Association between high-resolution MRI-detected extramural vascular invasion and tumour microcirculation estimated by dynamic contrast-enhanced MRI in rectal cancer: preliminary results

Yan Chen,Yiyan Liu,Baolan Lu,Xinyue Yang,Xiaojuan Xiao,Ziqiang Wen,Shenping Yu

doi:10.1186/s12885-019-5732-z

Abstract

BackgroundTo determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) status is associated with quantitative perfusion parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) in rectal cancer.MethodsSeventy-two patients with rectal adenocarcinoma who underwent curative surgery alone within 2 weeks following rectal MRI were enrolled in this retrospective study. mrEMVI status was determined based on high-resolution MRI. The quantitative perfusion parameters (Ktrans, kep and ve) derived from DCE-MRI were calculated from all sections containing tumours. DCE-MRI parameters and clinicopathological variables in patients with different mrEMVI statuses were compared.ResultsFor patients who were mrEMVI positive, the tumours demonstrated significantly lower kep values (P = 0.012) and higher ve values (P = 0.021) than tumours of patients who were mrEMVI negative, while the Ktrans value displayed no significant difference (P = 0.390). The patients who were mrEMVI positive had larger tumour size, higher pathological tumour stage and increased regional nodal metastases compared to those who were mrEMVI negative (2.9 cm vs. 3.5 cm, P = 0.011; 63.8% vs. 92.0%, P = 0.010; 36.2% vs. 76.0%, P = 0.001; respectively).ConclusionsThis study demonstrated for the first time that tumour microcirculation is altered in mrEMVI-positive patients with rectal adenocarcinoma, as evidenced by significantly lower kep and higher ve values. In addition, these patients were more likely to have a larger tumour size, a higher pathological tumour stage and regional nodal metastases than mrEMVI-negative patients.

Highlights

To determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion status is associated with quantitative perfusion parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) in rectal cancer
Higher pathological tumour stage (T3–4) was significantly more frequent in the MRI-detected EMVI (mrEMVI)-positive group (63.8% vs. 92.0%, P = 0.010). mrEMVI-positive status was associated with increased regional nodal metastases when compared with mrEMVI-negative status (36.2% vs. 76.0%, P = 0.001)
There was no significant difference in tumour location, differentiation or synchronous distant metastasis between different mrEMVI statuses (P = 0.355, 0.234 and 0.426, respectively)

Summary

Introduction

To determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) status is associated with quantitative perfusion parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) in rectal cancer. Extramural vascular invasion (EMVI), defined histologically as the presence of tumour cells within blood vessels outside the muscularis propria of the rectal wall, is associated with a higher risk of local and distant recurrence. Chen et al BMC Cancer (2019) 19:498 in-plane resolution of 0.5–0.8 mm, is the primary imaging modality for preoperative local staging of rectal cancer [6]. This method has shown accuracy in identifying EMVI, especially in vessels greater than 3 mm in diameter [3, 7, 8]. The three principle parameters are the volume transfer constant between blood plasma and extravascular extracellular space (EES) (Ktrans, min− 1), the rate constant between EES and blood plasma (kep, min− 1) and the volume of EES per unit volume of tissue (ve, 0 < ve < 1) [15]

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