Detection of distant metastases in rectal cancer: contrast-enhanced CT vs whole body MRI

Abstract

To evaluate the diagnostic performance of whole-body MRI (WB-MRI) including contrast-enhanced T1-weighted imaging (T1WI) and WB-DWI in rectal cancer initial staging. This retrospective study was approved by the IRB and the requirement of informed consent was waived. From September 2013 to Feb 2015, patients who underwent rectal MRI including WB-MRI, as well as chest and abdominopelvic CT for initial staging, were included. WB-MRI consisted of contrast-enhanced T1-weighted imaging and DWI covering neck to the pelvis. Three radiologists reviewed WB-MRI and CECT independently for the M-classification. The diagnostic performance of CECT and WB-MRI was compared using a reference standard incorporating histology, FDG-PET results, and clinical follow-up. A total of 139 patients (male:female = 89:50, mean age 63.2 ± 12.4years) were included and metastasis was observed in 15.2% (21/139). WB-MRI showed significantly higher specificity (96.7% [114/118] vs. 85.6% [101/118], p = 0.001) and positive predictive value (PPV) (80% [16/20] vs. 48.5% [16/33], p < 0.001) than CECT. However, there were no significant differences in sensitivity (76.2% [16/21] for both, p > 0.99) and negative predictive value (95.3% [101/106] at CECT vs. 95.8% [114/119] at WB-MRI, p = 0.77) between CECT and WB-MRI. WB-MRI showed higher specificity and PPV than CECT in newly diagnosed rectal cancer. Adding WB-MRI to standard rectal MRI is a feasible option for initial staging workup of rectal cancer. • WB-MRI showed a higher specificity and PPV than those of CECT for identifying metastasis at initial staging workup of rectal cancer. • WB-MRI and CECT did not show a significant difference in sensitivity and NPV for the M-classification. • WB-MRI can be used as an alternative to CECT for the initial M-classification modality in newly diagnosed rectal cancer.