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MRI in rectal cancer patients on ‘watch and wait’: patterns of response and their evolution

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Abstract

Purpose

Evaluate MR patterns of response and their evolution in rectal cancer patients on watch and wait (WW).

Methods

We retrospectively reviewed 337 MRIs of 60 patients (median follow-up: 12 months; range: 6–49 months). Baseline MRIs (available in 34/60 patients) were evaluated for tumor morphology, location, thickness, circumferential involvement, nodal status and EMVI. First post-treatment MRIs (in all patients) were additionally evaluated for pattern of response on T2 and DWI. Change in post-treatment scar thickness and scar depth angle between the first and second post-treatment scans was also evaluated. Evolution of the response pattern/recurrence were evaluated till the last available scan.

Results

On the baseline scans, 20/34 (59%) patients had polypoidal tumor with 12/20 having ≤ 25% circumferential wall involvement. We saw five patterns of response-normalized rectal wall (2/60–3%), minimal fibrosis (23/60–38%), full thickness fibrosis (16/60–27%), irregular fibrosis (11/60–18%) and split scar (6/60–10%), with 2/60 (3%) showing possible residual disease. On the first post-treatment scans, 12/60 (20%) had restricted diffusion, with 3/12 having persistent restriction till last follow-up. Post-treatment fibrosis/split scar remained stable in 44/60 (73%) cases and improved further in the rest. 9/60 (15%) patients developed regrowth/recurrence. Patients with recurrence had < 10 mm scar thickness and < 21° change in scar angle between the first and second post-treatment MRIs.

Conclusion

Most patients on WW protocol developed minimal or full thickness fibrosis, majority of which remained stable on follow-up.

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Abbreviations

WW:

Watch and wait

NACRT:

Neoadjuvant chemoradiotherapy

DRE:

Digital rectal examination

MRI:

Magnetic resonance imaging

DWI:

Diffusion-weighted imaging

IRB:

Institutional Review Board

PACS:

Picture Archiving and Communication System

DICOM:

Digital Imaging and Communications in Medicine

EMR:

Electronic medical records

S.CEA:

Serum carcino-embryonic antigen

FOV:

Field of view

ADC:

Apparent diffusion coefficient

GI:

Gastrointestinal

EMVI:

Extramural venous invasion

CECT:

Contrast-enhanced CT

CR:

Complete response

PPV:

Positive predictive value

pCR:

Pathologic complete response

DFI:

Disease-free interval

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Authors and Affiliations

  1. Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India

    Aashna Karbhari, Akshay D Baheti, Suman K Ankathi, Purvi D Haria, Amit Choudhari, Aparna Katdare, Amrita Guha & Suyash Kulkarni

  2. Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India

    Avnish Saklani & Mufaddal Kazi

  3. Department of Radiation Oncology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India

    Reena Engineer

  4. Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India

    Vikas Ostwal

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  1. Aashna Karbhari
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  2. Akshay D Baheti
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Correspondence to Akshay D Baheti.

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Karbhari, A., Baheti, A.D., Ankathi, S.K. et al. MRI in rectal cancer patients on ‘watch and wait’: patterns of response and their evolution. Abdom Radiol 48, 3287–3296 (2023). https://doi.org/10.1007/s00261-023-04003-y

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