Abstract
ObjectiveTo investigate the accuracy of preoperative computed tomography (CT), magnetic resonance (MR) imaging and diffusion-weighted imaging with background body signal suppression (DWIBS) in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures.Methods and MaterialsFifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS) were compared with the final histological findings.ResultsThe accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01) but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05). The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria.ConclusionMRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.
Highlights
Rectal cancer is a common disease and a major cause of mortality in Western countries [1,2,3], in recent years, the prevalence of rectal cancer in China is rapidly increasing, largely due to changes in lifestyle [4]
Prediction of nodal staging in patients with primary rectal carcinoma is important for prognosis, and preoperative assessment of lymph node involvement has important value in developing the therapeutic schedule and a new auxiliary treatment [5,6,7,8]
The present study first demonstrates the comparison of preoperative prediction of nodal involvement in patients with primary rectal carcinoma through three imaging modalities including computed tomography (CT), magnetic resonance (MR) imaging, and diffusion-weighted imaging with background body signal suppression (DWIBS)
Summary
Rectal cancer is a common disease and a major cause of mortality in Western countries [1,2,3], in recent years, the prevalence of rectal cancer in China is rapidly increasing, largely due to changes in lifestyle [4]. Prediction of nodal staging in patients with primary rectal carcinoma is important for prognosis, and preoperative assessment of lymph node involvement has important value in developing the therapeutic schedule and a new auxiliary treatment [5,6,7,8]. Multi-detector-row CT (MDCT) can provide high-quality thin section CT volume images and high resolution reconstructed images in a short examination time in the routine clinical applications [9,10]. CT image can provide comprehensive information on spatial relationships among tumors, lymph nodes, and vicinity structures of the rectum. Enhanced CT [8] is currently widely used for the detection metastasis of the peritoneal and pelvic cavity, especially in patients with rich intraperitoneal fat tissue, but enhanced CT is not very efficient in discriminating enlarged lymph node from blood vessels
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