Preoperative MRI Staging Research Articles

Imaging Modalities for Preoperative Staging of Rectal Cancer in Developing Countries: A Comparative Study of F-FDG PET/CT and MRI

Rectal cancer represents a significant health care challenge globally, demanding accurate pre-operative staging to guide therapeutic interventions and prognostic estimations.This study aims to compare the efficacy and use of F-FDGPET/CT and MRI in preoperative staging of rectal cancer in developing countries such as india. Using a cross-sectional study design, a total of 70 patients diagnosed with rectal cancer were prospectively enrolled and equally divided Into group A and group B. For group A f- fdg PET/CT and for group B MRI was conducted. The primary outcome measures were accuracy, sensitivity, and specificity of each imaging modalityin detecting local tumor extent (T stage), lymph nodeinvolvement (N stage), and distant metastasis (M stage). Histopathological biopsy was taken for each patient and considered as reference standard. Data were analyzed using descriptive statistics and diagnostic accuracy measures.Results showed that both F-FDG PET/CT (71.4%) and MRI(75..5%) had high accuracy in T staging, with comparablesen sitivity (F -FDG PET/CT - 59.6%, MRI - 72.0%) and specificity ( F -FDG- 94.8% , MRI - 82.2%). MRI showed higher sensitivity ( 78.6%) in detecting lymph node involvement than F-FDG PET/CT (72.2%) .F-FDG PET/xCT demonstrated higher sensitivity in detecting distant metastasis compared to MRI. Conclusion: F-FDG PET/CT and MRI are comparable for preoperative staging of rectal cancer, with their own limitations and benifits . MRI provides detailed information about the local tissue involvement, and presence of lymph node metastases where as F-FDG PET/CT is more helpful in detecting distant metastases. But as MRI is more readily available and is more cost effective than F-FDG PET/CT in developing countries such as india, it should be used as the imaging modality of choice for pre - operative staging of rectal cancer.

Evaluation of multi-parameter MRI in preoperative staging of endometrial carcinoma

BackgroundEndometrial carcinoma (EC) is a prevalent gynecological malignancy, necessitating accurate preoperative staging for effective treatment planning. This study explores the application value of multi-parameter MRI in diagnosing and staging endometrial cancer. MethodsSeventy-six patients diagnosed with endometrial cancer underwent 3.0 T pelvic MRI within two weeks before surgery. Imaging data were analyzed based on FIGO clinical staging criteria. The study assessed the sensitivity, specificity, positive predictive value, and negative predictive value of MRI for each stage. ResultsPostoperative pathology confirmed 71 cases of endometrial adenocarcinoma, 3 serous adenocarcinoma, and 2 clear cell carcinomas. MRI staging showed a high consistency (Kappa value = 0.786) with postoperative pathology. The overall accuracy of MRI diagnosis was 86.8%. Sensitivity and specificity varied for each stage: IA (91.3%, 96.2%), IB (88.6%, 93.8%), II (97.4%, 89.2%), and III (84.2%, 100%). ConclusionWhile there was a slight misdiagnosis rate, the overall accuracy of preoperative MRI for endometrial cancer was high, aiding in precise diagnosis and clinical staging. MRI effectively identified myometrial infiltration, cervical involvement, paracentral extension, and lymph node metastasis. Further research with larger sample sizes is recommended for enhanced reliability.

Locoregional staging of breast cancer: contrast-enhanced mammography versus breast magnetic resonance imaging

PurposeBreast cancer diagnosis often involves assessing the locoregional spread of the disease through MRI, as multicentricity, multifocality and/or bilaterality are increasingly common. Contrast-enhanced mammography (CEM) is emerging as a potential alternative method. This study compares the performance of CEM and MRI in preoperative staging of women with confirmed breast carcinoma. Patients were also asked to fill in a satisfaction questionnaire to rate their comfort level with each investigation.MethodsFrom May 1st, 2021 to May 1st, 2022, we enrolled 70 women with confirmed breast carcinoma who were candidates for surgery. For pre-operative locoregional staging, all patients underwent CEM and MRI examination, which two radiologists evaluated blindly. We further investigated all suspicious locations for disease spread, identified by both CEM and MRI, with a second-look ultrasound (US) and eventual histological examination.ResultsIn our study cohort, MRI and CEM identified 114 and 102 areas of focal contrast enhancement, respectively. A true discrepancy between MRI and CEM occurred in 9 out of 70 patients examined. MRI reported 8 additional lesions that proved to be false positives on second-look US in 6 patients, while it identified 4 lesions that were not detected by CEM and were pathological (true positives) in 3 patients.ConclusionsCEM showed results comparable to MRI in the staging of breast cancer in our study population, with a high rate of patient acceptability.

ThTP4.13 Discrepancy between preoperative MRI staging and post-operative histopathology staging in rectal cancer patients who had primary surgery. A retrospective study at a District General Hospital

Abstract Aim The aim of this retrospective study was to analyse the discrepancy between preoperative MRI staging and post-operative histopathology staging of rectal cancer patients who had primary surgery. Methods A retrospective cohort study analysed the records of 47 patients with histology confirmed rectal cancer over the period of 5 years from 2017 to 2022. Data was collected from the hospital database. Results Forty-seven patients were evaluated. The mean age of presentation was 72 years. Out of 47 patients 65.95% (n=31/47) were men; 34.05 % (n=16/47) were women. Discrepancy in T staging and N staging were found in 44% (n=21/47) and 49% (n=22/45) patients respectively. Two patients had inconclusive N staging on preoperative MRI. In T stage discrepancy, 86 % ( n=18/21) were upstaged and 14% (n=3/21) were downstaged. In N stage discrepancy, 73%(n=16/22) were upstaged and 27% (n=6/22) were downstaged. Conclusion There was significant discrepancy in preoperative MRI staging and post-operative histopathology staging in our study. Discrepancy in rectal cancer staging has critical effects on management, outcomes, and survival rates of patients. Appropriate and accurate clinical radiological staging enables multi-disciplinary teams to plan optimal management approaches.

Analysis of correlation of pre-therapeutic assessment and the final diagnosis in endometrial cancer: role of tumor volume in the magnetic resonance imaging.

To evaluate whether the introduction of tumor volume as new parameter in the MRI assessment could improve both concordance between preoperative and postoperative staging, and the identification of histological findings. A retrospective observational study with 127 patients with endometrial cancer (EC) identified between 2016 and 2021 at the Juan Ramon Jimenez University Hospital, Huelva (Spain) was carried out. Tumor volume was measured in three ways. Analyses of Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) were performed. Although preoperative MRI had an 89.6% and 66.7% sensitivity for the detection of deep mucosal invasion and cervical stroma infiltration, preoperative assessment had an intraclass correlation coefficient of 0.517, underestimating tumor final stage in 12.6% of cases, with a poor agreement between preoperative MRI and postoperative staging (κ=0.082) and low sensitivity (14.3%) for serosa infiltration. The cut-off values for all three volume parameters had good/excellent AUC (0.73-0.85), with high sensitivity (70-83%) and specificity (64-84%) values for all histopathological variables. Excellent/good agreement was found all volume parameters for the identification of deep myometrial invasion (0.71), cervical stroma infiltration (0.80), serosa infiltration (0.81), and lymph node metastases (0.81). Tumor volume measurements have good predictive capacity to detect histopathological findings that affect final tumor staging and might play a crucial role in the preoperative assessment of patients with endometrial cancer in the future.

Cost-Effectiveness of Breast Cancer Staging Modalities: Counterpoint-Breast MRI Can be Cost-Effective for Breast Cancer Staging, Particularly in This Era of Treatment De-Escalation.

This article does not include an abstract. Please see the accompanying Cost-Effectiveness of Breast Cancer Staging Modalities: Point-Contrast-Enhanced Mammography as an Alternative to Breast MRI for Preoperative Staging in Patients with Breast Cancer. Point by Marc B. I. Lobbes.

Cost-Effectiveness of Breast Cancer Staging Modalities: Point-Contrast-Enhanced Mammography as an Alternative to Breast MRI for Preoperative Staging in Patients With Breast Cancer.

This article does not include an abstract. Please see the accompanying Cost-Effectiveness of Breast Cancer Staging Modalities: Counterpoint-Breast MRI Can be Cost-Effective for Breast Cancer Staging, Particularly in This Era of Treatment De-Escalation. Counterpoint by Brian N. Dontchos and Habib Rahbar.

Impact of MRI on the post-therapeutic diagnosis of T4 esophageal cancer.

Opportunities for T4b esophageal cancer patients to receive curative surgery are increasing with the development of multidisciplinary treatments. However, the best modality to accurately diagnose infiltration to the organs surrounding T4b esophageal cancer is still unknown. The aim of this study was to determine the performance of CT and MRI in diagnosing T stage in T4b esophageal cancer, with reference to the pathological diagnosis. A retrospective medical records review of patients with T4b esophageal cancer patients from January 2017 to December 2021 was conducted. Among 125 patients who were treated for cT4b esophageal cancer in Osaka University Hospital, 30 patients were diagnosed with cT4b esophageal cancer by CT, ycT staging with CT (contrast-enhanced images) and MRI (T2-FSE images), and curative R0 resection was performed. Preoperative MRI staging was independently performed by two experienced radiologists. The diagnostic performance of CT and MRI were examined using McNemar's test. Nineteen and 12 patients were diagnosed with ycT4b by CT and MRI, respectively. Combined T4b organ resection was performed in 15 patients. A pathological diagnosis of ypT4b was made in 11 cases. In comparison to CT, MRI showed a higher diagnostic performance, specificity (47% vs. 89%, p = 0.013), and accuracy (60% vs. 90%, p = 0.015) for CT vs. MRI. Our results-with reference to the pathological diagnosis-revealed that MRI had a superior diagnostic performance to CT for diagnosing T4b esophageal cancer invading the surrounding organs. An accurate diagnosis of T4b esophageal cancer may facilitate the implementation of appropriate treatment strategies.

Customized Denonvilliers' Fascia Excision: An Advanced Total Mesorectal Excision Technique for Anteriorly Located Rectal Cancer.

The role of Denonvilliers' fascia in achieving a negative circumferential resection margin during anterior total mesorectal excision has been controversial. Opinions on whether to dissect in the anterior or posterior surgical plane varies among researchers. We performed total mesorectal excision with selective en bloc resection of Denonvilliers' fascia based on preoperative MRI staging, preoperative clinical tumor stage, and tumor level in selected patients with anterior rectal tumors adherent to Denonvilliers' fascia. Between March and August 2021, 5 patients who underwent robotic (n = 4) and laparoscopic (n = 1) total mesorectal excision for anteriorly located low rectal adenocarcinomas after neoadjuvant chemoradiotherapy were enrolled in this study. Transabdominal total mesorectal excision dissection is performed by changing to a plane anterior to Denonvilliers' fascia, with partial or total excision tailored to the tumor level and depth of invasion as a further step in circumferential resection margin clearing. Customized excision of Denonvilliers' fascia was performed by dissecting through the extramesorectal plane. This anterior plane permits resection of Denonvilliers' fascia, exposing the prostate and seminal vesicles. Two tumors were located at the seminal vesicle level and 3 were found at the prostate level. The mean distance from the anal verge to the distal margin of the tumor was 4.8 ± 0.9 cm. Denonvilliers' fascia was preserved in 1 patient and partially excised in 4. Customized Denonvilliers' fascia excision was performed in 3 robotic ultralow anterior resections with coloanal anastomosis, 1 laparoscopic ultralow anterior resection with coloanal anastomosis, and 1 robot-assisted abdominoperineal resection. The circumferential resection margins in all patients were negative. Anterior dissection in front of Denonvilliers' fascia can be selectively performed during total mesorectal excision based on preoperative planning, tumor location, and clinical tumor stage. Preoperative MRI and magnified operative views in minimally invasive platforms provide access to more precise surgical planes for clear circumferential resection, achieving optimal functional outcomes and oncological safety.

Role of MRI in pre-operative staging of endometrial cancer: A diagnostic accuracy study

Endometrial cancer (EC) is a commonly occurring cancer among post-menopausal women. Pre-treatment imaging of the extent of disease can influence the decisions in the management of EC. MRI with its diffusion weighted (DW) images can help in better depiction of the primary tumour, its local extension and extrauterine spread to the peritoneum and lymph nodes. This study was conducted to know the role of MRI for pre-operative staging of endometrial cancer and as a guide for pelvic lymph nodal dissection.It was a descriptive cross-sectional study conducted at a tertiary care hospital patients diagnosed with primary endometrial adenocarcinoma on biopsy. Patients with advanced disease requiring chemotherapy prior to surgery were excluded. Fifty consecutive patients were subjected to MRI Pelvis with abdominal screening in the week preceding definitive surgery, Findings from imaging were compared with final histopathology for concurrence on tumour size, depth of myometrial invasion, presence of adnexal, nodal and cervical stromal involvement.Majority of the patients in this study were post-menopausal women. Sensitivity of MRI for staging of Endometrial Carcinoma in this study was 91.84% and Accuracy was 90%. When compared to HPE for lymph node positivity, MRI had sensitivity of 100%, specificity of 97.87%, PPV of 75%, NPV of 100% and accuracy of 98%.Pre-operative MRI in the week prior to the planned surgery can help in accurately staging the endometrial carcinoma in terms of myometrial infiltration, cervical stromal infiltration as well as pelvic lymph nodal involvement.

TH3.6 Comparison Between Preoperative MRI and Postoperative Histopathological Staging in Rectal Cancer Surgery (RCS)

Abstract Aim To evaluate diagnostic values of preoperative MRI imaging staging in comparison to postoperative histopathological staging (HPS) in rectal cancer surgery. Methods A retrospective chart auditing was performed on all RCS patients from 2019 till 2021. Data collected included patient demographic, preoperative MRI imaging and postoperative histopathological analysis. Results A total number of 83 rectal surgeries were performed during the given period, mean age was 67(±11) and 60% were males. 62.7% (52) of patients underwent anterior resection (low AR 27.7%). APR and Hartmann's procedure were performed in 27.7% and 6% of patients. Complete resection was achieved in 95.2% with average LN harvest of 20.5 (±5.8) nodes. The most common Tumour (T) burdens on preoperative MRI and postoperative HPS were T2 (45.6%) and T3 (44.5%) respectively with MRI diagnostic accuracy of 47%. Lymph nodes analysis showed diagnostic preoperative predictive values of 56.6%. Extramural vascular invasion (EMVI) was accounted in 68 Pre-MRI with diagnostic accuracy of 50.6%. Pre-MRI evaluated 69 CRM and accurately commented in 73.5%. Although Pre-MRI staging had tendency to over-stage tumour burden, lymph nodes analysis and EMVI in around 30% of reported cases. It showed accuracy in diagnostic values in CRM prediction with around 73%. Conclusion Preoperative MRI diagnostic values showed differences when compared with postoperative histopathological analysis. Pre-MRI showed a tendency to over-staging in tumour size, LNs and EMVI. However, Pre-MRI showed favourable values in accurately describing CRM which is the main factor affecting the outcome of surgery and the ongoing treatment.

Treatment strategies for locally recurrent rectal cancer

The evolution of rectal cancer treatment over the last two decades including advances in surgical technique (total mesorectal excision) [1], the advent of pre-operative MRI staging [2], and judicious use of neoadjuvant therapy [3] has resulted in a significant reduction in local recurrence of approximately 5–10% [4–6]. However, the effects of locally recurrent rectal cancer (LRRC) can be devastating, with a median survival of approximately 8 months and a multitude of distressing symptoms including pelvic pain, rectal bleeding and mucous discharge, all of which can adversely affect a patient's quality of life [7,8].

A Concise Review on the Utilization of Abbreviated Protocol Breast MRI over Full Diagnostic Protocol in Breast Cancer Detection.

Breast MRI possesses high sensitivity for detecting breast cancer among the current clinical modalities and is an indispensable imaging practice. Breast MRI comprises diffusion-weighted imaging, ultrafast, and T2 weighted and T1 weighted CE (contrast-enhanced) imaging that may be utilized for improving the characterization of the lesions. This multimodal evaluation of breast lesions enables outstanding discrimination between the malignant and benign and malignant lesions. The expanding indications of breast MRI confirm the far superiority of MRI in preoperative staging, especially in the estimation of tumour size and identifying tumour foci in the contralateral and ipsilateral breast. Recent studies depicted that experts can meritoriously utilize this tool for improving breast cancer surgery despite their existence of no significant long term outcomes. For managing the, directly and indirectly, associated screening cost, abbreviated protocols are found to be more beneficial. Further, in some of the patients who were treated with neoadjuvant chemotherapy, breast MRI is utilized for documenting response. It is therefore essential to realise that oncological screening must be easily available, cost-effective, and time-consuming. Earlier detection of this short sequence protocol leads to prior and early breast cancer disease in high risky female populations like women with dense breasts, prehistoric evidence, etc. This proper utilization of AP reduces unnecessary mastectomies. Hence, this review focused on the explorative information for strongly suggesting the benefits of AP breast MRI compared to full diagnostic protocol MRI.

PCN56 Contrast Enhanced Mammography (CEM) VS Contrast Enhanced Breast MRI As a Preoperative Staging EXAM in Women with NEWLY Diagnosed Breast Cancer: A Budget IMPACT Analysis

This study estimates the budget impact of introducing contrast enhanced mammography (CEM) as an alternative to breast MRI for preoperative staging in women with newly diagnosed breast cancer. A budget impact model was developed from a commercial US payer perspective with one-year time horizon. A literature search was performed to determine the diagnostic performance and downstream costs after undergoing CEM vs breast MRI. Diagnostic procedure costs were determined using IBM® MarketScan® database. Costs were adjusted to November 2020 US dollars using healthcare specific consumer price indices. In a hypothetical commercial health plan of 5 million members, 28,500 women with newly diagnosed breast cancer were estimated to receive a preoperative staging exam. The mean reimbursement cost was lower for CEM than breast MRI ($551 vs $1,077). Due to increased specificity, the number of false positives (FP) after CEM exam were lower than breast MRI (7,752 vs 10,944), resulting in fewer unnecessary biopsies (651 vs 919) and fewer women receiving more extensive surgery following a FP. As a result, the total additional cost associated with increased biopsies and change in surgical treatment plan due to FP was significantly lower than breast MRI ($52,309,675 vs $73,848,953) resulting in cost savings of $21,539,278 to the health plan. The total mean cost of change in surgical treatment plan due to true positives (TP) were similar in CEM and breast MRI. The net cost savings of undergoing CEM vs breast MRI were $36,530,278 with $1,282 total cost savings per cancer diagnosis and $7.31 total cost savings per member. After performing sensitivity analysis, similar results were obtained compared to base-case study across all tested scenarios. CEM may be a viable substitute to breast MRI for preoperative staging of breast cancer owing to similar sensitivity but higher specificity and lower cost.

Contrast-enhanced Mammography: State of the Art.

Contrast-enhanced mammography (CEM) has emerged as a viable alternative to contrast-enhanced breast MRI, and it may increase access to vascular imaging while reducing examination cost. Intravenous iodinated contrast materials are used in CEM to enhance the visualization of tumor neovascularity. After injection, imaging is performed with dual-energy digital mammography, which helps provide a low-energy image and a recombined or iodine image that depict enhancing lesions in the breast. CEM has been demonstrated to help improve accuracy compared with digital mammography and US in women with abnormal screening mammographic findings or symptoms of breast cancer. It has also been demonstrated to approach the accuracy of breast MRI in preoperative staging of patients with breast cancer and in monitoring response after neoadjuvant chemotherapy. There are early encouraging results from trials evaluating CEM in the screening of women who are at an increased risk of breast cancer. Although CEM is a promising tool, it slightly increases radiation dose and carries a small risk of adverse reactions to contrast materials. This review details the CEM technique, diagnostic and screening uses, and future applications, including artificial intelligence and radiomics.

Application value of endoscopic ultrasonography combined with enhanced MRI in preoperative staging of rectal cancer

Application value of endoscopic ultrasonography combined with enhanced MRI in preoperative staging of rectal cancer

Invited Commentary: FIGO Staging Classification for Cervical Cancer-Behold the Big Picture.

Invited Commentary: FIGO Staging Classification for Cervical Cancer-Behold the Big Picture.

MRI cT1-2 rectal cancer staging accuracy: a population-based study.

BackgroundAdequate MRI‐based staging of early rectal cancers is essential for decision‐making in an era of organ‐conserving treatment approaches. The aim of this population‐based study was to determine the accuracy of routine daily MRI staging of early rectal cancer, whether or not combined with endorectal ultrasonography (ERUS).MethodsPatients with cT1–2 rectal cancer who underwent local excision or total mesorectal excision (TME) without downsizing (chemo)radiotherapy between 1 January 2011 and 31 December 2018 were selected from the Dutch ColoRectal Audit. The accuracy of imaging was expressed as sensitivity, specificity, and positive predictive value (PPV) and negative predictive value.ResultsOf 7382 registered patients with cT1–2 rectal cancer, 5539 were included (5288 MRI alone, 251 MRI and ERUS; 1059 cT1 and 4480 cT2). Among patients with pT1 tumours, 54·7 per cent (792 of 1448) were overstaged by MRI alone, and 31·0 per cent (36 of 116) by MRI and ERUS. Understaging of pT2 disease occurred in 8·2 per cent (197 of 2388) and 27·9 per cent (31 of 111) respectively. MRI alone overstaged pN0 in 17·3 per cent (570 of 3303) and the PPV for assignment of cN0 category was 76·3 per cent (2733 of 3583). Of 834 patients with pT1 N0 disease, potentially suitable for local excision, tumours in 253 patients (30·3 per cent) were staged correctly as cT1 N0, whereas 484 (58·0 per cent) and 97 (11·6 per cent) were overstaged as cT2 N0 and cT1–2 N1 respectively.ConclusionThis Dutch population‐based analysis of patients who underwent local excision or TME surgery for cT1–2 rectal cancer based on preoperative MRI staging revealed substantial overstaging, indicating the weaknesses of MRI and missed opportunities for organ preservation strategies.

Application of MRI in the diagnosis of cervical cancer

Objective: Investigating the diagnostic value of MRI for cervical cancer, including preoperative staging, vagina involvement and lymph node metastasis is the aim of this pape. Methods: Select 116 patients with UCC of the second hospital of JiLin University from October 2016 to April 2019. All patients accept MRI examination. Ultimately, all patients accept surgical treatment. Use SPSS19.0 software to analyze MRI results of all the patients.Using the postoperative pathological results as the golden standard in the diagnosis of cervicalcancer diagnosis. The dates from the MRI preoperative staging, preoperative clinical staging and the postoperative pathologic staging were compared through chi-square test. And the dates of preoperative MRI in cervical cancer vagina involvement and lymph node metastasis diagnosis and postoperative pathological results were compared through Mcnemar chi-square test. The difference was statistically significant(P<0.05). Results: 1, The differences between MRI staging and the postoperative pathologic staging have no statistical significance (P>0.05), whilethe difference between MRI staging and preoperative clinical staging during was statistically significant (P<0.05). Using the postoperative pathological staging as the examination standards, the accuracy of preoperative clinical staging is only 67.5%, and cervical cancer overall preoperative MRI staging accuracy was 95%; 2, Preoperative MRI diagnosis and postoperative pathologic results in cervical vaginal involvement and lymph node metastasis has highsensitivity and specificity, were 97.0%, 96.2%, 93.2%, 97.8%. Checked by Mcnemar chi-square test, the differences between themhave no statisticalsignificance (P>0.05), namely the preoperative MRI diagnosis and postoperative pathological results have consistency in clinical. Conclusion: The combination of MRI and FIGO clinical stage can impro the accuracy of clinical staging of cervical cancer. MRI can be used as the important tool to assess cervical cancer preoperative staging, and to choose and formulate reasonable cervical cancer treatment plan.

Risk factor analysis for inaccurate pre-operative MRI staging in rectal cancer

BackgroundVarious tumor characteristics might lead to inaccurate local MRI-defined stage of rectal cancer and the purpose of this study was to explore the clinicopathological factors that impact on the precision pre-treatment MRI-defined stage of rectal cancer.MethodsA retrospectively analysis was conducted in non-metastatic rectal cancer patients who received radical tumor resection without neoadjuvant treatment during 2007–2015 in the Sixth Affiliated Hospital of Sun Yat-sen University. Clinical T stage and N stage defined by pelvic enhanced MRI and pathological stage were compared and patients were subdivided into accurate-staging, over-staging and under-staging subgroups. Logistic regressions were used to explore risk factors for over-staging or under-staging.ResultsFive hundred fifty-one cases of patients were collected. Among them, 109 cases (19.4%) of patients were over-T-staged and 50 cases (8.9%) were under-T-staged, while 78 cases (13.9%) were over-N-staged and 75 cases (13.3%) were under-N-staged. Logistic regression suggested that pre-operative bowel obstruction was risk factor for over-T-staging (OR = 3.120, 95%CI: 1.662–5.857, P < 0.001) as well as over-N-staging (OR = 3.494, 95%CI: 1.797–6.794, P < 0.001), while mucinous adenocarcinoma was a risk factor for under-N-staging (OR = 4.049, 95%CI: 1.876–8.772, P < 0.001). Patients with larger tumor size were at lower risk for over-T-staging (OR = 0.837, 95%CI: 0.717–0.976, P = 0.024) and higher risk for over-N-staging (OR = 1.434, 95%CI: 1.223–1.680, P < 0.001).ConclusionBowel obstruction, mucinous adenocarcinoma and tumor size might have impact on the pre-operative MRI T staging or N staging of rectal cancer. Our results reminded clinicians to assess clinical stage individually in such rectal cancer patients.