Accuracy of High-Resolution MRI with Lumen Distention in Rectal Cancer Staging and Circumferential Margin Involvement Prediction

ABSTRACT

OBJECTIVE: To evaluate the accuracy of magnetic resonance imaging (MRI) with lumen distention for rectal cancer staging and circumferential resection margin (CRM) involvement prediction. MATERIALS AND METHODS: Seventy-three patients with primary rectal cancer underwent high-resolution MRI with a phased-array coil performed using 60-80 mL room air rectal distention, 1-3 weeks before surgery. MRI results were compared to postoperative histopathological findings. The overall MRI T staging accuracy was calculated. CRM involvement prediction and the N staging, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed for each T stage. The agreement between MRI and histological results was assessed using weighted-kappa statistics. RESULTS: The overall MRI accuracy for T staging was 93.6% (k = 0.85). The accuracy, sensitivity, specificity, PPV and NPV for each T stage were as follows 91.8%, 86.2%, 95.5%, 92.6% and 91.3% for the group < or = T2; 90.4%, 94.6%, 86.1%, 87.5% and 94% for T3; 98,6%, 85.7%, 100%, 100% and 98.5% for T4, respectively. The predictive CRM accuracy was 94.5% (k = 0.86); the sensitivity, specificity, PPV and NPV were 89.5%, 96.3%, 89.5%, and 96.3% respectively. The N staging accuracy was 68.49% (k = 0.4). CONCLUSION: MRI performed with rectal lumen distention has proved to be an effective technique both for rectal cancer staging and involved CRM predicting.