer K (2014) Rectal cancer: dynamic contrast-enhanced MRI correlates with lymph node status and epidermal growth factor receptor expression. J Magn Reson Imaging 39:1436–1442CrossRefPubMed

32.

Yu XP, Wen L, Hou J, Bi F, Hu P, Wang H, Wang W (2016) Discrimination between metastatic and nonmetastatic mesorectal lymph nodes in rectal cancer using intravoxel incoherent motion diffusion-weighted magnetic resonance imaging. Acad Radiol 23:479–485CrossRefPubMed

33.

van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ, Påhlman L, Glimelius B, van de Velde C, Dutch Colorectal Cancer Group (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–582CrossRefPubMed

34.

Xie H, Zhou X, Zhuo Z, Che S, Xie L, Fu W (2014) Effectiveness of MRI for the assessment of mesorectal fascia involvement in patients with rectal cancer: a systematic review and meta-analysis. Dig Surg 31:123–134CrossRefPubMed

35.

Kim DJ, Kim JH, Lim JS, Yu JS, Chung JJ, Kim MJ, Kim KW (2010) Restaging of rectal cancer with MR imaging after concurrent chemotherapy and radiation therapy. Radiographics 30:503–516CrossRefPubMed

36.

Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H (2011) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology 260:771–780CrossRefPubMed

Title: Improved detection of a tumorous involvement of the mesorectal fascia and locoregional lymph nodes in locally advanced rectal cancer using DCE-MRI
Authors: Marco Armbruster
Melvin D’Anastasi
Veronika Holzner
Martin E. Kreis
Olaf Dietrich
Bernhard Brandlhuber
Anno Graser
Martina Brandlhuber
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 7/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3083-x

At a glance: The STEP trials

Springer Medicine

Improved detection of a tumorous involvement of the mesorectal fascia and locoregional lymph nodes in locally advanced rectal cancer using DCE-MRI

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2018

Prevalence of colorectal cancer in acute uncomplicated diverticulitis and the role of the interval colonoscopy

Fistulectomy with primary sphincter reconstruction

Risk factors for early postoperative complications and length of hospital stay in ileocecal resection and right hemicolectomy for Crohn’s disease: a single-center experience

Outcomes after rectosigmoid resection for endometriosis: a systematic literature review

Oncological outcomes of IBD-associated versus sporadic colorectal cancer in modern era: a matched case-control study

Time from colorectal cancer diagnosis to laparoscopic curative surgery—is there a safe window for prehabilitation?