Accuracy of MRI for predicting anterior peritoneal reflection involvement in locally advanced rectal cancer: a comparison with operative findings
Purpose To assess the diagnostic accuracy of preoperative rectal MRI for anterior peritoneal reflection (APR) involvement in rectal cancer through comparison with the surgeon’s operative findings. Methods This retrospective study was approved by the institutional review board; informed consent was w...
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| Veröffentlicht in: | Abdominal imaging 2022-02, Vol.47 (2), p.508-516 |
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| creator | Sim, Ki Choon Park, Beom Jin Kim, Min Ju Sung, Deuk Jae Han, Na Yeon Han, Yeo Eun Kwak, Jung-Myun An, Hyonggin |
| description | Purpose
To assess the diagnostic accuracy of preoperative rectal MRI for anterior peritoneal reflection (APR) involvement in rectal cancer through comparison with the surgeon’s operative findings.
Methods
This retrospective study was approved by the institutional review board; informed consent was waived. We enrolled 55 consecutive patients with suspected locally advanced mid-to-upper rectal cancer. All patients underwent rectal MRI using a 3T system. APR involvement in rectal cancer was assessed radiologically using a 5-point scale by two independent board-certified abdominal radiologists. The surgeon’s evaluation during surgery was regarded as the gold standard for APR involvement. The accuracy of rectal MRI in predicting APR involvement was obtained.
Results
Rectal MRI showed good APR identification (rater 1, 92.7%; rater 2, 94.7%). On preoperative rectal MRI, rater 1 diagnosed 19 (34.5%) patients as having APR involvement and rater 2 diagnosed 28 (50.9%) as having APR involvement. There was moderate agreement (
κ
= 0.602,
p
|
| doi_str_mv | 10.1007/s00261-021-03356-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2604467433</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2624605190</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-a8c792924d5cf8d59b0608bc7fa07fcc47907d58203721c66a274b766fbcfc973</originalsourceid><addsrcrecordid>eNp9kc9qFTEUxgdRbKl9ARcScONm9EySSWbcleKfQqVQKrgLmTNJTckk1yRz5T6Gb2yut1Zw0UU4Sc7v-07I1zQvO3jbAch3GYCKrgVaF2O9aMWT5pgyIVqAfnj6sOffjprTnO8AoBN919H-eXPE-MDpKIfj5tcZ4po07ki05Mv1BbExkU0ys8Piwi3RoZjk9ne1lBiM9iQZ601tx0Bc2Ea_NYsJpe6Jj6i93xE9b3VAM1cUS1Xg_pTeE00wLhudXK7an658J7H66uK2hlgX5joxv2ieWe2zOb2vJ83Xjx9uzj-3l1efLs7PLltksi-tHlCOdKR87tEOcz9OIGCYUFoN0iJyOYKc-4ECk7RDITSVfJJC2AktjpKdNG8OvpsUf6wmF7W4jMZ7HUxcs6ICOBeSM1bR1_-hd3FNob6uUpQL6LsRKkUPFKaYc_0ktUlu0WmnOlD7zNQhM1UzU38yU6KKXt1br9Ni5gfJ34QqwA5Arq1wa9K_2Y_Y_gZnNKOl</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2624605190</pqid></control><display><type>article</type><title>Accuracy of MRI for predicting anterior peritoneal reflection involvement in locally advanced rectal cancer: a comparison with operative findings</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Sim, Ki Choon ; Park, Beom Jin ; Kim, Min Ju ; Sung, Deuk Jae ; Han, Na Yeon ; Han, Yeo Eun ; Kwak, Jung-Myun ; An, Hyonggin</creator><creatorcontrib>Sim, Ki Choon ; Park, Beom Jin ; Kim, Min Ju ; Sung, Deuk Jae ; Han, Na Yeon ; Han, Yeo Eun ; Kwak, Jung-Myun ; An, Hyonggin</creatorcontrib><description>Purpose
To assess the diagnostic accuracy of preoperative rectal MRI for anterior peritoneal reflection (APR) involvement in rectal cancer through comparison with the surgeon’s operative findings.
Methods
This retrospective study was approved by the institutional review board; informed consent was waived. We enrolled 55 consecutive patients with suspected locally advanced mid-to-upper rectal cancer. All patients underwent rectal MRI using a 3T system. APR involvement in rectal cancer was assessed radiologically using a 5-point scale by two independent board-certified abdominal radiologists. The surgeon’s evaluation during surgery was regarded as the gold standard for APR involvement. The accuracy of rectal MRI in predicting APR involvement was obtained.
Results
Rectal MRI showed good APR identification (rater 1, 92.7%; rater 2, 94.7%). On preoperative rectal MRI, rater 1 diagnosed 19 (34.5%) patients as having APR involvement and rater 2 diagnosed 28 (50.9%) as having APR involvement. There was moderate agreement (
κ
= 0.602,
p
< 0.001) between the two raters with regard to the evaluation of APR involvement. During surgery, the surgeon confirmed APR involvement in 13 (23.6%) patients. The sensitivity, specificity, PPV, and NPV of preoperative MRI for APR involvement were 69.2%, 76.2%, 47.4%, and 88.9%, respectively. The diagnostic accuracy of MRI for predicting APR involvement was 74.6%.
Conclusion
Preoperative rectal MRI provides accurate anatomical information regarding APR involvement with high conspicuity. However, MRI has relatively low sensitivity (< 70%) and a low PPV (< 50%) with regard to the assessment of APR involvement in rectal tumors.
Graphical Abstract
Both rater 1 and rater 2 evaluated these images as positive involvement of APR. The patient underwent laparoscopic low anterior resection after preoperative evaluation. However, during surgery, the surgeon evaluated APR involvement as negative, and the final pathologic staging was confirmed as T3.</description><identifier>ISSN: 2366-004X</identifier><identifier>EISSN: 2366-0058</identifier><identifier>DOI: 10.1007/s00261-021-03356-6</identifier><identifier>PMID: 34842978</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Accuracy ; Cancer ; Colorectal cancer ; Conspicuity ; Diagnostic systems ; Evaluation ; Gastroenterology ; Hepatology ; Hollow Organ GI ; Humans ; Imaging ; Informed consent ; Laparoscopy ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Medicine ; Medicine & Public Health ; Neoplasm Staging ; Patients ; Peritoneum ; Preoperative Care ; Radiology ; Rectal Neoplasms - diagnostic imaging ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Rectum ; Retrospective Studies ; Sensitivity and Specificity ; Surgeons ; Surgery ; Tumors</subject><ispartof>Abdominal imaging, 2022-02, Vol.47 (2), p.508-516</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-a8c792924d5cf8d59b0608bc7fa07fcc47907d58203721c66a274b766fbcfc973</citedby><cites>FETCH-LOGICAL-c375t-a8c792924d5cf8d59b0608bc7fa07fcc47907d58203721c66a274b766fbcfc973</cites><orcidid>0000-0002-7289-3683</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00261-021-03356-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00261-021-03356-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34842978$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sim, Ki Choon</creatorcontrib><creatorcontrib>Park, Beom Jin</creatorcontrib><creatorcontrib>Kim, Min Ju</creatorcontrib><creatorcontrib>Sung, Deuk Jae</creatorcontrib><creatorcontrib>Han, Na Yeon</creatorcontrib><creatorcontrib>Han, Yeo Eun</creatorcontrib><creatorcontrib>Kwak, Jung-Myun</creatorcontrib><creatorcontrib>An, Hyonggin</creatorcontrib><title>Accuracy of MRI for predicting anterior peritoneal reflection involvement in locally advanced rectal cancer: a comparison with operative findings</title><title>Abdominal imaging</title><addtitle>Abdom Radiol</addtitle><addtitle>Abdom Radiol (NY)</addtitle><description>Purpose
To assess the diagnostic accuracy of preoperative rectal MRI for anterior peritoneal reflection (APR) involvement in rectal cancer through comparison with the surgeon’s operative findings.
Methods
This retrospective study was approved by the institutional review board; informed consent was waived. We enrolled 55 consecutive patients with suspected locally advanced mid-to-upper rectal cancer. All patients underwent rectal MRI using a 3T system. APR involvement in rectal cancer was assessed radiologically using a 5-point scale by two independent board-certified abdominal radiologists. The surgeon’s evaluation during surgery was regarded as the gold standard for APR involvement. The accuracy of rectal MRI in predicting APR involvement was obtained.
Results
Rectal MRI showed good APR identification (rater 1, 92.7%; rater 2, 94.7%). On preoperative rectal MRI, rater 1 diagnosed 19 (34.5%) patients as having APR involvement and rater 2 diagnosed 28 (50.9%) as having APR involvement. There was moderate agreement (
κ
= 0.602,
p
< 0.001) between the two raters with regard to the evaluation of APR involvement. During surgery, the surgeon confirmed APR involvement in 13 (23.6%) patients. The sensitivity, specificity, PPV, and NPV of preoperative MRI for APR involvement were 69.2%, 76.2%, 47.4%, and 88.9%, respectively. The diagnostic accuracy of MRI for predicting APR involvement was 74.6%.
Conclusion
Preoperative rectal MRI provides accurate anatomical information regarding APR involvement with high conspicuity. However, MRI has relatively low sensitivity (< 70%) and a low PPV (< 50%) with regard to the assessment of APR involvement in rectal tumors.
Graphical Abstract
Both rater 1 and rater 2 evaluated these images as positive involvement of APR. The patient underwent laparoscopic low anterior resection after preoperative evaluation. However, during surgery, the surgeon evaluated APR involvement as negative, and the final pathologic staging was confirmed as T3.</description><subject>Accuracy</subject><subject>Cancer</subject><subject>Colorectal cancer</subject><subject>Conspicuity</subject><subject>Diagnostic systems</subject><subject>Evaluation</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Hollow Organ GI</subject><subject>Humans</subject><subject>Imaging</subject><subject>Informed consent</subject><subject>Laparoscopy</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasm Staging</subject><subject>Patients</subject><subject>Peritoneum</subject><subject>Preoperative Care</subject><subject>Radiology</subject><subject>Rectal Neoplasms - diagnostic imaging</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Rectum</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tumors</subject><issn>2366-004X</issn><issn>2366-0058</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc9qFTEUxgdRbKl9ARcScONm9EySSWbcleKfQqVQKrgLmTNJTckk1yRz5T6Gb2yut1Zw0UU4Sc7v-07I1zQvO3jbAch3GYCKrgVaF2O9aMWT5pgyIVqAfnj6sOffjprTnO8AoBN919H-eXPE-MDpKIfj5tcZ4po07ki05Mv1BbExkU0ys8Piwi3RoZjk9ne1lBiM9iQZ601tx0Bc2Ea_NYsJpe6Jj6i93xE9b3VAM1cUS1Xg_pTeE00wLhudXK7an658J7H66uK2hlgX5joxv2ieWe2zOb2vJ83Xjx9uzj-3l1efLs7PLltksi-tHlCOdKR87tEOcz9OIGCYUFoN0iJyOYKc-4ECk7RDITSVfJJC2AktjpKdNG8OvpsUf6wmF7W4jMZ7HUxcs6ICOBeSM1bR1_-hd3FNob6uUpQL6LsRKkUPFKaYc_0ktUlu0WmnOlD7zNQhM1UzU38yU6KKXt1br9Ni5gfJ34QqwA5Arq1wa9K_2Y_Y_gZnNKOl</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Sim, Ki Choon</creator><creator>Park, Beom Jin</creator><creator>Kim, Min Ju</creator><creator>Sung, Deuk Jae</creator><creator>Han, Na Yeon</creator><creator>Han, Yeo Eun</creator><creator>Kwak, Jung-Myun</creator><creator>An, Hyonggin</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>JQ2</scope><scope>K7-</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7289-3683</orcidid></search><sort><creationdate>20220201</creationdate><title>Accuracy of MRI for predicting anterior peritoneal reflection involvement in locally advanced rectal cancer: a comparison with operative findings</title><author>Sim, Ki Choon ; Park, Beom Jin ; Kim, Min Ju ; Sung, Deuk Jae ; Han, Na Yeon ; Han, Yeo Eun ; Kwak, Jung-Myun ; An, Hyonggin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-a8c792924d5cf8d59b0608bc7fa07fcc47907d58203721c66a274b766fbcfc973</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Accuracy</topic><topic>Cancer</topic><topic>Colorectal cancer</topic><topic>Conspicuity</topic><topic>Diagnostic systems</topic><topic>Evaluation</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Hollow Organ GI</topic><topic>Humans</topic><topic>Imaging</topic><topic>Informed consent</topic><topic>Laparoscopy</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasm Staging</topic><topic>Patients</topic><topic>Peritoneum</topic><topic>Preoperative Care</topic><topic>Radiology</topic><topic>Rectal Neoplasms - diagnostic imaging</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectum</topic><topic>Retrospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sim, Ki Choon</creatorcontrib><creatorcontrib>Park, Beom Jin</creatorcontrib><creatorcontrib>Kim, Min Ju</creatorcontrib><creatorcontrib>Sung, Deuk Jae</creatorcontrib><creatorcontrib>Han, Na Yeon</creatorcontrib><creatorcontrib>Han, Yeo Eun</creatorcontrib><creatorcontrib>Kwak, Jung-Myun</creatorcontrib><creatorcontrib>An, Hyonggin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Computer Science Collection</collection><collection>Computer Science Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Abdominal imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sim, Ki Choon</au><au>Park, Beom Jin</au><au>Kim, Min Ju</au><au>Sung, Deuk Jae</au><au>Han, Na Yeon</au><au>Han, Yeo Eun</au><au>Kwak, Jung-Myun</au><au>An, Hyonggin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accuracy of MRI for predicting anterior peritoneal reflection involvement in locally advanced rectal cancer: a comparison with operative findings</atitle><jtitle>Abdominal imaging</jtitle><stitle>Abdom Radiol</stitle><addtitle>Abdom Radiol (NY)</addtitle><date>2022-02-01</date><risdate>2022</risdate><volume>47</volume><issue>2</issue><spage>508</spage><epage>516</epage><pages>508-516</pages><issn>2366-004X</issn><eissn>2366-0058</eissn><abstract>Purpose
To assess the diagnostic accuracy of preoperative rectal MRI for anterior peritoneal reflection (APR) involvement in rectal cancer through comparison with the surgeon’s operative findings.
Methods
This retrospective study was approved by the institutional review board; informed consent was waived. We enrolled 55 consecutive patients with suspected locally advanced mid-to-upper rectal cancer. All patients underwent rectal MRI using a 3T system. APR involvement in rectal cancer was assessed radiologically using a 5-point scale by two independent board-certified abdominal radiologists. The surgeon’s evaluation during surgery was regarded as the gold standard for APR involvement. The accuracy of rectal MRI in predicting APR involvement was obtained.
Results
Rectal MRI showed good APR identification (rater 1, 92.7%; rater 2, 94.7%). On preoperative rectal MRI, rater 1 diagnosed 19 (34.5%) patients as having APR involvement and rater 2 diagnosed 28 (50.9%) as having APR involvement. There was moderate agreement (
κ
= 0.602,
p
< 0.001) between the two raters with regard to the evaluation of APR involvement. During surgery, the surgeon confirmed APR involvement in 13 (23.6%) patients. The sensitivity, specificity, PPV, and NPV of preoperative MRI for APR involvement were 69.2%, 76.2%, 47.4%, and 88.9%, respectively. The diagnostic accuracy of MRI for predicting APR involvement was 74.6%.
Conclusion
Preoperative rectal MRI provides accurate anatomical information regarding APR involvement with high conspicuity. However, MRI has relatively low sensitivity (< 70%) and a low PPV (< 50%) with regard to the assessment of APR involvement in rectal tumors.
Graphical Abstract
Both rater 1 and rater 2 evaluated these images as positive involvement of APR. The patient underwent laparoscopic low anterior resection after preoperative evaluation. However, during surgery, the surgeon evaluated APR involvement as negative, and the final pathologic staging was confirmed as T3.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>34842978</pmid><doi>10.1007/s00261-021-03356-6</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7289-3683</orcidid></addata></record> |
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| ispartof | Abdominal imaging, 2022-02, Vol.47 (2), p.508-516 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Accuracy Cancer Colorectal cancer Conspicuity Diagnostic systems Evaluation Gastroenterology Hepatology Hollow Organ GI Humans Imaging Informed consent Laparoscopy Magnetic resonance imaging Magnetic Resonance Imaging - methods Medicine Medicine & Public Health Neoplasm Staging Patients Peritoneum Preoperative Care Radiology Rectal Neoplasms - diagnostic imaging Rectal Neoplasms - pathology Rectal Neoplasms - surgery Rectum Retrospective Studies Sensitivity and Specificity Surgeons Surgery Tumors |
| title | Accuracy of MRI for predicting anterior peritoneal reflection involvement in locally advanced rectal cancer: a comparison with operative findings |
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