The influence of endorectal filling on rectal cancer staging with MRI

To assess the influence of endorectal filling (EF) on rectal cancer staging. 47 patients who underwent a staging MRI of rectal cancer in the period from 2011 to 2014 were included. The MRI protocol included T weighted fast spin echo sequences without and with EF at 3 T (EF-MRI). Images were scored b...

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Bibliographic Details
Published in:	British journal of radiology Vol. 91; no. 1089; p. 20180205
Main Authors:	Stijns, Rutger Ch, Scheenen, Tom Wj, de Wilt, Johannes Hw, Fütterer, Jurgen J, Beets-Tan, Regina Gh
Format:	Journal Article
Language:	English
Published:	England The British Institute of Radiology 01-09-2018
Subjects:	Humans Magnetic Resonance Imaging - methods Neoplasm Staging - methods Rectal Neoplasms - diagnostic imaging Rectal Neoplasms - pathology
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Summary:	To assess the influence of endorectal filling (EF) on rectal cancer staging. 47 patients who underwent a staging MRI of rectal cancer in the period from 2011 to 2014 were included. The MRI protocol included T weighted fast spin echo sequences without and with EF at 3 T (EF-MRI). Images were scored by two readers for T-stage, distance of the lower pole of the tumour to the anorectal junction, distance to the mesorectal fascia (MRF), and number of (suspicious) lymph nodes. Agreement in T-staging was calculated using the Cohen's κ value. Comparison of continuous variables was performed using Wilcoxon matched pairs signed-rank test. The interobserver agreement for T-staging with and without EF-MRI showed a poor agreement between both readers (weighted κ = 0.156, weighted κ = 0.037, respectively). Tumours tended to be overstaged more prominently with EF-MRI. The accuracy of predicting the pathological T-stage slightly improved from 55% with EF to 64% without EF for Reader 1 and from 59 to 68% for Reader 2, respectively. The distance of the tumour to the anorectal junction increased from 33.9 to 49.3 mm (p < 0.001) after EF for Reader 2. EF-MRI did not significantly influence the number of (suspicious) lymph nodes and distance to the mesorectal fascia. EF-MRI did not lead to an improved tumour staging and it has the potential to influence the distance to a key anatomical landmark. EF-MRI is therefore not recommended in primary staging rectal cancer. Advances in knowledge: EF-MRI may not be used as an additional tool to stage rectal cancer patients, as it does not seem to facilitate in locoregionally staging the disease.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0007-1285 1748-880X
DOI:	10.1259/bjr.20180205