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How a rectal cancer MR course significantly increased MR/
pathology correlation
Poster No.:
C-2296
Congress:
ECR 2016
Type:
Scientific Exhibit
Authors:
S. Zaid , G. Mauri , A. Tori , F. Crivelli , L. Solbiati , F. Zurleni ;
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Busto Arsizio/IT, Milan/IT, Rozzano/IT
Keywords:
Abdomen, Pelvis, Oncology, MR, Imaging sequences, Staging,
Efficacy studies, Multidisciplinary cancer care, Cancer, Pathology
DOI:
10.1594/ecr2016/C-2296
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Page 1 of 18
Aims and objectives
To retrospectively compare pre-operative magnetic resonance (MR) staging of rectal
cancer patients based on standard and advanced MR protocol.
Images for this section:
Fig. 1: Rectal Polyp: coronal T2w high-spatial-resolution
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Fig. 2: Low rectal cancer (semianular): axial T2w standard protocol lower resolution
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Methods and materials
Following a training course on pelvic MR, an updated imaging protocol was adopted
in our Unit from February to September 2015 for staging 27 histologically proven
rectal cancer patients. Staging results in this group were compared with a group of 21
patients investigated with standard protocol between February 2014 and January 2015.
Post-surgical histopathology results were considered as reference standard. Advanced
imaging included high-spatial-resolution thin-section T2 weighted sequences in sagittal,
coronal and axial planes parallel and orthogonal to the rectal lesion. All MR exams
were interpreted by the same radiologist with 21 non-proforma and 27 pro-forma reports.
Depth of wall invasion, involvement of levator ani muscle and intersphinteric planes,
circumferential resection margin, extramural vascular invasion and nodal staging were
considered.
Images for this section:
Page 4 of 18
Fig. 3: Rectal Polyp (axial T2w): stage T1
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Fig. 4: Rectal Polyp (sag T2w): stage T1
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Fig. 5: Rectal semianular cancer (axial T2w): stage T3a
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Fig. 6: Rectal semianular cancer (coronal T2w): stage T3a
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
Page 8 of 18
Page 9 of 18
Fig. 7: Histological section of rectum containing tumoral mass invading the wall. Black
ink indicates radial resection margin.
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
Fig. 8: Rectal semianular cancer (histological preparation): adenocarcinoma, preserved
muscularis propria (non invasive portion of tumor)
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
Page 10 of 18
Fig. 9: Rectal semianular cancer (histology): tumoral nests invade mesorectal fat beyond
muscularis propria (T3a) 25X
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Fig. 10: Lymphovascular Pseudoinvasion D2-40 stain negative (400X)
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Fig. 11: Immunohistochemical stain for Desmin showing tumoral invasion into the
subserosa through the muscolaris propria (25X)
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
Page 13 of 18
Results
With standard and advanced protocol accuracy in regional lymph nodes invasion (N) was
respectively 10/21 (47%) and 19/27 (70%) (p=0.142), depth of invasion was accurately
determined in 16/21 (76%) and 25/27 (92%) patients (p=0.215), accuracy rates were 0/2
(0%) and 2/3 (66%) of T1 (0.400), 2/4 (50%) and 5/6 (83%) of T2 (p=0.500), 6/7 (85%) and
10/10 (100%) of T3 (p=0.411), 8/8 and 9/9 (100%) of T4 (p=1.000). Inaccurate evaluation
of T corresponded to overstaging.
Images for this section:
Page 14 of 18
Fig. 12: Rectal semianular cancer: coronal T2w standard protocol, stage T3d (lower
resolution)
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Fig. 13: Rectal semianular cancer: coronal T2w standard protocol, mucine characterized
by hyperintense signal
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
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Fig. 14: Rectal cancer: T2w high-spatial-resolution thin-slice focusing on enlarged
mesolectal Lymph Nodes characterised by homogeneous signal and smooth margins,
all criteria supporting inflammatory state rather than pathologic.
© Radiology Dept, Busto Arsizio General Hospital - Busto Arsizio/IT
Page 17 of 18
Conclusion
Advanced MR pelvic imaging allows accurate preoperative staging in rectal cancer.
Appropriate radiologist training is key to obtaining high correlation between pre-operative
MR and histology pro-forma reports, offering appropriate multidisciplinary therapeutic/
surgical planning.
Personal information
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