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Primary and post-chemoradiotherapy staging using MRI in rectal cancer: the role of diffusion imaging in the assessment of perirectal infiltration.
- Source :
-
Abdominal radiology (New York) [Abdom Radiol (NY)] 2019 Nov; Vol. 44 (11), pp. 3674-3682. - Publication Year :
- 2019
-
Abstract
- Purpose: To analyze changes in MRI diagnostic accuracy in main rectal tumor (T) evaluation resulting from the use of diffusion-weighted imaging (DWI), according to the degree of experience of the radiologist.<br />Methods: This is a cross-sectional study of a database including one hundred 1.5 T MRI records (2011-2016) from patients with biopsy-proven rectal cancer, including primary staging and post-chemoradiotherapy follow-up. All cases were individually blindedly reviewed by ten radiologists: three experienced in rectal cancer, three specialized in other areas, and four residents. Each case was assessed twice to detect perirectal infiltration: first, evaluating just high-resolution T2-weighted sequences (HRT2w); second, evaluation of DWI plus HRT2w sequences. Results were pooled by experience, calculating accuracy (area under ROC curve), sensitivity and specificity, predictive values, likelihood ratios, and overstaging/understaging. Histology of surgical specimens provided the reference standard.<br />Results: DWI significantly improved specificity by experienced radiologists in primary staging (63.2% to 75.9%) and, to a lesser extent, positive likelihood ratio (2.06 to 2.87); minimal changes were observed post-chemoradiotherapy, with a slight decrease of accuracy (0.657 to 0.626). Inexperienced radiologists showed a similar pattern, but with slight enhancement post-chemoradiotherapy (accuracy 0.604 to 0.621). Residents experienced small changes, with increased sensitivity/decreased specificity in both primary (69% to 72%/67.2% to 64.7%) and post-chemoradiotherapy (68.1% to 73.6%/47.3% to 44.6%) staging.<br />Conclusions: Adding DWI to HRT2w significantly improved specificity for the detection of perirectal infiltration at primary staging by experienced radiologists and also by inexperienced ones, although to a lesser extent. In the post-neoadjuvant treatment subgroup, only minimal changes were observed.
- Subjects :
- Adult
Aged
Aged, 80 and over
Biopsy
Colonoscopy
Cross-Sectional Studies
Female
Humans
Image Interpretation, Computer-Assisted
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Invasiveness
Neoplasm Staging
Predictive Value of Tests
Rectal Neoplasms pathology
Retrospective Studies
Sensitivity and Specificity
Chemoradiotherapy
Diffusion Magnetic Resonance Imaging methods
Rectal Neoplasms diagnostic imaging
Rectal Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2366-0058
- Volume :
- 44
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Abdominal radiology (New York)
- Publication Type :
- Academic Journal
- Accession number :
- 31332499
- Full Text :
- https://doi.org/10.1007/s00261-019-02139-4