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European Radiology
Published in: European Radiology 4/2018

Open Access 01-04-2018 | Gastrointestinal

The impact of MRI sequence on tumour staging and gross tumour volume delineation in squamous cell carcinoma of the anal canal

Authors: Davide Prezzi, Ramin Mandegaran, Sofia Gourtsoyianni, Katarzyna Owczarczyk, Andrew Gaya, Robert Glynne-Jones, Vicky Goh

Published in: European Radiology | Issue 4/2018

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Abstract

Objectives

To compare maximum tumour diameter (MTD) and gross tumour volume (GTV) measurements between T2-weighted (T2-w) and diffusion-weighted (DWI) MRI in squamous cell carcinoma of the anal canal (SCCA) and assess sequence impact on tumour (T) staging. Second, to evaluate interobserver agreement and reader delineation confidence.

Methods

The staging MRI scans of 45 SCCA patients (25 females) were assessed retrospectively by two independent radiologists (0 and 5 years’ experience of anal cancer MRI). MTD and GTV were delineated on both T2-w and high-b-value DWI images and compared between sequences; T staging was derived from MTD. Interobserver agreement was assessed and delineation confidence scored (1 to 5) by each observer.

Results

GTV and MTD were significantly and systematically lower on DWI versus T2-w sequences by 14.80%/9.98% (MTD) and 29.70%/12.25% (GTV) for each reader, respectively, causing T staging discordances in approximately a quarter of cases. Bland-Altman limits of agreement were narrower and intraclass correlation coefficients higher for DWI. Delineation confidence was greater on DWI: 40/42 cases were scored confidently (4 or 5) by each reader, respectively, versus 31/36 cases based on T2-w images.

Conclusions

Sequence selection affects SCCA measurements and T stage. DWI yields higher interobserver agreement and greater tumour delineation confidence.

Key Points

• MTD and GTV measurements are significantly lower on DWI than on T 2 -w MRI.
• Such differences cause T staging discordances in up to a quarter of cases.
• DWI results in higher agreement between inexperienced and experienced observers.
• DWI offers greater tumour delineation confidence to inexperienced readers.
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Metadata
Title
The impact of MRI sequence on tumour staging and gross tumour volume delineation in squamous cell carcinoma of the anal canal
Authors
Davide Prezzi
Ramin Mandegaran
Sofia Gourtsoyianni
Katarzyna Owczarczyk
Andrew Gaya
Robert Glynne-Jones
Vicky Goh
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-5133-0

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