Resonance Imaging In Local Staging Research Articles

Transvaginal ultrasound versus magnetic resonance imaging in local staging of endometrial cancer.

Transvaginal ultrasound versus magnetic resonance imaging in local staging of endometrial cancer.

Value of Pelvic Magnetic Resonance Imaging in Local Staging of Rectal Cancer

Abstract Background: The prognosis for patients with rectal cancer is closely related to the stage of the disease at the time of diagnosis. Currently, rectal Magnetic Resonance Imaging (MRI) is the most encouraging imaging modality for local staging of rectal cancer. Aim of Sudy: This study aimed to evaluate the role of pelvic MRI in staging of the rectal cancer for management decision. Patients and Methods: This prospective study included 30 patients who proved to have rectal cancer by clinical and histopathological studies. Pelvic MRI was accomplished for all patients according to the following protocol: Sagittal T2WI; Axial T2WI; Axial T 1 SPIR; Axial T 1 WI; and Coronal T2 TSE. T staging and N staging were performed for the lesions. Results: Thirty patients were included in this study, 21 males and 9 females with their ages range between 19 and 80 years (mean=43 years). MRI defined the location of the tumor in the upper third (2 cases), 6 cases at the middle third and in 21 cases at the lower third of the rectum. T staging: No lesions were staged as T1, one case was staged as T2, twenty-three lesions were diagnosed as T3; five cases were diagnosed to have T4 lesion (local infiltration) involving; prostate (4 cases) and infiltrating the skin and penile root in another case. The operative findings confirmed MRI data in those cases. One case was staged as T0 stage following proctoscopic resection of rectal polyp and proved to be rectal carcinoma (villous carcinoma). The sensitivity of MRI was identical to (100%) operative and histopathological assessment in all T stages from (T 1 to T4). N staging: The N stage was interpreted according to the TNM classification, any enlarged node in this study was suspected to be positive for metastatic deposits. Conclusions: Pelvic MRI provides high resolution images of the entire mesorectum allowing for an accurate staging of rectal cancer. It offers multiplannar capabilities with high resolution, non-invasive however it is relatively a costly examination. It is of high value in building up the best therapy strategy for cancer rectum patients.

Out-of-bounds: The significance of extraprostatic extension on multiparametric magnetic resonance imaging for local staging of prostate cancer.

Out-of-bounds: The significance of extraprostatic extension on multiparametric magnetic resonance imaging for local staging of prostate cancer.

Accuracy of pelvic magnetic resonance imaging in local staging for rectal cancer: a single local health district, real world experience.

Neoadjuvant chemoradiotherapy plays a key role in reducing local recurrence rates for locally advanced rectal cancer. Pelvic magnetic resonance imaging (pMRI) is the gold standard for local clinical staging which allows clinicians to decide the treatment patients receive. A more advanced tumour or the presence of high-risk features on pMRI mean that neoadjuvant therapy will be offered to these patients. Understanding the accuracy of pMRI in local staging for rectal cancer is therefore crucial. A retrospective cohort analysis of the accuracy of pMRI staging in a subgroup of patients who had primary rectal cancer surgery without neoadjuvant therapy was performed. Specificity and sensitivity for T-staging, N-staging and presence of high-risk features (threatened circumferential resection margin and extramural venous invasion) were calculated. Patients who had previous pelvic surgery, previous pelvic radiotherapy and previous surgery for continence were excluded. A total of 114 patients were included in the analysis. MRI accurately predicts T-stage in 56.6% and N-stage in 55.8%. Prediction of extramural disease was accurate in 51%. A negative circumferential resection margin was accurately predicted in 98.6% of patients. Overall adherence to reporting proforma was 15.8%. Overall, this study provided valuable information about the clinical staging of patients with rectal cancer who are at an early stage within a large regional catchment area in Australia with pMRI. These results allow us to assess the accuracy of our local staging with ramifications to the clinical decisions being made in the context of the more recent trials which questioned the need for neoadjuvant chemo-radiotherapy in all node positive patients.

AB214. The accuracy of magnetic resonance imaging in local staging of rectal cancer post neoadjuvant chemoradiotherapy

Background: Patients who are diagnosed with rectal cancer routinely undergo neoadjuvant chemoradiotherapy in our institution. A cohort of these patients undergo restaging magnetic resonance imaging (MRI) pelvis after neoadjuvant treatment, in addition to a pre-treatment MRI. This study aimed to compare local MRI staging with post-operative resection histology report in order to determine the accuracy of pre-operative MRI.

Additional diagnostic value of Diffusion-Weighted Magnetic Resonance Imaging to conventional Magnetic Resonance Imaging in local staging of primary uterine cervical cancer

Objective: Magnetic resonance (MR) imaging is a helpful modality for detecting and staging gynecological cancers. Diffusion-weighted imaging (DWI) could improve the accuracy rates of MR imaging. The aim of this study was to assess the additional diagnostic value of DWI over conventional MR imaging in assessing the local extent of primary cervical cancer. Method: Forty patients with primary uterine cervical cancer were enrolled in the study, prospectively. All MR examinations were performed using a 1.5 Tesla Unit MR with a body coil. Sagittal and axial T2-weighted MR images, sagittal and axial DWI (at b values of 0, 500,1000 s/mm 2 ) with ADC maps were obtained. The images were evaluated by two different readers independently. The degree of the interobserver agreement between the radiologists was assessed with kappa statistics. Results: Mean age of the study population was 50.7±11.1 years. Kappa values ranged from 0.76 to 1 for both readers indicating excellent agreement. Accuracy rates were as follows for reader 1 respectively with conventional and conventional plus DWI; stromal invasion 0.92/0.95; parametrial invasion 0.87/0.92; vaginal invasion 0.87/0.92; pelvic sidewall invasion 0.90/0.97. Accuracy rates were as follows for reader 2 respectively with conventional and conventional plus DWI images; stromal invasion 0.90/0.95; parametrial invasion 0.87/0.92; vaginal invasion 0.87/0.97; pelvic sidewall invasion 0.90/0.95. Conclusions: MR provides satisfactory accuracy rates in the evaluation of the local extent of uterine cervical carcinoma, and adding DWI improves the diagnostic performance of conventional MR.

Three-Dimensional Transvaginal Sonography and Magnetic Resonance Imaging for Local Staging of Cervical Cancer: An Agreement Study.

To evaluate the agreement of clinical examination, 2-dimensional (2D) sonography, and 3-dimensional (3D) sonography with magnetic resonance imaging (MRI) for local staging of cervical cancer. We conducted a prospective study including women with a diagnosis of carcinoma of the cervix. All women were staged clinically and underwent 2D and 3D transvaginal sonography and MRI before treatment for assessing tumor size and parametrial, bladder, and rectal involvement using the examiner's subjective impression. Agreement between sonography and MRI was assessed by calculating the κ index and percentage of agreement. Forty women were included (mean age ± SD, 46.6 ± 11.4 years). Eleven had early-stage (IA and IB1) disease, and 29 had advanced-stage (IB2-IVB) disease. A significant correlation for tumor size estimation was found between MRI and pelvic examination (r = 0.754; P < .001), MRI and 2D sonography (r = 0.649; P < .001), and MRI and 3D sonography (r = 0.657; P< .001). Agreement for parametrial infiltration between MRI and pelvic examination was fair (κ = 0.26; 95% confidence interval [CI], 0.10-0.54; 62.5% agreement), between MRI and 2D sonography was moderate (κ = 0.41; 95% CI, 0.15-0.66; 70.0% agreement), and between MRI and 3D sonography was good (κ = 0.60; 95% CI, 0.35-0.85; 80.0% agreement). Agreement for bladder involvement between MRI and pelvic examination was moderate (κ = 0.48; 95% CI, 0.10-0.99; 95.0% agreement), between MRI and 2D sonography was moderate (κ = 0.48; 95% CI, 0.10-0.99; 95.0% agreement), and between MRI and 3D sonography was very good (κ = 0.84; 95% CI, 0.55-1.0; 97.5% agreement). Agreement for rectal involvement was not calculated because of the very small number of cases. Three-dimensional sonography showed good agreement with MRI for assessing parametrial infiltration and bladder involvement in cervical cancer.

Laparoscopic intersphincteric resection and hand-sewn coloanal anastomosis: a natural orifice specimen extraction technique.

The incidence of rectal cancer in India is on the rise, and unlike in the West, predominantly younger individuals are affected. Surgery for rectal cancer has evolved over the years with the ultimate goals of sphincter preservation and better quality of life, besides oncological safety. With the routine use of magnetic resonance imaging for local staging, intersphincteric resection has become a viable alternative to abdominoperineal resection. Similarly, there is enough evidence to consider laparoscopic surgery as feasible and oncologically safe for rectal cancer. Thus laparoscopic intersphincteric resection fulfills all the objectives of modern-day rectal cancer surgery. Here we describe the technical points while performing the surgery as well as short-term results of our own series.

Influence of Magnetic Resonance Imaging in the Decision to Preserve or Resect Neurovascular Bundles at Robotic Assisted Laparoscopic Radical Prostatectomy

We evaluated the accuracy of preoperative multiparametric 3.0-T magnetic resonance imaging for local staging of prostate cancer and its influence in the decision to preserve neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. The study included 353 patients who had confirmed prostate cancer and underwent preoperative magnetic resonance imaging and robotic assisted laparoscopic radical prostatectomy between 2008 and 2011. The extent of neurovascular bundle sparing was initially determined on the basis of the clinical information and the nerve sparing surgical plan was reevaluated after review of the magnetic resonance imaging report. The value of preoperative magnetic resonance imaging in the prediction of extracapsular extension and in the decision of surgical plan according to D'Amico risk classification was analyzed. The magnetic resonance imaging performed correct staging, over staging and under staging in 261 (73.9%), 43 (12.2%), and 49 (13.9%) patients, respectively. After review of the magnetic resonance imaging reports, the initial surgical plan was not changed in 260 patients (74%) and was changed in 93 patients (26%). Robotic assisted laparoscopic radical prostatectomy was changed to a more preservable neurovascular bundle sparing procedure in 53 patients (57%) and changed to a more aggressive neurovascular bundle resecting procedure in 40 patients (43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of magnetic resonance imaging in predicting extracapsular extension showed a tendency to increase from low to high risk groups (33%, 46%, 80%, respectively, p <0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients (of 129, 31%) and 27 patients (of 67, 40%), respectively. Preoperative magnetic resonance imaging significantly improves the decision making to preserve or resect the neurovascular bundle at robotic assisted laparoscopic radical prostatectomy, which lacks haptic feedback.

Role of endorectal coil magnetic resonance imaging in local staging of rectal cancer: Experience from a single center

Purpose: In order to obtain an improvement in preoperative staging accuracy for rectal cancer, new imaging modalities are now under investigation. The purpose of our study was to evaluate the accuracy of endorectal coil magnetic resonance imaging (ECMRI) in the preoperative local staging of rectal cancer and correlation with intraoperative and histopathologic staging of retrieved specimen with respect to depth of tumor invasion and lymph node metastasis. Materials and Methods: The study was a prospective one and included 38 patients with biopsy proved rectal cancer. ECMRI studies were performed on a 1.5 Tesla MR unit using a standard endorectal coil. All patients underwent surgery and a comparative evaluation of ECMRI and surgical and pathological staging was done. Accuracy, sensitivity, specificity, and positive and negative predictive value (PPV and NPV) were assessed. Results: The diagnostic accuracy of ECMRI for T1/T2 tumors was 90%; for T3 and T4 tumors accuracy was 100% each. For perirectal lymph node metastasis, the diagnostic accuracy of ECMRI was 83.3%. Conclusion: ECMRI is a reliable radiologic tool for local (T) staging of rectal cancer and has excellent diagnostic accuracy, sensitivity, and specificity. ECMRI is also useful in detecting perirectal lymph node metastasis, but accuracy is not as good as that for T staging.

Magnetic Resonance Imaging in Local Staging of Endometrial Carcinoma: Diagnostic Performance, Pitfalls, and Literature Review

To assess the diagnostic accuracy of magnetic resonance imaging in local staging of endometrial carcinoma, and to review the results and pitfalls described in the literature. Thirty women with a histological diagnosis of endometrial carcinoma underwent magnetic resonance imaging. Unenhanced T2-weighted and dynamic contrast-enhanced Ti-weighted sequences were obtained. Hysterectomy and salpingo-oophorectomy was performed in all patients. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the detection of deep myometrial and cervical infiltration. For deep myometrial infiltration T2-weighted sequences reached a sensitivity of 85%, specificity of 76%, PPV of 73%, NVP of 87%, and accuracy of 80%, while contrast-enhanced scans reached a sensitivity of 90%, specificity of 80%, PPV of 82%, NPV of 89%, and accuracy of 85%. For cervical infiltration T2-weighted sequences reached a sensitivity of 75%, specificity of 88%, PPV of 50%, NPV of 96%, and accuracy of 87%, while contrast-enhanced scans reached a sensitivity of 100%, specificity of 94%, PPV of 75%, NPV of 100%, and accuracy of 95%. Unenhanced and dynamic gadolinium-enhanced magnetic resonance allows accurate assessment of myometrial and cervical infiltration. Information provided by magnetic resonance imaging can define prognosis and management.

Value of 3-T Magnetic Resonance Imaging in Local Staging of Prostate Cancer

Whole-body 3-T magnetic resonance (MR) scanners are presently becoming more widely available in the clinical setting. The increased signal-to-noise ratio inherent at 3 T as compared with 1.5 T offers potentials for clinical MR imaging such as shortening of imaging time and increased spatial, spectral, or temporal resolution or a combination of these. As a result, high-in-plane-resolution anatomic MR images can be obtained. This review will address the advantages and drawbacks of local staging with MR imaging at 3 T in patients with prostate cancer. Furthermore, the current diagnostic performance of prostate MR imaging in staging prostate cancer at high field strength is discussed.

Magnetic Resonance Imaging for Local Staging of Gastric Carcinoma

Preoperative staging of gastric carcinoma is limited by the fact that available imaging modalities do not enable accurate evaluation of the depth of infiltration of the gastric wall. The aim of this study was to evaluate the efficiency of conventional magnetic resonance imaging (MRI) in local staging of gastric carcinoma. Sixty-five specimens of patients with proven gastric carcinoma were examined immediately after gastrectomy. Examination was performed with a 1-T MRI and included T1-weighted, T2-weighted, and opposed phase images. Images were analyzed for the number of visible wall layers and their signal intensity characteristics, for tumor localization and depth of infiltration. T-stage was classified according to the TNM system. Finally, the staging by MRI was compared with the histopathological staging of the specimens. The mucosal, submucosal, and proper muscle layers could be differentiated by the typical signal intensities. Depiction of the subserosa or serosa was not possible. In 65 specimens, 67 carcinomas were found by the pathologist. Sixty-four of 67 (96%) histologically proven carcinomas were correctly localized by MRI; T-staging accuracy was 50% only, mainly because of overstaging pT2 tumors as T3. MRI enables differentiation of gastric wall layers and, therefore, technically allows the evaluation of the local tumor stage of gastric carcinomas. However, infiltration of the subserosal and serosal layer cannot be proved accurately. Overstaging pT2 tumors is one of the most predominant problems. Yet further technical developments in high-resolution imaging of the gastric wall may improve T-staging in the near future and overcome today's staging limitations.

Positron emission tomography for urological tumours.

For urological tumours, positron emission tomography (PET) is currently most useful in testicular cancer. In patients with residual masses or raised marker levels after treatment, PET is both sensitive and specific for detecting recurrent disease, at suspected and unsuspected sites. Although fewer studies are available it also appears to be useful for staging at diagnosis, although this requires further investigation. Prostate cancer imaging has been more variable, with studies showing that PET cannot reliably differentiate between tumour and hypertrophy. It is not as good as a bone scan for defining bone metastases. In renal cancer, PET can be used to define the primary tumour, providing better staging of local recurrence than computed tomography (CT), and to define metastatic disease. There are few studies in bladder cancer, and despite excretion of the tracer via the bladder in early studies, it has better results than CT or magnetic resonance imaging for local staging; again it can detect metastases. Overall, the place of PET in urological tumours is developing, with the strongest areas undoubtedly being testicular and renal cancer. Tracers other than fluorodeoxyglucose are being examined and are providing further information.

Dynamic endorectal magnetic resonance imaging for local staging and detection of neurovascular bundle involvement of prostate cancer: correlation with histopathologic results

Objectives. To assess the staging accuracy and detection of neurovascular bundle involvement by dynamic subtraction contrast-enhanced endorectal magnetic resonance imaging (MRI) in patients with localized prostate cancer. Methods. In 38 patients with biopsy-proven prostate cancer, endorectal MRI was performed on a 1.5-Tesla magnetic resonance system using the dynamic technique with gadolinium-diethylenetriaminepentaacetic acid bolus enhancement. Two radiologists prospectively assessed the tumor involvement, localization, capsular penetration, seminal vesicle invasion, and neurovascular bundle involvement. All patients subsequently underwent radical prostatectomy, and the MRI findings were correlated with the histopathologic results. Results. The overall accuracy of detecting cancer localization in the prostate was 72%. The detection of involvement in the peripheral zone had an 80% accuracy rate, but for lesions in the transition zone, the rate was 63%. The sensitivity and specificity of tumor detection was 81% and 79% for peripheral zone cancers and 37% and 97% for transition zone cancers, respectively. The accuracy rate, was 84%, 97%, and 97% for the detection of capsular penetration, seminal vesicle invasion, and neurovascular bundle involvement, respectively. Conclusions. Prostatic MRI with an endorectal surface coil using the dynamic technique more accurately detected tumor localization, capsular penetration, seminal vesicle invasion, and neurovascular bundle involvement than previously reported methods. The detection of tumor localization was more accurate in the peripheral zone than in the transition zone. This technique may be useful for the selection of patients for radical prostatectomy and, particularly, for identifying candidates for nerve-sparing surgery.

Endorectal magnetic resonance imaging in local staging of prostate carcinoma.

Endorectal magnetic resonance imaging in local staging of prostate carcinoma.

Use of Endorectal Surface Coil Magnetic Resonance Imaging for Local Staging of Prostate Cancer

A total of 111 patients with clinically localized prostate cancer (stage A or B) underwent endorectal surface coil magnetic resonance imaging (MRI) for preoperative staging of the disease. Of the patients 43 with advanced disease on endorectal surface coil MRI (33 with stage C and 10 with stage D disease) received alternative therapy, as did 21 with stage B disease on MRI The overall staging accuracy for the remaining 47 patients was 68%, with a 74% accuracy rate in staging advanced disease and a 91% accuracy rate for depiction of seminal vesicle involvement. Failure to recognize microscopic extracapsular disease was responsible for the majority of staging inaccuracies in this highly select group of patients. Endorectal surface coil MRI provides extremely high resolution images of the prostate and periprostatic structures, and is an exciting new modality for local staging of prostatic carcinoma.