Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 6/2011

Open Access 01-06-2011 | Gastrointestinal

Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer

Authors: Doenja M. J. Lambregts, Vincent C. Cappendijk, Monique Maas, Geerard L. Beets, Regina G. H. Beets-Tan

Published in: European Radiology | Issue 6/2011

Login to get access

Abstract

Objectives

To evaluate the accuracy of standard MRI, diffusion-weighted MRI (DWI) and fusion images for the diagnosis of locally recurrent rectal cancer in patients with a clinical suspicion of recurrence.

Methods

Forty-two patients with a clinical suspicion of recurrence underwent 1.5-T MRI consisting of standard T2-weighted FSE (3 planes) and an axial DWI (b0,500,1000). Two readers (R1,R2) independently scored the likelihood of recurrence; [1] on standard MRI, [2] on standard MRI+DWI, and [3] on T2-weighted+DWI fusion images.

Results

19/42 patients had a local recurrence. R1 achieved an area under the ROC-curve (AUC) of 0.99, sensitivity 100% and specificity 83% on standard MRI versus 0.98, 100% and 91% after addition of DWI (p = 0.78). For R2 these figures were 0.87, 84% and 74% on standard MRI and 0.91, 89% and 83% with DWI (p = 0.09). Fusion images did not significantly improve the performance. Interobserver agreement was κ0.69 for standard MRI, κ0.82 for standard MRI+DWI and κ0.84 for the fusion images.

Conclusions

MRI is accurate for the diagnosis of locally recurrent rectal cancer in patients with a clinical suspicion of recurrence. Addition of DWI does not significantly improve its performance. However, with DWI specificity and interobserver agreement increase. Fusion images do not improve accuracy.
Literature
1.
Jeffery M, Hickey BE, Hider PN (2007) Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 24:CD002200
2.
Kusters M, Marijnen CA, van de Velde CJ, Rutten HJ, Lahaye MJ, Kim JH, Beets-Tan RG, Beets GL (2010) Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol 36:470–476PubMed
3.
Caricato M, Borzomati D, Ausania F, Valeri S, Rosignoli A, Coppola R (2006) Prognostic factors after surgery for locally recurrent rectal cancer: an overview. Eur J Surg Oncol 32:126–132PubMedCrossRef
4.
Desch CE, Benson AB 3rd, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Pfister DG, Virgo KS, Petrelli NJ, American Society of Clinical Oncology (2005) Colorectal cancer surveillance: 2005 update of an American society of clinical oncology practice guideline. J Clin Oncol 23:8512–8519PubMedCrossRef
5.
Glimelius B, Påhlman L, Cervantes A, ESMO Guidelines Working Group (2010) Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v82–86PubMedCrossRef
6.
Titu LV, Nicholson AA, Hartley JE, Breen DJ, Monson JR (2006) Routine follow-up by magnetic resonance imaging does not improve detection of resectable local recurrences from colorectal cancer. Ann Surg 243:348–352PubMedCrossRef
7.
Schaefer O, Langer M (2007) Detection of recurrent rectal cancer with CT, MRI and PET/CT. Eur Radiol 17:2044–54PubMedCrossRef
8.
Valentini V, Aristei C, Glimelius B, Minsky BD, Beets-Tan R, Borras JM, Haustermans K, Maingon P, Overgaard J, Pahlman L, Quirke P, Schmoll HJ, Sebag-Montefiore D, Taylor I, Van Cutsem E, Van de Velde C, Cellini N, Latini P, Committee S (2009) Multidisciplinary rectal cancer management: 2nd european rectal cancer consensus conference (EURECA-CC2). Radiother Oncol 92:148–163PubMedCrossRef
9.
Takeuchi O, Saito N, Koda K, Sarashina H, Nakajima N (1999) Clinical assessment of positron emission tomography for the diagnosis of local recurrence in colorectal cancer. Br J Surg 86:932–937PubMedCrossRef
10.
Flamen P, Stroobants S, Van Cutsem E, Dupont P, Bormans G, De Vadder N, Penninckx F, Van Hoe L, Mortelmans L (1999) Additional value of whole-body positron emission tomography with fluorine-18-2-fluoro-2-deoxy-D-glucose in recurrent colorectal cancer. J Clin Oncol 17:894–901PubMed
11.
Even-Sapir E, Parag Y, Lerman H, Gutman M, Levine C, Rabau M, Figer A, Metser U (2004) Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. Radiology 232:815–822PubMedCrossRef
12.
Vliegen RF, Beets-Tan RG, Vanhauten B, Driessen A, Oellers M, Kessels AG, Arens A, Beets GL, Buijsen J, van Baardwijk A, de Ruysscher D, Lammering G (2008) Can an FDG-PET/CT predict tumor clearance of the mesorectal fascia after preoperative chemoradiation of locally advanced rectal cancer? Strahlenther Onkol 184:457–464PubMedCrossRef
13.
Dresen RC, Kusters M, Daniels-Gooszen AW, Cappendijk VC, Nieuwenhuijzen GA, Kessels AG, de Bruïne AP, Beets GL, Rutten HJ, Beets-Tan RG (2010) Absence of tumor invasion into pelvic structures in locally recurrent rectal cancer: prediction with preoperative MR imaging. Radiology 256:143–150PubMedCrossRef
14.
Dresen RC, Beets GL, Rutten HJ, Engelen SM, Lahaye MJ, Vliegen RF, de Bruïne AP, Kessels AG, Lammering G, Beets-Tan RG (2009) Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part I. Are we able to predict tumor confined to the rectal wall? Radiology 252:71–80PubMedCrossRef
15.
Kuo LJ, Chern MC, Tsou MH, Liu MC, Jian JJ, Chen CM, Chung YL, Fang WT (2005) Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. Dis Colon Rectum 48:23–28PubMedCrossRef
16.
Barbaro B, Vitale R, Leccisotti L, Vecchio FM, Santoro L, Valentini V, Coco C, Pacelli F, Crucitti A, Persiani R, Bonomo L (2010) Restaging locally advanced rectal cancer with MR imaging after chemoradiation therapy. Radiographics 30:699–716PubMedCrossRef
17.
Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188:1622–1635PubMedCrossRef
18.
Namimoto T, Awai K, Nakaura T, Yanaga Y, Hirai T, Yamashita Y (2009) Role of diffusion-weighted imaging in the diagnosis of gynecological diseases. Eur Radiol 19:745–760PubMedCrossRef
19.
Rao SX, Zeng MS, Chen CZ, Li RC, Zhang SJ, Xu JM, Hou YY (2008) The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection. Eur J Radiol 65:299–303PubMedCrossRef
20.
Nishie A, Stolpen AH, Obuchi M, Kuehn DM, Dagit A, Andresen K (2008) Evaluation of locally recurrent pelvic malignancy: performance of T2- and diffusion-weighted MRI with image fusion. J Magn Reson Imaging 28:705–713PubMedCrossRef
21.
Tsushima Y, Takano A, Taketomi-Takahashi A, Endo K (2007) Body diffusion-weighted MR imaging using high b-value for malignant tumor screening: usefulness and necessity of referring to T2-weighted images and creating fusion images. Acad Radiol 14:643–650PubMedCrossRef
22.
Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282PubMed
23.
Rosset A, Spadola L, Ratib O (2004) OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging 17:205–216PubMedCrossRef
24.
DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845PubMedCrossRef
25.
Cohen J (1986) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220CrossRef
26.
Syk E, Torkzad MR, Blomqvist L, Nilsson PJ, Glimelius B (2008) Local recurrence in rectal cancer: anatomic localization and effect on radiation target. Int J Radiat Oncol Biol Phys 72:658–664PubMedCrossRef
27.
de Lange EE, Fechner RE, Wanebo HJ (1989) Suspected recurrent rectosigmoid carcinoma after abdominoperineal resection: MR imaging and histopathologic findings. Radiology 170:323–328PubMed
28.
Vandecaveye V, De Keyzer F, Nuyts S, Deraedt K, Dirix P, Hamaekers P, Vander Poorten V, Delaere P, Hermans R (2007) Detection of head and neck squamous cell carcinoma with diffusion weighted MRI after (chemo)radiotherapy: correlation between radiologic and histopathologic findings. Int J Radiat Oncol Biol Phys 67:960–971PubMedCrossRef
29.
Blomqvist L, Holm T, Goranson H, Jacobsson H, Ohlsen H, Larsson SA (1996) MR imaging, CT and CEA scintigraphy in the diagnosis of local recurrence of rectal carcinoma. Acta Radiol 37:779–784PubMedCrossRef
30.
Beets-Tan RG, Beets GL, Borstlap AC, Oei TK, Teune TM, von Meyenfeldt MF, van Engelshoven JM (2000) Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI? Abdom Imaging 25:533–541PubMedCrossRef
31.
Kinkel K, Tardivon AA, Soyer P, Spatz A, Lasser P, Rougier P, Vanel D (1996) Dynamic contrast-enhanced subtraction versus T2-weighted spin-echo MR imaging in the follow-up of colorectal neoplasm: a prospective study of 41 patients. Radiology 200:453–458PubMed
32.
Torricelli P, Pecchi A, Luppi G, Romagnoli R (2003) Gadolinium-enhanced MRI with dynamic evaluation in diagnosing the local recurrence of rectal cancer. Abdom Imaging 28:19–27PubMedCrossRef
33.
Blomqvist L, Fransson P, Hindmarsh T (1998) The pelvis after surgery and radio-chemotherapy for rectal cancer studied with Gd-DTPA-enhanced fast dynamic MR imaging. Eur Radiol 8:781–787PubMedCrossRef
Metadata
Title
Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer
Authors
Doenja M. J. Lambregts
Vincent C. Cappendijk
Monique Maas
Geerard L. Beets
Regina G. H. Beets-Tan
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
European Radiology / Issue 6/2011
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-010-2052-8

Other articles of this Issue 6/2011

European Radiology 6/2011 Go to the issue

Musculoskeletal

Imaging of the Achilles tendon in spondyloarthritis: a comparison of ultrasound and conventional, short and ultrashort echo time MRI with and without intravenous contrast

Ultrasound

Intraductally applied contrast-enhanced ultrasound (IA-CEUS) for evaluating obstructive disease and secretory dysfunction of the salivary glands

Chest

Computer-aided detection of pulmonary embolism at CT pulmonary angiography: can it improve performance of inexperienced readers?

Neuro

Changes in AVM angio-architecture and hemodynamics after stereotactic radiosurgery assessed by dynamic MRA and phase contrast flow assessments

Musculoskeletal

Tractography of lumbar nerve roots: initial results

Musculoskeletal

MRI differentiates femoral condylar ossification evolution from osteochondritis dissecans. A new sign