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Magnetic Resonance Imaging-Detected Extramural Venous Invasion in Rectal Cancer before and after Preoperative Chemoradiotherapy: Diagnostic Performance and Prognostic Significance

  • Gastrointestinal
  • Published:
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Abstract

Objectives

We evaluated the diagnostic performance of magnetic resonance imaging (MRI) in terms of identifying extramural venous invasion (EMVI) in rectal cancer patients with preoperative chemoradiotherapy (CRT) and its prognostic significance.

Methods

During 2008–2010, 200 patients underwent surgery following preoperative CRT for rectal cancer. Two radiologists independently reviewed all pre- and post-CRT MRI retrospectively. We investigated diagnostic performance of pre-CRT MR-EMVI (MR-EMVI) and post-CRT MR-EMVI (yMR-EMVI), based on pathological EMVI as the standard of reference. We assessed correlation between MRI findings and patients’ prognosis, such as disease-free survival (DFS) and overall survival (OS). Additionally, subgroup analysis in MR- or yMR-EMVI-positive patients was performed to confirm the significance of the severity of EMVI in MRI on patient’s prognosis.

Results

The sensitivity and specificity of yMR-EMVI were 76.19% and 79.75% (area under the curve: 0.830), respectively. In univariate analysis, yMR-EMVI was the only significant MRI factor in DFS (P = 0.027). The mean DFS for yMR-EMVI (+) patients was significantly less than for yMR-EMVI (−) patients: 57.56 months versus 72.46 months.

Conclusion

yMR-EMVI demonstrated good diagnostic performance. yMR-EMVI was the only significant EMVI-related MRI factor that correlated with patients’ DFS in univariate analysis; however, it was not significant in multivariate analysis.

Key Points

• Diagnostic performance of MRI for EMVI after preoperative chemoradiotherapy is good.

• The mean DFS was lower in yMR-EMVI-positive than yMR-EMVI-negative patients.

• MRI can facilitate prognosis prediction of rectal cancer patients with preoperative chemoradiotherapy.

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Abbreviations

AUC:

Area under the curve

CRT:

Chemoradiotherapy

DFS:

Disease-free survival

MR-vTRG:

EMVI tumour regression grading assessed by magnetic resonance

EMVI:

Extramural venous invasion

MR-EMVI:

Initial MRI-detected EMVI

MRI:

Magnetic resonance imaging

OS:

Overall survival

(y)pEMVI:

Pathologically proven EMVI

yMR-EMVI:

Post-chemoradiotherapy MRI-detected EMVI

ROC:

Receiver operating characteristic

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Authors and Affiliations

  1. Department of Radiology, Chung-Ang University Hospital, Seoul, Korea

    Eun Sun Lee

  2. College of Medicine and Graduate School of Medicine, Chung-Ang University, Seoul, Korea

    Eun Sun Lee

  3. Department of Radiology, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea

    Eun Sun Lee, Min Ju Kim & Bo Yun Hur

  4. Centre for Colorectal Cancer, National Cancer Centre, Goyang, Gyeonggi-do, Korea

    Sung Chan Park, Jong Hee Hyun, Hee Jin Chang, Ji Yeon Baek, Sun Young Kim, Dae Yong Kim & Jae Hwan Oh

  5. Department of Oncology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea

    Sun Young Kim

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  1. Eun Sun Lee
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  2. Min Ju Kim
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Correspondence to Min Ju Kim.

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Guarantor

The scientific guarantor of this publication is Dr. Min Ju Kim

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

This study has received funding by a grant from the National Cancer Centre of Korea (NCC-1710880)

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Lee, E.S., Kim, M.J., Park, S.C. et al. Magnetic Resonance Imaging-Detected Extramural Venous Invasion in Rectal Cancer before and after Preoperative Chemoradiotherapy: Diagnostic Performance and Prognostic Significance. Eur Radiol 28, 496–505 (2018). https://doi.org/10.1007/s00330-017-4978-6

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  • DOI: https://doi.org/10.1007/s00330-017-4978-6

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