Multi-parametric MRI of rectal cancer - do quantitative functional MR measurements correlate with radiologic and pathologic tumor stages?

U I Attenberger; L R Pilz; J N Morelli; D Hausmann; F Doyon; R Hofheinz; P Kienle; S Post; H J Michaely; S O Schoenberg; D J Dinter

doi:10.1016/j.ejrad.2014.03.012

Multi-parametric MRI of rectal cancer - do quantitative functional MR measurements correlate with radiologic and pathologic tumor stages?

Eur J Radiol. 2014 Jul;83(7):1036-1043. doi: 10.1016/j.ejrad.2014.03.012. Epub 2014 Mar 22.

Authors

U I Attenberger¹, L R Pilz², J N Morelli³, D Hausmann⁴, F Doyon⁵, R Hofheinz⁶, P Kienle⁵, S Post⁵, H J Michaely¹, S O Schoenberg¹, D J Dinter¹

Affiliations

¹ Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany.
² Medical Faculty Mannheim, University of Heidelberg, Germany.
³ Scott & White Memorial Hospital and Clinic, Temple, TX, USA.
⁴ Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany. Electronic address: [email protected].
⁵ Department of Surgery, University Medical Center Mannheim, Germany.
⁶ Department of Oncology, University Medical Center Mannheim, Germany.

PMID: 24791649
DOI: 10.1016/j.ejrad.2014.03.012

Abstract

Purpose: The purpose of this study is two-fold. First, to evaluate, whether functional rectal MRI techniques can be analyzed in a reproducible manner by different readers and second, to assess whether different clinical and pathologic T and N stages can be differentiated by functional MRI measurements.

Materials and methods: 54 patients (38 men, 16 female; mean age 63.2 ± 12.2 years) with pathologically proven rectal cancer were included in this retrospective IRB-approved study. All patients were referred for a multi-parametric MRI protocol on a 3 Tesla MR-system, consisting of a high-resolution, axial T2 TSE sequence, DWI and perfusion imaging (plasma flow -s PFTumor) prior to any treatment. Two experienced radiologists evaluated the MRI measurements, blinded to clinical data and outcome. Inter-reader correlation and the association of functional MRI parameters with c- and p-staging were analyzed.

Results: The inter-reader correlation for lymph node (ρ 0.76-0.94; p<0.0002) and primary tumor (ρ 0.78-0.92; p<0.0001) apparent diffusion coefficient and plasma flow (PF) values was good to very good. PFTumor values decreased with cT stage with significant differences identified between cT2 and cT3 tumors (229 versus 107.6 ml/100ml/min; p=0.05). ADCTumor values did not differ significantly. No substantial discrepancies in lymph node ADCLn values or short axis diameter were found among cN1-3 stages, whereas PFLn values were distinct between cN1 versus cN2 stages (p=0.03). In the patients without neoadjuvant RCT no statistically significant differences in the assessed functional parameters on the basis of pathologic stage were found.

Conclusion: This study illustrates that ADC as well as MR perfusion values can be analyzed with good interobserver agreement in patients with rectal cancer. Moreover, MR perfusion parameters may allow accurate differentiation of tumor stages. Both findings suggest that functional MRI parameters may help to discriminate T and N stages for clinical decision making.

Keywords: Diffusion weighted imaging; Dynamic contrast enhancement; Multi-parametric MRI; Rectal cancer.

Publication types

Comparative Study

MeSH terms

Carcinoma / diagnostic imaging
Carcinoma / pathology*
Carcinoma / secondary*
Diffusion Magnetic Resonance Imaging / methods*
Female
Humans
Lymph Nodes / diagnostic imaging
Lymph Nodes / pathology*
Lymphatic Metastasis
Magnetic Resonance Angiography / methods*
Male
Multimodal Imaging / methods*
Neoplasm Staging / methods
Observer Variation
Radiography
Rectal Neoplasms / diagnostic imaging
Rectal Neoplasms / pathology*
Reproducibility of Results
Sensitivity and Specificity
Single-Blind Method
Statistics as Topic