Abstract
e14095 Background: We previously reported accuracy of high-resolution (HR) magnetic resonance imaging (MRI) in preoperative staging of rectal cancer (Ann Surg Oncol 2009). Especially, accurate nodal staging is essential for deciding treatment. The aim of this study was to evaluate whether an addition of diffusion-weighted (DW) MRI improve an accuracy of preoperative nodal staging for rectal cancer. Methods: Between April and December 2007, 40 patients with primary rectal cancer were examined with HRMRI and DWMRI using a 1.5-T or 3-T scanner and underwent radical surgery. Lymph node metastasis was assessed prospectively and classified according to the TNM system by pathologists blind to clinical information. A clinical fellow with 1-year experience of diagnostic radiology retrospectively reviewed HRMRI images and measured the short-axis diameters of the pelvic lymph nodes, and then HRMRI plus DWMRI images were evaluated. Patient-by-patient, receiver operating characteristic curve analyses were performed. Results: Of 18 patients with lymph node metastases, 17 had mesorectal and 5 had lateral pelvic node involvement (3, right; 2, left). Area under the receiver operating characteristic curves (AUCs) of HRMRI for mesorectal, right lateral pelvic, and left lateral pelvic nodes were 0.54 (95% confidence interval, 0.34–0.74), 0.49 (0.19–0.79), and 0.53 (0.19–0.88), respectively. AUCs of HRMRI plus DWMRI for mesorectal, right lateral pelvic, and left lateral pelvic nodes were 0.62 (0.44–0.81), 0.89 (0.76–1.0), and 0.96 (0.90–1.0), respectively. Conclusions: This study suggested that an addition of DWMRI to conventional HRMRI improved diagnositic accuracy of staging for both mesorectal and lateral pelvic lymph node metastases from rectal cancer. No significant financial relationships to disclose.
Published Version
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