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Improving staging of rectal cancer in the pelvis: the role of PET/MRI

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The role of positron emission tomography/magnetic resonance (PET/MR) in evaluating the local extent of rectal cancer remains uncertain. This study aimed to investigate the possible role of PET/MR versus magnetic resonance (MR) in clinically staging rectal cancer.

Methods

This retrospective two-center cohort study of 62 patients with untreated rectal cancer investigated the possible role of baseline staging PET/MR versus stand-alone MR in determination of clinical stage. Two readers reviewed T and N stage, mesorectal fascia involvement, tumor length, distance from the anal verge, sphincter involvement, and extramural vascular invasion (EMVI). Sigmoidoscopy, digital rectal examination, and follow-up imaging, along with surgery when available, served as the reference standard.

Results

PET/MR outperformed MR in evaluating tumor size (42.5 ± 21.03 mm per the reference standard, 54 ± 20.45 mm by stand-alone MR, and 44 ± 20 mm by PET/MR, P = 0.004), and in identifying N status (correct by MR in 36/62 patients [58%] and by PET/MR in 49/62 cases [79%]; P = 0.02) and external sphincter infiltration (correct by MR in 6/10 and by PET/MR in 9/10; P = 0.003). No statistically significant differences were observed in relation to any other features.

Conclusion

PET/MR provides a more precise assessment of the local extent of rectal cancers in evaluating cancer length, N status, and external sphincter involvement. PET/MR offers the opportunity to improve clinical decision-making, especially when evaluating low rectal tumors with possible external sphincter involvement.

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Data availability

The anonymized deidentified datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CT:

Computed tomography

EMVI:

Extramural vascular invasion

FDG:

2-Deoxy-2-[18F]fluoroglucose

MR:

Magnetic resonance

N:

Lymph node

PET/CT:

Positron emission tomography/computed tomography

PET/MR:

Positron emission tomography/magnetic resonance

T:

tumor

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Funding

This study received no specific funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA

    Onofrio A. Catalano, Susanna I. Lee, Felipe S. Furtado, Robin Striar, Umar Mahmood & Bruce Rosen

  2. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Onofrio A. Catalano, Felipe S. Furtado, Robin Striar, Umar Mahmood & Bruce Rosen

  3. Department of Radiology, University of Naples “Parthenope”, Naples, Italy

    Onofrio A. Catalano & Andrea Soricelli

  4. SDN IRCCS, Naples, Italy

    Chiara Parente, Andrea Soricelli & Marco Salvatore

  5. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Christy Cauley, Hiroko Kunitake, Liliana Bordeianou, David Berger & Rocco Ricciardi

  6. University of Naples Suor Orsola Benincasa, Napoli, NA, Italy

    Marco Salvatore

  7. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany

    Yan Li & Lale Umutlu

  8. Hospital Universitario Madrid Sanchinarro, Madrid, Spain

    Lina Garcia Cañamaque

  9. Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel

    David Groshar

  10. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    David Groshar

  11. Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Lawrence S. Blaszkowsky, David P. Ryan & Jeffrey W. Clark

  12. Vernon Cancer Center, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA, 02462, USA

    Lawrence S. Blaszkowsky

  13. Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Jeffrey W. Clark

  14. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Jennifer Wo & Theodore S. Hong

Authors
  1. Onofrio A. Catalano
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  2. Susanna I. Lee
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  8. Marco Salvatore
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  9. Yan Li
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  14. Lawrence S. Blaszkowsky
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  15. David P. Ryan
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  16. Jeffrey W. Clark
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  18. Theodore S. Hong
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  19. Hiroko Kunitake
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  20. Liliana Bordeianou
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  21. David Berger
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  22. Rocco Ricciardi
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  23. Bruce Rosen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis, and first draft were performed primarily by Onofrio Antonio Catalano. All authors commented on previous versions of the manuscript, as well as read and approved the final manuscript.

Corresponding author

Correspondence to Onofrio A. Catalano.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was reviewed by the Institutional Review Board and carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate/consent for publication

Informed consent was waived due to the retrospective nature of the study.

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Not applicable.

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Summary statement

PET/MR is a promising modality in staging rectal cancer in the pelvis, especially in assessing cancer length, lymphadenopathy and external sphincter involvement.

Key results

PET/MR enabled more accurate evaluation of tumor size, N status, and external sphincter infiltration.

Although PET/MR ensured a better assessment of the T stage than MR, the differences were not statistically significant.

This article is part of the Topical Collection on Oncology - Digestive tract

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Catalano, O.A., Lee, S.I., Parente, C. et al. Improving staging of rectal cancer in the pelvis: the role of PET/MRI. Eur J Nucl Med Mol Imaging 48, 1235–1245 (2021). https://doi.org/10.1007/s00259-020-05036-x

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  • DOI: https://doi.org/10.1007/s00259-020-05036-x

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