Magnetic Resonance Imaging In Preoperative Staging Research Articles

Enhancing Precision in Rectal Cancer Care: Unravelling the Correlation Between MRI Locoregional Staging and Prognostic Factors, With Post-resection Pathology.

Introduction Magnetic resonance imaging (MRI) serves as a pivotal tool in the preoperative assessment of rectal cancer. This study aims to evaluate the accuracy of preoperative MRI pelvis in rectal cancer for locoregional staging, circumferential margin (CRM+), and vascular invasion (V1) with postoperative histopathological findings. Methods All patients who underwent preoperative staging MRI pelvis scanning for histology-proven primary rectal adenocarcinoma between January 2020 and July 2022 were included in this study. Preoperative MRI assessment data, including tumor (T), nodal (N) staging, and other prognostic factors, including circumferential margin and vascular invasion, were compared with histopathological reports. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were calculated. Agreement between MRI and pathology reports was evaluated using the weighted kappa statistic. Results The study included 143 patients. The accuracy of MRI is at its peak for T0 and T4 tumors (T0-97.9%,T4-93.37). The weighted kappa statistic for T staging is 0.401, and for N staging, it is 0.286. The standard kappa statistic for extramural vascular invasion (V) and circumferential resection margin (CRM) is 0.269 and 0.225, respectively. Conclusion MRI demonstrates fair agreement with pathology regarding T and N staging and exhibits high specificity for CRM and V1.

The role of transarterial chemoembolization with drug-eluting beads “Sphere-Spectrum” in the treatment of primary and recurrent tumors of the female reproductive system complicated by bleeding

Background. Transarterial chemoembolization (TACE) with drug-eluting beads has been used in the treatment of tumors of the female reproductive system complicated by bleeding. However, questions arise: how to integrate the method into the treatment regimen and at what stage should it be applied?Aim. To evaluate the effectiveness of TACE in tumors of the female reproductive system complicated by bleeding at different stages of the disease.Materials and methods. A retrospective analysis of 80 women with primary (group 1) and 20 with recurrent tumors (group 2) of the reproductive system, who underwent 110 TACE with drug-eluting beads “Sphere-Spectrum” (100 primary, 10 repeated), is presented. Mostly used drug-eluting beads “Sphere-Spectrum”. The indication for TACE was tumor bleeding. For dynamic control, magnetic resonance imaging of the small pelvis was performed no later than 14 days before, 14–21 days and 1–3 months after TACE.Results. Hemostasis after TACE in all cases was achieved by the end of 1 day. There was no progression of the tumor process in any case. In group 1, 56 women (70 %) after TACE were operated on (stages 1B–2A), although according to preoperative magnetic resonance imaging staging, only 34 women (43 %) were subject to surgical treatment; 3 women underwent radiation therapy, 23 – chemoradiotherapy, systemic chemotherapy and immunotherapy in accordance with the stage of the disease. In group 2, 3 women were operated on after correction of their somatic condition and tumor reduction, 3 women underwent chemoradiotherapy, 14 women continued systemic chemotherapy.Conclusion. TACE has shown high efficiency as a hemostatic and antitumor therapy. It should be included in the treatment regimen for women with bleeding from tumors of the reproductive system at any stage of the disease, which allows expanding the available options for antitumor therapy for this category of patients; at the same time, the use of TACE as a monomethod requires further study.

Value of diffusion-weighted imaging in preoperative evaluation and prediction of postoperative supplementary therapy for patients with cervical cancer.

BackgroundWith the continuous progress of medical imaging technology, evaluation of cervical cancer is increasingly dependent on imaging methods. Diffusion-weighted imaging (DWI) plays an important role, and apparent diffusion coefficient (ADC) value is a unique quantitative parameter in the research of cervical cancer.MethodsIn this prospective study, a total of 273 patients diagnosed with stage IB1 to IIIC1 cervical cancer based on the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging guidelines who underwent pelvic 3.0T magnetic resonance imaging (MRI), including MRI and DWI, were enrolled, and the diagnostic value of preoperative staging of cervical cancer was compared between the MRI and DWI groups. The DWI group was used to explore the potential association of mean ADC (ADCmean) with different pathological characteristics and receiver operating characteristic (ROC) curves of ADCmean generated to predict the appropriate postoperative supplementary therapy.ResultsThe diagnostic coincidence rate of DWI was higher than that of MRI in preoperative staging of cervical cancer (χ2, P<0.05) and determined as stages IB1 + IB2 + IIA1 (90.91%), IB3 + IIA2 (93.48%), and IIIC1p (95.16%). The DWI staging results were consistent with postoperative pathological staging (Kappa value =0.865, P<0.001). We observed significant differences in ADCmean values in relation to pathological type, histological grade, depth of stromal infiltration, tumor diameter, lymphovascular invasion, and pelvic lymph node metastasis of cervical cancer (all P<0.05). The area under the ROC curve (AUC) was 0.815, with the best predictive value for postoperative supplementary therapy in cervical cancer (sensitivity 80.0%, specificity 74.0%) at ADCmean of 0.910×10−3 mm2/s.ConclusionsThe DWI is a useful tool for preoperative evaluation of cervical cancer. In local cervical lesions, ADCmean varies in relation to different clinicopathological characteristics and a reference index of <0.910×10−3 mm2/s can be effectively applied to predict the need for postoperative supplementary therapy.

Using Deep Learning with Convolutional Neural Network Approach to Identify the Invasion Depth of Endometrial Cancer in Myometrium Using MR Images: A Pilot Study.

Myometrial invasion affects the prognosis of endometrial cancer. However, discrepancies exist between pre-operative magnetic resonance imaging staging and post-operative pathological staging. This study aims to validate the accuracy of artificial intelligence (AI) for detecting the depth of myometrial invasion using a deep learning technique on magnetic resonance images. We obtained 4896 contrast-enhanced T1-weighted images (T1w) and T2-weighted images (T2w) from 72 patients who were diagnosed with surgico-pathological stage I endometrial carcinoma. We used the images from 24 patients (33.3%) to train the AI. The images from the remaining 48 patients (66.7%) were used to evaluate the accuracy of the model. The AI then interpreted each of the cases and sorted them into stage IA or IB. Compared with the accuracy rate of radiologists’ diagnoses (77.8%), the accuracy rate of AI interpretation in contrast-enhanced T1w was higher (79.2%), whereas that in T2w was lower (70.8%). The diagnostic accuracy was not significantly different between radiologists and AI for both T1w and T2w. However, AI was more likely to provide incorrect interpretations in patients with coexisting benign leiomyomas or polypoid tumors. Currently, the ability of this AI technology to make an accurate diagnosis has limitations. However, in hospitals with limited resources, AI may be able to assist in reading magnetic resonance images. We believe that AI has the potential to assist radiologists or serve as a reasonable alternative for pre-operative evaluation of the myometrial invasion depth of stage I endometrial cancers.

Magnetic resonance imaging for preoperative staging of pancreatic cancer based on the 8th edition of AJCC guidelines.

Preoperative staging of pancreatic cancer determines the choice of treatment. Magnetic resonance imaging (MRI) plays an important role in preoperative staging of pancreatic cancer. The American Joint Committee on Cancer (AJCC) TNM staging system was revised to its 8th version in 2016, there has been no report correlating the 8th edition of the AJCC TNM staging with preoperative MRI examinations and pathological findings. The purpose of our study is to determine the staging accuracy and evaluate the resectability by using MRI about pancreatic cancer compared with intraoperative or pathological findings according to the 8th edition of the AJCC TNM staging system. One hundred thirty-two patients with a pathological diagnosis of pancreatic cancer who underwent preoperative MRI were identified. The clinical data, MRI findings and pathological findings were analyzed. Preoperative MRI staging and resectability evaluation were compared with pathological findings. The accuracy of MRI for preoperative T and N staging was evaluated, and the sensitivity, specificity and accuracy of MRI in evaluating the resectability were assessed. All the staging and resectability assessments were according to the 8th edition of the AJCC TNM staging system. Analysis showed that the accuracy of MRI for evaluation of the T and N stages was 82.6% (109/132) and 74.2% (98/132), respectively. The sensitivity and specificity of MRI in assessing the resectability were 94.2% and 71.4%, respectively. Integrating the 8th edition of the AJCC TNM stage, no significant differences were identified between the preoperative MRI and pathological results for the staging of pancreatic cancer (P=0.805). MRI is highly accurate for T staging and moderately accurate for N staging. MRI provides important preoperative evaluation of the stage and resectability of pancreatic cancer based on the 8th edition of the AJCC TNM staging system.

Impact of peri-prostatic fat measurements using MRI on the prediction of prostate cancer with transrectal ultrasound-guided biopsy

ObjectivesTo estimate the impact of peri-prostatic fat (PPF) measurements using preoperative magnetic resonance imaging on the prediction of prostate cancer (PCa) with transrectal ultrasound-guided biopsy. Patients and methodsWe performed a retrospective 2-center study on 660 consecutive patients receiving transrectal ultrasound-guided biopsy-biopsy from June 2016 to October 2018. Pathologic and immunohistochemical characteristics were collected. PPF measurements including PPF area (PPFA) and PPFA to prostate area (PA) ratio (PPFA/PA) were assessed by preoperative staging magnetic resonance imaging. Clinical variables were correlated with Gleason score by using Spearman (ρ) correlation coefficients. Multivariable analysis was performed to identify independent predictors of PCa. The diagnostic performance was estimated using ROC curves. ResultsThe Gleason score was significantly correlated with age (ρ = 0.114, P = 0.035), prostate-specific antigen (PSA) (ρ = 0.482, P < 0.001), PIRADS scoring (ρ = 0.403, P < 0.001) and PPFA/PA (ρ = 0.238, P < 0.001). Multivariate analysis revealed that PPFA/PA, age, digital rectal examination, family history of PCa, PSA, and PIRADS scoring were independently predictive of PCa. The ROC AUC to detect PCa or clinically significant PCa (CS-PCa; Gleason Score 3 + 4 or greater) improved with the addition of PPFA/PA (PCa: 0.93 vs. 0.89; CS-PCa: 0.92 vs. 0.90). ConclusionPPFA/PA is an independent predictor for PCa along with age, digital rectal examination, family history of PCa, PSA, and PIRADS scoring. PPF measurements especially PPFA/PA may help detect PCa or CS-PCa, thus helping improve PCa risk stratification and screening to avoid unnecessary biopsies.

Assessment of MRI-detected lesions on screening tomosynthesis in patients with newly diagnosed breast cancer

ObjectivesThe purpose of this study is to retrospectively evaluate the presence of screening digital breast tomosynthesis (DBT) correlates for suspicious lesions detected on pre-operative staging magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer. MethodsAfter approval from the institutional review board (IRB), screening DBTs on breast cancer patients with BI-RADS 4 or 5 staging MRI exams between 8/1/17 and 8/1/18 were assessed for presence of DBT correlates for suspicious MRI findings. The pathology of the index lesion, type of additional MRI finding (mass, non-mass enhancement, or focus), correlative finding on tomosynthesis (mass, asymmetry/focal asymmetry, distortion, or calcifications), size on MRI and tomosynthesis, breast density, and pathology of the additional lesion were recorded. The chi-square test of association was used unless otherwise specified. Confidence intervals for proportions were estimated using the Wilson's score method. Results17/70 (24%) of additional lesions seen on pre-operative MRI exams in patients with newly diagnosed cancer had a mammographic correlate on corresponding screening DBT. There was no significant relationship between the presence of a mammographic correlate and the type of MRI finding (mass, NME, or focus), breast density, size of lesion, pathology of index cancer, or pathology of the additional lesion (p≥ 0.05). Conclusions76% of additional lesions seen on pre-operative staging MRI in patients with newly diagnosed breast cancer are not seen retrospectively on screening DBT. Since about 24% of MRI-detected additional lesions may have a DBT correlate, DBT exams should be reviewed in patients recalled for further workup of findings seen on pre-operative MRI since this may facilitate DBT-guided biopsy of suspicious lesions, which is preferable to MRI-guided biopsy for cost and patient comfort reasons.

The Diagnostic Value of MRI for Preoperative Staging in Patients with Endometrial Cancer: A Meta-Analysis

To assess the diagnostic accuracy of magnetic resonance imaging (MRI) for detecting myometrial invasion, cervical invasion, and lymph node metastases in endometrial cancer. A systematic literature search was performed in PubMed, Embase, Cochrane Library, Web of Science, and Clinical trials. The methodological quality of each study was assessed by using the standard Quality Assessment of Diagnostic Accuracy Studies-2. Statistical analysis included evaluating publication bias, assessing threshold effect, exploring heterogeneity, pooling data, meta-regression, forest plot, and summary receiver-operating characteristics curves construction. Fourteen studies could be analyzed. For detecting deep myometrial invasion, the pooled sensitivity and specificity were 0.79 and 0.81 respectively, and patients younger than 60 years old demonstrated higher sensitivity (0.84) and specificity (0.90). The diagnostic accuracy is highest by jointly using T2-weighted image, dynamic contrast-enhanced MRI, and diffusion weighted imaging to detect the deep myometrial invasion. There were low sensitivity and high specificity for the diagnosis of cervical invasion (0.53, 0.95), cervical stromal invasion (0.50, 0.95), pelvic or/and para-aortic lymph node metastases (0.59, 0.95), and pelvic lymph node metastases (0.65, 0.95). MRI has good diagnostic performance for assessing myometrial invasion in patients with endometrial cancer, especially in patients younger than 60 years old. Dynamic contrast-enhanced MRI and diffusion weighted imaging can help improve sensitivity and specificity for detecting myometrial invasion. MRI shows high specificity for detecting cervical invasion and lymph node metastases in endometrial cancer.

Role of MRI in staging and surgical planning and its clinicopathological correlation in patients with renal cell carcinoma.

Background and Aims:Radiological evaluation of renal cell carcinoma (RCC) is used for non-invasive staging for better surgical planning. However, the correlation of radiological staging using magnetic resonance imaging (MRI) with histopathological findings has not been done so far. The aim of this study is to assess the role of MRI in pre-operative staging of RCC in patients undergoing radical nephrectomy and nephron sparing surgery (NSS) and correlate it with histopathological findings.Settings and Design:This prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India.Methods:MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). Preoperative staging was based on 2010 TNM staging system. The preoperative parameters in MRI were tumor size, detection/breach of pseudocapsule, tumor extension into perirenal fat and detection of tumor venous thrombus. The staging on MRI was compared with surgical and pathological staging.Statistical Analysis Used:The agreement between these three staging methods was determined using the kappa statistics (0.0-0.2, poor; 0.2-0.4, fair; 0.4-0.6, moderate; 0.6-0.8, good; 0.8-1.0, excellent).Results:30 patients with suspected RCC underwent NSS (n = 10) and radical nephrectomy (n = 20). Mean tumor size was 9.66 ± 2.99 cm in the radical nephrectomy group and 4.06 ± 1.16 cm in the NSS group. There was perfect agreement between MRI, surgical and pathological staging for breach of pseudocapsule (κ =1.0, Percentage of Agreement = 100%, P < 0.05). In none of the patients, MRI missed extension beyond the Gerota's fascia or presence of venous thrombus.Conclusion:MRI staging of RCC is an accurate predictor of the surgical and pathological stage and has the potential to become a useful tool for preoperative identification of patients with RCC who can undergo NSS.

Accuracy of Magnetic Resonance Imaging in Staging Rectal Cancer with Multidisciplinary Team: A Single-Center Experience.

Purpose: To investigate the accuracy of magnetic resonance imaging (MRI) in preoperative staging diagnosis for rectal cancer with multidisciplinary team (MDT) discussion.Methods: The retrospective study included 377 patients of rectal cancer with preoperative MRI staging from February 2015 to April 2018, in which 137 patients (36 received MDT discussion) received neoadjuvant therapy, 240 did not (97 received MDT discussion) and direct surgery was given. With postoperative pathological stage as the standard, the accuracy of MRI in preoperative staging for rectal cancer with MDT discussion was compared with non-MDT.Results: For direct surgery group, 21 out 97 (21.6%) patients changed their therapy strategy due to the change of the stage assessment after MDT. The accuracy of MRI for the diagnosis of preoperative N stage with MDT was significantly higher than those without MDT (56.2% vs. 42.1%, P=0.021). And for those without lymph node metastasis, the accuracy of MRI was higher after MDT (61.2% vs. 37.8%, P=0.009). For neoadjuvant therapy group, 7 out of 36 (19.4%) patients altered their therapy after MDT because of the changed stage. MDT improved the accuracy of restaging N stage with MRI (70.0% vs. 33.3%, P=0.003). The accuracy of MRI in staging T stage seemed not improved after MDT in both groups.Conclusions: In conclusion, MDT discussion increased the accuracy of MRI in preoperative staging diagnosis for rectal cancer. This mode could give a more accurate clinical stage of patients, which was in favor of choosing a preferable therapy strategy.

Significance of MRI in rectal carcinoma therapy optimization - correlation of preoperative T- and N-staging with definitive histopathological findings.

In past decades, both prognosis and therapy of rectal cancer patients showed significant improvement, on the other hand, the incidence of rectal carcinoma continues to have a rising tendency. According to current UICC classification, patients in stage II rectal cancer or higher are indicated for neoadjuvant chemoradiotherapy (nCRT). Magnetic resonance imaging (MRI) is currently the most common diagnostic method used for preoperative staging of rectal cancer. Several studies already pointed out the inaccuracy of preoperative lymph node staging in patients with rectal cancer. The present study analyzed overall accuracy of MRI staging of rectal cancer and thus its accuracy in neoadjuvant therapy indication, by comparing preoperative MRI staging with definitive histopathologic results from resected tumors. This study evaluated cases of 92 patients with rectal tumor that underwent MRI examination followed by surgical resection. Tumors included in the analysis were ranging from T1 to T3b according to TNM staging, with free circumferential resection margin (CRM), distance form mesorectal fascia more than 5 mm, negative intersphincteric plane and also negative extramural venous invasion (EMVI), while the N stage was not decisive. In all cases both N-staging and T-staging were evaluated histologically and compared with preoperative MRI results. Significant difference in preoperative and postoperative N-staging was shown in 51 patients (61.45%). In majority of cases MRI lead to overstaging, which was observed in 44 cases (53.1 %), with complete negativity of lymph nodes proven by histological examination in 34 cases. On the other hand, understaging of lymph nodes was observed only in 7 cases (7.4 %). The T-staging did not show significant differences. Results from this study confirm that MRI plays an important role in T-staging of rectal tumors, however, there are admittedly issues in N-staging of tumors, which should lead to reevaluation of neoadjuvant therapy indication in patients with positive lymph nodes according to MRI examination. Based on the results of this study, we see the future of preoperative staging of rectal tumors in precise T-staging together with accurate assessment of CRM and distance of tumor from mesorectal fascia as well as evaluation of intersphinteric plane and EMVI.

Clinical findings and outcomes of MRI staging of breast cancer in a diverse population.

The performance of magnetic resonance imaging (MRI), the effect of patient factors, and resulting surgical management in underserved and ethnically diverse breast cancer (BC) patient populations have been understudied. We retrospectively analyzed the data of 1116 consecutive patients who were newly diagnosed with in situ or invasive BC with preoperative staging MRI. Non-index lesions (NILs) were defined as abnormal MRI findings with BI-RADS score of 4 or 5 in breast or axillary nodes not previously detected by conventional imaging. Occult cancers (OCs) were NILs found to be malignant by biopsy or surgery. Logistic regression was used to examine associations between probabilities of NILs or OCs and patient characteristics. Staging MRI detected NILs and OCs in 24% and 7.5% of patients, respectively. Of 1116 patients, 271 (24%) had 327 NILs, and 84 (7.5%) had 87 OCs. Follow-up information was available for 306 NILs. Ipsilateral breast NILs (n = 124) were seen in 115 patients (10.3%), with OCs (n = 51) seen in 48 patients (4.4%). Contralateral breast NILs (n = 134) were seen in 118 (10.6%) patients, with OCs (n = 20) seen in 20 patients (1.8%). Laterality (p < 0.001) and disease stage (p = 0.018) were associated with probability of OC. Patients without BRCA mutations had a significantly higher probability of having NILs (p = 0.003) but not OCs. Our study provides useful estimates of the rates of NILs and OCs anticipated in a younger, uninsured, ethnically diverse population. Prospective trials and larger pooled retrospective analyses are needed to define the long-term impacts of MRI staging after a BC diagnosis.

Pre-operative MRI staging of endometrial cancer in a multicentre cancer network: can we match single centre study results?

To evaluate the staging accuracy of magnetic resonance imaging (MRI) for endometrial cancer in daily practice over a 3-year period at a tertiary referral centre receiving scans from a large number of hospitals with varying protocols. To compare these daily practice results to published data from single-centre studies. After ethical approval, MRI staging records for 270 studies from nine network and three centre hospitals were retrospectively collected and compared with final operative histopathology. The International Federation of Gynaecology and Obstetrics (FIGO) stage, depth of invasion assessment and cervical stromal invasion were analysed and reasons for discrepancies reviewed. MRI-based complete FIGO stage was fully concordant with histopathology in 65.6%. MRI accuracy for depth of myometrial invasion and cervical stromal invasion was 73.3% and 89.3% respectively. Our results did not match the high accuracy previously reported in studies based on single centres. Published MRI staging accuracy from small single-centre studies were not replicated in a tertiary referral centre receiving scans with heterogeneous protocols over a 3-year period. These results highlight the challenges faced in daily practice and may reflect achievable and realistic MRI staging accuracies in large rapid throughput referral networks. Adherence to standardised high-quality protocols may help to improve future results. • Three-year MRI-staging accuracy for endometrial cancer in a multicentre cancer network • Daily practice MRI-staging accuracy did not meet results of single-centre studies • Large scale cancer network MRI-staging accuracies should be further evaluated • Treatment recommendations should be based on achievable MRI-staging accuracies.

Role of magnetic resonance imaging in the planning of breast cancer treatment strategies: comparison with conventional imaging techniques.

ObjectiveTo assess the role of magnetic resonance imaging (MRI) in the planning of breast cancer treatment strategies.Materials and MethodsThe study included 160 women diagnosed with breast cancer, who underwent breast MRI for preoperative staging. Using Pearson's correlation coefficient (r), we compared the size of the primary tumor, as determined by MRI, by conventional imaging (mammography and ultrasound), and in the pathological examination (gold standard). The identification of lesions not identified in previous examinations was also evaluated, as was its influence on treatment planning.ResultsThe mean age of the patients was 52.2 years (range, 30–81 years), and the most common histological type was invasive ductal carcinoma (in 60.6% of the patients). In terms of the tumor size determined, MRI correlated better with the pathological examination than did mammography (r = 0.872 vs. 0.710) or ultrasound (r = 0.836 vs. 0.704). MRI identified additional lesions in 53 patients (33.1%), including malignant lesions in 20 (12.5%), which led to change in the therapeutic planning in 23 patients (14.4%).ConclusionBreast MRI proved to be more accurate than conventional imaging in determining the dimensions of the main tumor and was able to identify lesions not identified by other methods evaluated, which altered the therapeutic planning in a significant proportion of cases.

Breast Cancer Heterogeneity: MR Imaging Texture Analysis and Survival Outcomes.

Purpose To determine the relationship between tumor heterogeneity assessed by means of magnetic resonance (MR) imaging texture analysis and survival outcomes in patients with primary breast cancer. Materials and Methods Between January and August 2010, texture analysis of the entire primary breast tumor in 203 patients was performed with T2-weighted and contrast material-enhanced T1-weighted subtraction MR imaging for preoperative staging. Histogram-based uniformity and entropy were calculated. To dichotomize texture parameters for survival analysis, the 10-fold cross-validation method was used to determine cutoff points in the receiver operating characteristic curve analysis. The Cox proportional hazards model and Kaplan-Meier analysis were used to determine the association of texture parameters and morphologic or volumetric information obtained at MR imaging or clinical-pathologic variables with recurrence-free survival (RFS). Results There were 26 events, including 22 recurrences (10 local-regional and 12 distant) and four deaths, with a mean follow-up time of 56.2 months. In multivariate analysis, a higher N stage (RFS hazard ratio, 11.15 [N3 stage]; P = .002, Bonferroni-adjusted α = .0167), triple-negative subtype (RFS hazard ratio, 16.91; P < .001, Bonferroni-adjusted α = .0167), high risk of T1 entropy (less than the cutoff values [mean, 5.057; range, 5.022-5.167], RFS hazard ratio, 4.55; P = .018), and T2 entropy (equal to or higher than the cutoff values [mean, 6.013; range, 6.004-6.035], RFS hazard ratio = 9.84; P = .001) were associated with worse outcomes. Conclusion Patients with breast cancers that appeared more heterogeneous on T2-weighted images (higher entropy) and those that appeared less heterogeneous on contrast-enhanced T1-weighted subtraction images (lower entropy) exhibited poorer RFS. © RSNA, 2016 Online supplemental material is available for this article.

Is the accuracy of preoperative MRI stage in rectal carcinoma influenced by tumor height?

514 Background: In order to select patients with adenocarcinoma of the rectum (RC) for optimal treatment strategies, there is a need for accurate staging of the neoplastic disease. Here, magnetic resonance imaging (MRI) is considered to be the gold standard. However, some concerns have been raised about the reproducibility of earlier results. Newer treatment strategies which include organ saving in RC patients will further emphasize the need. The aim of the present study was to evaluate the degree of accuracy of the MRI staging. Methods: All patients diagnosed with RC in northern Denmark 2009-2013 (n = 1017) were screened for inclusion. All MRI were performed on 1.5 T MRI scanners and the evaluations were made by in all four expert GI-radiologists. Only patients who were offered surgery without preoperative treatment were included (n = 357). The result of the preoperative MRI staging was correlated to the postoperative histopathological stage. Results: There were 56, 131 and 190 patients respectively with low- (0-5 cm from the anal verge), mid- (5-10 cm) and high RC (10-15 cm). MRI T-staging was in accordance with the histopathology in 84 % of the cases (81% for low, 86% for mid, and 83% for high tumors, respectively) and the accuracy was not affected by tumor height. The results were consistent over time. Concerning the MRI staging of nodal-involvement, there was a sensitivity of 88% and a specificity of 30%. Data regarding tumor invasion and distance from the tumor to mesorectal fascia will be presented at the meeting. Conclusions: MRI T-stage correlated well with postoperative histopathological T-stage, whereas the correlation to nodal involvement was poor and in accordance with previous results.

Second-look ultrasonography for MRI-detected suspicious breast lesions in patients with breast cancer.

Purpose:The purpose of this study is to evaluate the use of second-look ultrasonography (US) for investigating additional suspicious lesions detected on preoperative staging magnetic resonance imaging (MRI) for breast cancer.Methods:Between September 2008 and August 2010, 1,970 breast MRIs were performed at our medical institution for the evaluation of breast cancer before surgery. Second-look US was recommended for 135 patients with 149 suspicious lesions, following the MRI interpretation, and 108 patients with 121 lesions were included in this study. The detection rate on second-look US, according to the lesion type, diameter, and histopathological outcome, was analyzed.Results:Of the 121 lesions considered in this study, 97 (80.2%) were diagnosed on MRI as masses and 24 (19.8%) as non-mass-like lesions; 105 lesions (86.8%) were correlated and 16 (13.2%) were not correlated with the findings of second-look US. Of the 105 correlated lesions, 29 (27.6%) were proven to be malignant and 76 (72.4%) were benign. Although a greater number of large malignant lesions were correlated on second-look US than small benign lesions, there was no statistically significant difference according to lesion diameter or type, as seen on MRI or pathology.Conclusion:We have concluded that second-look US is a useful diagnostic tool for lesions incidentally detected on breast MRI, as in this study, it could identify 86.8% of the MRI-detected breast lesions.

Locally advanced rectal cancer: The value of magnetic resonance imaging as a predictive tool.

e14666 Background: Magnetic Resonance Imaging (MRI) of pelvis stratifies patients (pts) with rectal cancer (ca) according to locally advanced disease (dx) &amp; risk of local recurrence. By determining the extent of lymph node (LN) positivity, it enables the appropriate selection of pts for neoadjuvant therapy (NAT) prior to curative surgical resection (Sx). We assessed our institution’s experience of NAT versus upfront Sx in stage I-III rectal ca to ascertain the utility of MRI as a predictive tool in LN status evaluation. Methods: We retrospectively reviewed a prospectively maintained database for all pts with a diagnosis of stage I-III rectal ca from January 2006 to September 2012 in a specialist colorectal cancer centre. We analysed data with respect to preoperative MRI staging &amp; definitive histopathological confirmation of LN stage. Results: A total of 210 pts were identified that had Sx for rectal ca with curative intent. Of these, 112 pts received NAT while 98 had upfront Sx. Of those who proceeded directly to Sx, there were 41 females &amp; 57 males. Average age in this group was 73.4 years (range 33 -90). LN staging by MRI was accurate in 45.9% (n=45). LN status could not be evaluated (Nx) in 17.3% (n=17). In 19.4% (n=19) more advanced LN staging was apparent on histology while in 17.3% (n=17) LN stage was deemed more aggressive by MRI. Of those who had NAT, there were 75 males &amp; 37 females. Average age was 62.3 years (range 26-82). In this cohort, 81.3% (n=91) had both a preoperative MRI &amp; pathology report available for comparison. MRI in this group matched histology in 61.5% (n=56). Nx was recorded in 3.3 % (n=3). In 17.6% (n=16) more aggressive LN involvement was evident at histology while 17.6% (n= 16) had less advanced dx at tissue sampling. Overall in this study, MRI accurately predicted LN status in 53.4% (n=101). Conclusions: While MRI is a valuable tool in determining those pts with rectal ca that would benefit from NAT, its predictive value has limitations. With further analysis of the dataset at our institution, we aim to identify other factors involved &amp; create a predictive nomogram for the rectal ca pt with locally advanced dx. We plan to validate this work by including data from other Irish cancer centres.

Assessment of Preoperative Magnetic Resonance Imaging Staging in Patients With Hepatocellular Carcinoma Undergoing Resection Compared With the Seventh American Joint Committee on Cancer System

The aim of this study was to compare the prognostic utility of a staging system using magnetic resonance imaging (MRI) with the seventh American Joint Committee on Cancer (AJCC) staging system in patients with hepatocellular carcinoma (HCC) who underwent hepatic resection. A total of 175 consecutive patients with HCC who underwent curative hepatic resection after MRI between January 2000 and December 2007 were analyzed. In lieu of microvascular invasion, which is used by the AJCC staging system, we devised an MRI staging system in which a size criterion of 2 cm was used to differentiate between tumor stages 1 and 2. All patients were retrospectively staged using the seventh AJCC staging system and the preoperative MRI staging system. Differences in disease-free and overall survival rates between different stages by the MRI and AJCC staging systems were analyzed using the Kaplan-Meier method with log-rank testing. The predictive accuracy of the 2 staging systems was directly compared using the time-dependent receiver operating characteristic curve analysis. Median follow-up period was 222.9 weeks. During the follow-up period, 74 (42.3%) patients experienced tumor recurrence and 22 (12.6%) died. The median disease-free survival and overall survival were 131.1 and 222.9 weeks, respectively. Both staging systems were excellent for the prediction of disease-free survival across different tumor stages but failed to predict overall survival differences between stages 1 and 2. For disease-free and overall survivals, the time-dependent receiver operating characteristic curve analysis revealed no significant differences in predictive accuracy between the 2 staging systems. A preoperative MRI staging system using a size threshold instead of microvascular invasion may predict the prognosis of HCC patients undergoing hepatic resection as accurately as the seventh AJCC tumor-node-metastasis staging system.

Uterine Cervical Malignancy: Diagnostic Accuracy of MRI with Histopathologic Correlation

Objective:Cervical cancer is the third most common malignancy in women worldwide. Accurate staging of the disease is crucial in planning the optimal treatment strategy. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in the assessment of extension and staging of cervical malignancy in correlation with histopathologic examination.Materials and Methods:Thirty females with untreated pathologically proven uterine cervical carcinoma were included in this prospective study. The patients were 40 - 65 years of age and their average age was 45 years. All patients were subjected to routine clinical staging workup and underwent MRI for preoperative staging. Preoperative MRI findings were reviewed and compared with the final pathological staging that is the Gold Standard of reference.Results:Histopathologic examination established that of the 30 tumors, 22 (73.3%) were squamous cell carcinoma. According to the International Federation of Gynecology and Obstetrics (FIGO) staging criteria, 2/30 patients (6.6%) were stage IB, 12/30 (40.3%) were IIA, 8/30 were IIB (26.6%), and 8/30 (26.6%) were IVA. MRI had a sensitivity of 100% and specificity 85.7% in the detection of parametrial infiltration, and a sensitivity of 100% and specificity of 90% in the detection of vaginal infiltration. It was sensitive (100%) and specific (100%) in detecting tumor extension to the stroma, urinary bladder, and rectum. Pathological examination demonstrated stage IB cervical carcinoma in 2/30 patients (6.6%), stage IIA disease in 10/30 patients (33.3%), stage IIB in 6/30 patients (20%), and stage IV disease in 8/30 patients (26.6%). MRI features demonstrated stage IB in 2/30 patients (6.6%), stage IIA disease in 12/30 patients (40%), stage IIB in 8/30 patients (26.6%), and stage IV disease in 8/30 patients (26.6%). MRI staging of cervical carcinoma was in concordance with histopathologic staging in stages IB and IVA and over-staging in IIA and IIB stages.Conclusion:MRI is an optimal non-invasive modality for preoperative staging of uterine cervical malignancy, and crucial in subsequent more accurate treatment planning.