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Adverse Features on Rectal MRI Identify a High-risk Group that May Benefit from More Intensive Preoperative Staging and Treatment

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Magnetic resonance imaging (MRI) is highly accurate in local staging of rectal cancer. It can identify features known to be associated with increased risk of metastatic disease. We evaluated the incidence of synchronous metastatic disease on fludeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) and contrast-enhanced multiple-row detector computed tomography (ceMDCT) in MRI-stratified high- and low-risk rectal cancers. The aim was to determine the incidence of synchronous metastatic disease according to MRI risk features.

Methods

A total of 236 patients with rectal cancer were recruited to a study evaluating FDG-PET/CT. All patients underwent MRI staging and were stratified into high and low risk (high risk: extramural venous invasion, extramural spread of >5 mm or T4, involved circumferential resection margin or intersphincteric plane involved for low rectal tumors). Confirmed metastases were those identified on FDG-PET/CT and ceMDCT.

Results

Imaging data were available for 230 (97.5%) of 236 patients. Incidence of confirmed distant metastases was significantly greater in the MRI high-risk group, with 28 (20.7%) of 135 (95% confidence interval [CI] 14.8–28.3), versus the low-risk group, with 4 (4.2%) of 95 (95% CI 1.7–10.3) (odds ratio 6.0, 95% CI 2.0–17.6, P < 0.001).

Conclusions

Adverse features found on rectal MRI identify patients at increased risk of synchronous metastatic disease. This group may benefit from additional preoperative investigation for synchronous metastases such as FDG-PET/CT or liver MRI and from alternative neoadjuvant chemotherapy regimens including induction chemotherapy.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Croydon University Hospital, Croyden, UK

    Chris J. Hunter MBChB, MRCS & Muti Abulafi MS, FRCS

  2. Faculty of Medicine, Laval University, Quebec City, QC, Canada

    Aurelie Garant

  3. Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada

    Té Vuong MD, FRCPC

  4. Department of Medical Imaging, Montreal General Hospital, Montreal, QC, Canada

    Giovanni Artho MD & Robert Lisbona MD, FRCPC

  5. Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK

    Paris Tekkis BMedSci, BMBS, MD, FRCS

  6. Department of Diagnostic Imaging, The Royal Marsden Hospital, London, UK

    Gina Brown MBBS, MRCP, FRCR, MD

Authors
  1. Chris J. Hunter MBChB, MRCS
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  2. Aurelie Garant
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  3. Té Vuong MD, FRCPC
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  4. Giovanni Artho MD
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  5. Robert Lisbona MD, FRCPC
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  6. Paris Tekkis BMedSci, BMBS, MD, FRCS
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  7. Muti Abulafi MS, FRCS
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  8. Gina Brown MBBS, MRCP, FRCR, MD
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Corresponding author

Correspondence to Gina Brown MBBS, MRCP, FRCR, MD.

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Hunter, C.J., Garant, A., Vuong, T. et al. Adverse Features on Rectal MRI Identify a High-risk Group that May Benefit from More Intensive Preoperative Staging and Treatment. Ann Surg Oncol 19, 1199–1205 (2012). https://doi.org/10.1245/s10434-011-2036-1

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  • DOI: https://doi.org/10.1245/s10434-011-2036-1

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