Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence

Waleed Abdelfattah Mousa; Tarek Fawzy Abdella

doi:doi:10.11648/j.ijmi.20170502.13

| Peer-Reviewed

Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence

Waleed Abdelfattah Mousa, Tarek Fawzy Abdella

Published in International Journal of Medical Imaging (Volume 5, Issue 2)

Received: 19 December 2016 Accepted: 3 January 2017 Published: 25 March 2017

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Objective: MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. Background: Colorectal cancer (CRC) is the third most common cancer in both sexes combined worldwide, after prostate and breast cancer with an incidence of 40 in 100,000. Rectal carcinoma accounts for more than one-third of colorectal tumors and is associated with signiﬁcant morbidity and mortality. Currently, MRI using diffusion weighted sequence is the most sensitive and specific modality in staging rectal cancer as it is able to depict the mesorectal fascia and its relation to the tumor margins precisely. Methods: This study included 50 patients, (32 male and 18 female) previously diagnosed as cancer rectum based on proctoscope and histopathological biopsy. The age range of the patients was from 18 years to 78 years. All patients will be subjected to the following: detailed history, clinical examination, proctoscopic assessment and histopathological data. All patients underwent MRI of the pelvis specifically cancer rectum protocol. Results: The most frequently encountered clinical presentation among cancer rectum patients was bleeding per rectum (14), constipation (26), incidentally discovered liver metastasis (6) and intestinal obstruction (4). MRI evaluation of T staging in correlation to the histopathological examination showed sensitivity (80%), specificity (93%), accuracy (94%). Lymph node (LN) metastatic spread was evaluated by MRI and showed sensitivity (87%), specificity (92%), accuracy (92.6%), PPV (84.8%) and NPV (96.7%). Regarding circumferential resection margin (CRM) MRI assessment revealed; sensitivity (96%), specificity (94%), accuracy (96%), PPV (95%) and NPV (94.3%). Conclusions: MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal fascia involvement, lymph nodes, and distant metastasis. MRI can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment.

Published in	International Journal of Medical Imaging (Volume 5, Issue 2)
DOI	10.11648/j.ijmi.20170502.13
Page(s)	19-25
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Magnetic Resonance Imaging, Diffusion, Cancer Rectum, Tumor Staging

References

[1]	Siegel R, Naishadham D, Jemal A. Cancer statistics, CA Cancer J Clin 2013; 63: 11–30.
[2]	Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. 1997: 12: 594–642.
[3]	D. M. Ganeshan, et al. MRI Evaluation of Rectal Carcinoma, Cross-Sectional Imaging of the Abdomen and Pelvis: A Practical Algorithmic Approach, New York: Springer, 2015: 417-433.
[4]	Klessen, C., Rogalla, P., & Taupitz, M. Local staging of rectal cancer: the current role of MRI. European radiology 2007; 2: 379-389.
[5]	Ümit Tapan, Mustafa Özbayrak, Servet Tatlı. MRI in local staging of rectal cancer: an update. Diagnostic Interventional Radiology 2014; 20: 390-398.
[6]	Suk Hee Heo, Jin Woong Kim, Sang Soo Shin, et al. Multimodal imaging evaluation in staging of rectal cancer. world journal of gastroenterology 2014; 15: 4244-4255.
[7]	Harmeet K, Haesun C, Y Nancy Y, et al. MR Imaging for Preoperative Evaluation of Primary Rectal Cancer: Practical Considerations radioGraphics 2012; 3: 389-409.
[8]	J. Evans, U. Patel, and G. Brown. Rectal Cancer: Primary Staging and Assessment After Chemoradiotherapy Seminars on Radiation Oncology 2013; 21: 169-177.
[9]	Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999; 211: 215–222. [PubMed]
[10]	Shihab OC, Heald RJ, Rullier E, et al. Defining the surgical planes on MRI improves surgery for cancer of the low rectum. Lancet Oneal. 2009; 10: 1207–1211. [PubMed]
[11]	H. Kwok, I. P. Bissett, G. L. Hill. Preoperative staging of rectal cancer. International Journal of Colorectal Disease. 2000; 15: 9-20
[12]	Elizabeth Furey, Kartik S, Jhaveri. Magnetic resonance imaging in rectal cancer. Clinics Northern America 2014; 22: 165-190.
[13]	Rao S-X, Zeng M-S, et al. Assessment of T staging and mesorectal fascia status using high-resolution MRI in rectal cancer with rectal distention. World J Gastroenterol. 2007; 13: 4141-4146.
[14]	Algebally AM et al. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging. Pol J Radiol. 2015; 80: 115-21
[15]	Matsuoka H, Nakamura A, Masaki T, et al. Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res. 2007; 27: 3529-3533
[16]	Wong, et al. Effect of endorectal coils on staging of rectal cancers by magnetic resonance imaging. Hong Kong Med J 2010; 16: 421-439.
[17]	C. C. Moreno, et al. Magnetic resonance imaging of rectal cancer: staging and restaging evaluation. World J Gastroenterol 2014; 15: 4244-4255.
[18]	Zhang XM, Zhang HL, et al. 3-T MRI of rectal carcinoma: preoperative diagnosis, staging and planning of sphincter-sparing surgery. AJR Am J Roentgenol 2008; 5: 1271–8.
[19]	HY. Lee et al. Prognostic Significance of Metastatic Lymph Node Ratio in Node-Positive Colon Carcinoma. Annals of Surgical Oncology 14; 5: 1712-1717.
[20]	Brown G, Richards CJ, Bourne MW, et al: Morpho¬logic predictors of lymph node status in rectal can¬cer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 2003; 2: 371-377.
[21]	Eisar Al-Sukhni, Laurent Milot, Mark Fruitman, et al. Diagnostic Accuracy of MRI for Assessment of T Category, Lymph Node Metastases, and Circumferential Resection Margin Involvement in Patients with Rectal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2012; 19: 2212-2223.

Cite This Article

Plain Text BibTeX RIS

APA Style

Waleed Abdelfattah Mousa, Tarek Fawzy Abdella. (2017). Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence. International Journal of Medical Imaging, 5(2), 19-25. https://doi.org/10.11648/j.ijmi.20170502.13

Copy | Download

ACS Style

Waleed Abdelfattah Mousa; Tarek Fawzy Abdella. Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence. Int. J. Med. Imaging 2017, 5(2), 19-25. doi: 10.11648/j.ijmi.20170502.13

Copy | Download

AMA Style

Waleed Abdelfattah Mousa, Tarek Fawzy Abdella. Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence. Int J Med Imaging. 2017;5(2):19-25. doi: 10.11648/j.ijmi.20170502.13

Copy | Download

@article{10.11648/j.ijmi.20170502.13,
  author = {Waleed Abdelfattah Mousa and Tarek Fawzy Abdella},
  title = {Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence},
  journal = {International Journal of Medical Imaging},
  volume = {5},
  number = {2},
  pages = {19-25},
  doi = {10.11648/j.ijmi.20170502.13},
  url = {https://doi.org/10.11648/j.ijmi.20170502.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmi.20170502.13},
  abstract = {Objective: MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. Background: Colorectal cancer (CRC) is the third most common cancer in both sexes combined worldwide, after prostate and breast cancer with an incidence of 40 in 100,000. Rectal carcinoma accounts for more than one-third of colorectal tumors and is associated with signiﬁcant morbidity and mortality. Currently, MRI using diffusion weighted sequence is the most sensitive and specific modality in staging rectal cancer as it is able to depict the mesorectal fascia and its relation to the tumor margins precisely. Methods: This study included 50 patients, (32 male and 18 female) previously diagnosed as cancer rectum based on proctoscope and histopathological biopsy. The age range of the patients was from 18 years to 78 years. All patients will be subjected to the following: detailed history, clinical examination, proctoscopic assessment and histopathological data. All patients underwent MRI of the pelvis specifically cancer rectum protocol. Results: The most frequently encountered clinical presentation among cancer rectum patients was bleeding per rectum (14), constipation (26), incidentally discovered liver metastasis (6) and intestinal obstruction (4). MRI evaluation of T staging in correlation to the histopathological examination showed sensitivity (80%), specificity (93%), accuracy (94%). Lymph node (LN) metastatic spread was evaluated by MRI and showed sensitivity (87%), specificity (92%), accuracy (92.6%), PPV (84.8%) and NPV (96.7%). Regarding circumferential resection margin (CRM) MRI assessment revealed; sensitivity (96%), specificity (94%), accuracy (96%), PPV (95%) and NPV (94.3%). Conclusions: MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal fascia involvement, lymph nodes, and distant metastasis. MRI can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence
AU  - Waleed Abdelfattah Mousa
AU  - Tarek Fawzy Abdella
Y1  - 2017/03/25
PY  - 2017
N1  - https://doi.org/10.11648/j.ijmi.20170502.13
DO  - 10.11648/j.ijmi.20170502.13
T2  - International Journal of Medical Imaging
JF  - International Journal of Medical Imaging
JO  - International Journal of Medical Imaging
SP  - 19
EP  - 25
PB  - Science Publishing Group
SN  - 2330-832X
UR  - https://doi.org/10.11648/j.ijmi.20170502.13
AB  - Objective: MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. Background: Colorectal cancer (CRC) is the third most common cancer in both sexes combined worldwide, after prostate and breast cancer with an incidence of 40 in 100,000. Rectal carcinoma accounts for more than one-third of colorectal tumors and is associated with signiﬁcant morbidity and mortality. Currently, MRI using diffusion weighted sequence is the most sensitive and specific modality in staging rectal cancer as it is able to depict the mesorectal fascia and its relation to the tumor margins precisely. Methods: This study included 50 patients, (32 male and 18 female) previously diagnosed as cancer rectum based on proctoscope and histopathological biopsy. The age range of the patients was from 18 years to 78 years. All patients will be subjected to the following: detailed history, clinical examination, proctoscopic assessment and histopathological data. All patients underwent MRI of the pelvis specifically cancer rectum protocol. Results: The most frequently encountered clinical presentation among cancer rectum patients was bleeding per rectum (14), constipation (26), incidentally discovered liver metastasis (6) and intestinal obstruction (4). MRI evaluation of T staging in correlation to the histopathological examination showed sensitivity (80%), specificity (93%), accuracy (94%). Lymph node (LN) metastatic spread was evaluated by MRI and showed sensitivity (87%), specificity (92%), accuracy (92.6%), PPV (84.8%) and NPV (96.7%). Regarding circumferential resection margin (CRM) MRI assessment revealed; sensitivity (96%), specificity (94%), accuracy (96%), PPV (95%) and NPV (94.3%). Conclusions: MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal fascia involvement, lymph nodes, and distant metastasis. MRI can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment.
VL  - 5
IS  - 2
ER  -

Copy | Download

Author Information

Waleed Abdelfattah Mousa

Department of Diagnostic Radiology, Menoufia University, Menoufia, Egypt
Tarek Fawzy Abdella

Department of Diagnostic Radiology, Menoufia University, Menoufia, Egypt

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Waleed Abdelfattah Mousa, Tarek Fawzy Abdella. (2017). Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence. International Journal of Medical Imaging, 5(2), 19-25. https://doi.org/10.11648/j.ijmi.20170502.13

Copy | Download

ACS Style

Waleed Abdelfattah Mousa; Tarek Fawzy Abdella. Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence. Int. J. Med. Imaging 2017, 5(2), 19-25. doi: 10.11648/j.ijmi.20170502.13

Copy | Download

AMA Style

Waleed Abdelfattah Mousa, Tarek Fawzy Abdella. Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence. Int J Med Imaging. 2017;5(2):19-25. doi: 10.11648/j.ijmi.20170502.13

Copy | Download

@article{10.11648/j.ijmi.20170502.13,
  author = {Waleed Abdelfattah Mousa and Tarek Fawzy Abdella},
  title = {Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence},
  journal = {International Journal of Medical Imaging},
  volume = {5},
  number = {2},
  pages = {19-25},
  doi = {10.11648/j.ijmi.20170502.13},
  url = {https://doi.org/10.11648/j.ijmi.20170502.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmi.20170502.13},
  abstract = {Objective: MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. Background: Colorectal cancer (CRC) is the third most common cancer in both sexes combined worldwide, after prostate and breast cancer with an incidence of 40 in 100,000. Rectal carcinoma accounts for more than one-third of colorectal tumors and is associated with signiﬁcant morbidity and mortality. Currently, MRI using diffusion weighted sequence is the most sensitive and specific modality in staging rectal cancer as it is able to depict the mesorectal fascia and its relation to the tumor margins precisely. Methods: This study included 50 patients, (32 male and 18 female) previously diagnosed as cancer rectum based on proctoscope and histopathological biopsy. The age range of the patients was from 18 years to 78 years. All patients will be subjected to the following: detailed history, clinical examination, proctoscopic assessment and histopathological data. All patients underwent MRI of the pelvis specifically cancer rectum protocol. Results: The most frequently encountered clinical presentation among cancer rectum patients was bleeding per rectum (14), constipation (26), incidentally discovered liver metastasis (6) and intestinal obstruction (4). MRI evaluation of T staging in correlation to the histopathological examination showed sensitivity (80%), specificity (93%), accuracy (94%). Lymph node (LN) metastatic spread was evaluated by MRI and showed sensitivity (87%), specificity (92%), accuracy (92.6%), PPV (84.8%) and NPV (96.7%). Regarding circumferential resection margin (CRM) MRI assessment revealed; sensitivity (96%), specificity (94%), accuracy (96%), PPV (95%) and NPV (94.3%). Conclusions: MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal fascia involvement, lymph nodes, and distant metastasis. MRI can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence
AU  - Waleed Abdelfattah Mousa
AU  - Tarek Fawzy Abdella
Y1  - 2017/03/25
PY  - 2017
N1  - https://doi.org/10.11648/j.ijmi.20170502.13
DO  - 10.11648/j.ijmi.20170502.13
T2  - International Journal of Medical Imaging
JF  - International Journal of Medical Imaging
JO  - International Journal of Medical Imaging
SP  - 19
EP  - 25
PB  - Science Publishing Group
SN  - 2330-832X
UR  - https://doi.org/10.11648/j.ijmi.20170502.13
AB  - Objective: MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. Background: Colorectal cancer (CRC) is the third most common cancer in both sexes combined worldwide, after prostate and breast cancer with an incidence of 40 in 100,000. Rectal carcinoma accounts for more than one-third of colorectal tumors and is associated with signiﬁcant morbidity and mortality. Currently, MRI using diffusion weighted sequence is the most sensitive and specific modality in staging rectal cancer as it is able to depict the mesorectal fascia and its relation to the tumor margins precisely. Methods: This study included 50 patients, (32 male and 18 female) previously diagnosed as cancer rectum based on proctoscope and histopathological biopsy. The age range of the patients was from 18 years to 78 years. All patients will be subjected to the following: detailed history, clinical examination, proctoscopic assessment and histopathological data. All patients underwent MRI of the pelvis specifically cancer rectum protocol. Results: The most frequently encountered clinical presentation among cancer rectum patients was bleeding per rectum (14), constipation (26), incidentally discovered liver metastasis (6) and intestinal obstruction (4). MRI evaluation of T staging in correlation to the histopathological examination showed sensitivity (80%), specificity (93%), accuracy (94%). Lymph node (LN) metastatic spread was evaluated by MRI and showed sensitivity (87%), specificity (92%), accuracy (92.6%), PPV (84.8%) and NPV (96.7%). Regarding circumferential resection margin (CRM) MRI assessment revealed; sensitivity (96%), specificity (94%), accuracy (96%), PPV (95%) and NPV (94.3%). Conclusions: MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal fascia involvement, lymph nodes, and distant metastasis. MRI can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment.
VL  - 5
IS  - 2
ER  -

Copy | Download