RESUMO
Objective The aim of this study was to characterize the tissue involving the margin and study if this information will affect margin prediction on restaging magnetic resonance imaging (MRI) in low rectal adenocarcinoma (LRC) patients treated with neoadjuvant long-course chemoradiotherapy (LCCRT). Methods In this retrospective study of nonmetastatic LRC (distal margin <5 cm from the anal verge) treated with LCCRT followed by surgery, a radiologist blinded to outcome reread the restaging MRI and documented if the radial margin was involved by tumor, fibrosis, or mucin reaction using T2 high-resolution (HR) and diffusion-weighted imaging (DWI). The diagnostic performance of tumor-involving margin on restaging MRI was assessed using surgical histopathology as a reference. Interobserver agreement between three independent radiologists was assessed in a subset. Results We included 133 patients (80 males and 53 females) with a mean (range) age of 44.7 (21-86) years and 82% of them had well or moderately differentiated adenocarcinoma. Baseline MRI showed T3 ( n = 58) or T4 ( n = 60) disease in 89% of the patients. The pathological margin was positive in 21% ( n = 28) cases. In restaging MRI, the circumferential resection margin (CRM) ≤1 mm in 75.1% ( n = 100) cases and MRI predicted tumor, fibrosis, and mucin reaction at the margin in 60, 34, and 6%, respectively, and histopathology showed tumor cells in 33, 14.7, and 16.6% of them, respectively. LRC with tumor-involving margin and bad response (MR tumor regression grade [mr-TRG] 3-5) on restaging MRI had fourfold increased risk of positive pathological circumferential resection margin (pCRM). There was moderate and fair inter-reader agreement for the tissue type involving the CRM ( κ = 0.471) and mr-TRG ( κ = 0.266), p < 0.05. The use of both distance criteria and tumor-involving margins improved the diagnostic accuracy for margin prediction from 39 to 66% on restaging MRI. Conclusions Margin prediction on restaging MRI can be improved by characterizing the tissue type involving the margin in low rectal cancer patients. The inter-reader agreement was moderate for determining the tissue type.
RESUMO
Background: Cardiac signs can show illness progression and severity in a number of respiratory and cardiovascular disorders. The possible importance of CT findings in the prognosis and result of COVID-19 patients is related to the severity of lung disease and cardiac parameters. The CT-assessed cardiac indices are known for predicting the involvement of extent of diseases. Hence, the objective of this study was to correlate the extent of cardiovascular and respiratory involvement in predicting the severity of disease using CT-assessed cardiac indices in Indian population suffering from COVID-19. Methodology: A total of 120 COVID-19 patients were included following the inclusion criteria for one year. The confounding factors were assessed and analyzed. The correlation between the cumulative hazard function of death and duration in hospital along with survival rate were done in terms of pulmonary artery-to-aorta ratio (PA/A), and cardiothoracic ratio (CTR). Results: The analysis showed mean age of patients to be 49.5(±15.32) years in which mean females were 38(±31.7) and males were 82(±68.3). The interquartile range of CT severity was 8. The PA/A ratio in discharged patients was 0.85 when compared to deceased patients with 1.03 having statistically significant inference (P = 0.00). The CTR (P = 0.00), epicardial adipose thickness (P = 0.00), epicardial adipose density (P = 0.00), and D-dimer (P = 0.007) were showing statistically significant inference. Conclusion: The predictive values of CT-assessed cardiac indices might be used for predicting the involvement of cardiovascular and respiratory involvement in COVID-19 patients. It could have an impact on improving the possibilities of survival of patients suffering from COVID-19 in India.
