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Meng Y, Ai Q, Hu Y, Han H, Song C, Yuan G, Hou X, Weng W. Clinical development of MRI-based multi-sequence multi-regional radiomics model to predict lymph node metastasis in rectal cancer. Abdom Radiol (NY) 2024:10.1007/s00261-024-04204-z. [PMID: 38462557 DOI: 10.1007/s00261-024-04204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE We aim to construct a magnetic resonance imaging (MRI)-based multi-sequence multi-regional radiomics model that will improve the preoperative prediction ability of lymph node metastasis (LNM) in T3 rectal cancer. METHODS Multi-sequence MRI data from 190 patients with T3 rectal cancer were retrospectively analyzed, with 94 patients in the LNM group and 96 patients in the non-LNM group. The clinical factors, subjective imaging features, and the radiomic features of tumor and peritumoral mesorectum region of patients were extracted from T2WI and ADC images. Spearman's rank correlation coefficient, Mann-Whitney's U test, and the least absolute shrinkage and selection operator were used for feature selection and dimensionality reduction. Logistic regression was used to construct six models. The predictive performance of each model was evaluated by the receiver operating characteristic curve (ROC). The differences of each model were characterized by area under the curve (AUC) via the DeLong test. RESULTS The AUCs of T2WI, ADC single-sequence radiomics model and multi-sequence radiomics model were 0.73, 0.75, and 0.78, respectively. The multi-sequence multi-regional radiomics model with improved performance was created by combining the radiomics characteristics of the peritumoral mesorectum region with the multi-sequence radiomics model (AUC, 0.87; p < 0.01). The AUC of the clinical model was 0.68, and the MRI-clinical composite evaluation model was obtained by incorporating the clinical data with the multi-sequence multi-regional radiomics features, with an AUC of 0.89. CONCLUSION The MRI-based multi-sequence multi-regional radiomics model significantly improved the prediction ability of LNM for T3 rectal cancer and could be applied to guide surgical decision-making in patients with T3 rectal cancer.
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Affiliation(s)
- Yao Meng
- Department of Radiology, Xinhua Hospital Affiliated to Dalian University, No. 156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Qi Ai
- Department of Radiology, Xinhua Hospital Affiliated to Dalian University, No. 156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Yue Hu
- Department of Radiology, Xinhua Hospital Affiliated to Dalian University, No. 156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Haojie Han
- Department of Radiology, Xinhua Hospital Affiliated to Dalian University, No. 156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Chunming Song
- Department of Radiology, Xinhua Hospital Affiliated to Dalian University, No. 156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Guangou Yuan
- Department of Radiology, Xinhua Hospital Affiliated to Dalian University, No. 156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Xueyan Hou
- Department of Radiology, Xinhua Hospital Affiliated to Dalian University, No. 156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China
| | - Wencai Weng
- Department of Radiology, Xinhua Hospital Affiliated to Dalian University, No. 156 Wansui Street, Shahekou District, Dalian, 116021, Liaoning, China.
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Gerevini S, Cristiano L, D'Anna G, Castellano A, Vernooij MW, Yousry T, Pichiecchio A. Neuromuscular imaging in clinical practice: an ESNR survey of 30 centers. Neuroradiology 2024; 66:179-186. [PMID: 38110540 DOI: 10.1007/s00234-023-03255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/16/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE We assessed the current clinical imaging practice in the primary evaluation of neuromuscular disorders (NMD), with respect to standardized imaging, evaluation and reporting through a European and extra-European-wide survey. METHODS An online questionnaire was emailed to all European Society of Neuroradiology (ESNR) members (n = 1662) who had expressed their interest in NMD. The questionnaire featured 40 individual items. Information was gathered on the context of the practices, available and preferred imaging modalities, applied imaging protocols and standards for interpretation, reporting and communication. RESULTS A total of 30 unique entries from European and extra-European academic and non-academic institutions were received. Of these, 70% were neuroradiologists, 23% general radiologists and 7% musculoskeletal radiologists. Of the 30 responding institutes, 40% performed from 20 to 50 neuromuscular scans per year for suspected NMD. The principal modality used for a suspected myopathy was magnetic resonance imaging (MRI) (50%) or "mainly MRI" (47%). The primary imaging modality used for the evaluation of patients suspected of a neuropathy was MRI in 63% of all institutions and "mainly MRI" in 37%. For both muscle and nerve pathology, pelvic girdle and inferior limbs are the most scanned parts of the body (28%), followed by the thigh and leg (24%), whole body MR (24%), scapular girdle (16%), and the thigh in just 8% of institutions. Multiplanar acquisitions were performed in 50% of institutions. Convectional sequences used for muscle MRI included T2-STIR (88%), 2D T1weighted (w) (68%), T1 Dixon or equivalent (52%), T2 Dixon (40%), DWI (36%), 2D T2w (28%), T1 3D and T2 3D (20% respectively). For nerve MRI conventional sequences included T2-STIR (80%), DWI (56%), T2 3D (48%), 2D T2w (48%), T1 3D (44%), T1 Dixon or equivalent (44%), 2D T1 (36%), T2 Dixon (28%). Quantitative sequences were used regularly by 40% respondents. While only 28% of institutions utilized structured reports, a notable 88% of respondents expressed a desire for a standardized consensus structured report. Most of the respondents (93%) would be interested in a common MRI neuromuscular protocol and would like to be trained (87%) by the ESNR society with specific neuromuscular sessions in European annual meetings. CONCLUSIONS Based on the survey findings, we can conclude that the current approach to neuromuscular imaging varies considerably among European and extra-European countries, both in terms of image acquisition and post-processing. Some of the challenges identified include the translation of research achievements (related to advanced imaging) into practical applications in a clinical setting, implementation of quantitative imaging post-processing techniques, adoption of structured reporting methods, and communication with referring physicians.
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Affiliation(s)
- Simonetta Gerevini
- Head Diagnostic Imaging Department, Head Neuroradiology Unit, ASST Papa Giovanni XXIII, OMS Square, 1-24127, Bergamo, Italy
| | - Lara Cristiano
- Pediatric Neurology Unit, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, 00168, Rome, Italy.
| | - Gennaro D'Anna
- Neuroimaging Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele Vita-Salute San Raffaele University, Milan, Italy
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine Department of Epidemiology, Office ND-544, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Tarek Yousry
- BRR Department, UCL IoN, NHNN, Clinical Research Centre, UCLH, Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Anna Pichiecchio
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.
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Miranda J, Causa Andrieu P, Nincevic J, Gomes de Farias LDP, Khasawneh H, Arita Y, Stanietzky N, Fernandes MC, De Castria TB, Horvat N. Advances in MRI-Based Assessment of Rectal Cancer Post-Neoadjuvant Therapy: A Comprehensive Review. J Clin Med 2023; 13:172. [PMID: 38202179 PMCID: PMC10780006 DOI: 10.3390/jcm13010172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Rectal cancer presents significant diagnostic and therapeutic challenges, with neoadjuvant therapy playing a pivotal role in improving resectability and patient outcomes. MRI serves as a critical tool in assessing treatment response. However, differentiating viable tumor tissue from therapy-induced changes on MRI remains a complex task. In this comprehensive review, we explore treatment options for rectal cancer based on resectability status, focusing on the role of MRI in guiding therapeutic decisions. We delve into the nuances of MRI-based evaluation of treatment response following neoadjuvant therapy, paying particular attention to emerging techniques like radiomics. Drawing from our insights based on the literature, we provide essential recommendations for post-neoadjuvant therapy management of rectal cancer, all within the context of MRI-based findings.
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Affiliation(s)
- Joao Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
- Department of Radiology, University of Sao Paulo, R. Dr. Ovidio Pires de Campos, 75 Cerqueira Cesar, Sao Paulo 05403-010, Brazil
| | - Pamela Causa Andrieu
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Josip Nincevic
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
| | - Lucas de Padua Gomes de Farias
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91—Bela Vista, Sao Paulo 01308-050, Brazil;
- Department of Radiology, Allianca Saude, Av. Pres. Juscelino Kubitschek, 1830, Sao Paulo 01308-050, Brazil
| | - Hala Khasawneh
- Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA;
| | - Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Nir Stanietzky
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
| | - Tiago Biachi De Castria
- Department of Gastrointestinal Oncology, Moffit Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
- Morsani College of Medicine, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
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Dong X, Ren G, Chen Y, Yong H, Zhang T, Yin Q, Zhang Z, Yuan S, Ge Y, Duan S, Liu H, Wang D. Effects of MRI radiomics combined with clinical data in evaluating lymph node metastasis in mrT1-3a staging rectal cancer. Front Oncol 2023; 13:1194120. [PMID: 37909021 PMCID: PMC10614283 DOI: 10.3389/fonc.2023.1194120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/22/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To investigate the value of a clinical-MRI radiomics model based on clinical characteristics and T2-weighted imaging (T2WI) for preoperatively evaluating lymph node (LN) metastasis in patients with MRI-predicted low tumor (T) staging rectal cancer (mrT1, mrT2, and mrT3a with extramural spread ≤ 5 mm). Methods This retrospective study enrolled 303 patients with low T-staging rectal cancer (training cohort, n = 213, testing cohort n = 90). A total of 960 radiomics features were extracted from T2WI. Minimum redundancy and maximum relevance (mRMR) and support vector machine were performed to select the best performed radiomics features for predicting LN metastasis. Multivariate logistic regression analysis was then used to construct the clinical and clinical-radiomics combined models. The model performance for predicting LN metastasis was assessed by receiver operator characteristic curve (ROC) and clinical utility implementing a nomogram and decision curve analysis (DCA). The predictive performance for LN metastasis was also compared between the combined model and human readers (2 seniors). Results Fourteen radiomics features and 2 clinical characteristics were selected for predicting LN metastasis. In the testing cohort, a higher positive predictive value of 75.9% for the combined model was achieved than those of the clinical model (44.8%) and two readers (reader 1: 54.9%, reader 2: 56.3%) in identifying LN metastasis. The interobserver agreement between 2 readers was moderate with a kappa value of 0.416. A clinical-radiomics nomogram and decision curve analysis demonstrated that the combined model was clinically useful. Conclusion T2WI-based radiomics combined with clinical data could improve the efficacy in noninvasively evaluating LN metastasis for the low T-staging rectal cancer and aid in tailoring treatment strategies.
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Affiliation(s)
- Xue Dong
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Ren
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanhong Chen
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifang Yong
- Department of Radiology, Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Tingting Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiufeng Yin
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongyang Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shijun Yuan
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaqiong Ge
- Department of Medicine, GE Healthcare China, Shanghai, China
| | - Shaofeng Duan
- Department of Medicine, GE Healthcare China, Shanghai, China
| | - Huanhuan Liu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Nougaret S, Rousset P, Gormly K, Lucidarme O, Brunelle S, Milot L, Salut C, Pilleul F, Arrivé L, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Rullier E, Cotte E, Rouanet P, Beets-Tan RGH, Frulio N, Hoeffel C. Structured and shared MRI staging lexicon and report of rectal cancer: A consensus proposal by the French Radiology Group (GRERCAR) and Surgical Group (GRECCAR) for rectal cancer. Diagn Interv Imaging 2022; 103:127-141. [PMID: 34794932 DOI: 10.1016/j.diii.2021.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To develop French guidelines by experts to standardize data acquisition, image interpretation, and reporting in rectal cancer staging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and opinions of experts of GRERCAR (Groupe de REcherche en Radiologie sur le CAncer du Rectum [i.e., Rectal Cancer Imaging Research Group]) and GRECCAR (Groupe de REcherche en Chirurgie sur le CAncer du Rectum [i.e., Rectal Cancer Surgery Research Group]) were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts scoring of reporting template and protocol for data acquisition were collected; responses were analyzed and classified as "Recommended" versus "Not recommended" (when ≥ 80% consensus among experts) or uncertain (when < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer staging with MRI.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, Lyon 1 Claude-Bernard University, 69495 Pierre-Benite, France
| | - Kirsten Gormly
- Dr Jones & Partners Medical Imaging, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, 69495 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Cécile Salut
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hopital St Antoine, Paris, France
| | - Constance Hordonneau
- Department of Radiology, CHU Estaing, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes Cedex, France
| | - Valérie Laurent
- Department of Radiology, Brabois-Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06100 Nice, France
| | - Eric Rullier
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33600 Pessac, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX, Amsterdam, the Netherlands
| | - Nora Frulio
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
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Lossius W, Stornes T, Bernstein TE, Wibe A. Implementation of transanal minimally invasive surgery (TAMIS) for rectal neoplasms: results from a single centre. Tech Coloproctol 2021; 26:175-180. [PMID: 34905132 PMCID: PMC8857095 DOI: 10.1007/s10151-021-02556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
Background Local excisions are important in a tailored approach to treatment of rectal neoplasms. In cases of low risk T1 local excision facilitates rectal-preserving treatment. Transanal minimally invasive surgery (TAMIS) is the most recent alternative developed for local excision. In this study we evaluate the results after implementing TAMIS as the routine procedure for local excision of rectal neoplasms. Methods All patients who underwent TAMIS from January 2016 to January 2020 at St. Olav’s University Hospital were included, and clinical, pathological and oncological data were prospectively registered. The primary endpoint was local recurrence, and the secondary endpoint was complications. Results There were 76 patients (42 men, mean age was 69 years [range 26–88 years]), The mean tumour level was 82 mm (range 20–140 mm) from the anal verge measured on rigid proctoscopy, and mean tumour size was 32 mm (range 8–73 mm). Three patients experienced complications needing intervention (Clavien–Dindo > 3A). Seventeen patients had rectal adenocarcinoma, 9 of whom underwent R0 completion total mesorectal excision (cTME). Fifty-five patients had an adenoma, 3 of whom developed recurrence (5.4%) within 12 months. All recurrences were treated successfully with a new TAMIS procedure. In addition, TAMIS was used in treatment of 2 patients with a neuroendocrine tumour, 1 patient with a haemangioma and 1 patient with a solitary rectal ulcer. Conclusions TAMIS surgery is associated with a low risk of complications and a low recurrence rate in rectal neoplasms. In cases of adenocarcinoma, R0 cTME surgery is feasible in the sub-group with high risk T1 and T2 tumours.
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Affiliation(s)
- W Lossius
- Department of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - T Stornes
- Department of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - T E Bernstein
- Department of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Wibe
- Department of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Aryan M, Read T, Goldstein L, Burriss N, Grajo JR, Moser P, George TJ, Tan S, Iqbal A. Utility of Restaging MRI Following Neoadjuvant Chemoradiotherapy for Stage II-III Rectal Adenocarcinoma. Cureus 2021; 13:e19037. [PMID: 34858737 PMCID: PMC8612598 DOI: 10.7759/cureus.19037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/12/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is currently utilized for the pretreatment staging of locally advanced rectal cancer; however, there is no consensus regarding the utility of repeat MRI for restaging following neoadjuvant chemoradiotherapy (CRT). In this study, we aimed to investigate the clinical utility of restaging MRI after CRT in patients with clinical stage II-III rectal cancer. Methodology We performed a retrospective observational study at a tertiary care hospital. Our study population included patients with clinical stage II-III rectal cancer treated with neoadjuvant CRT who underwent both pre- and post-CRT MRI followed by surgical resection from 2012 to 2017. MRIs were reviewed by radiologists with an interest in rectal cancer MRI imaging using a standardized template. The utility of post-CRT MRI was evaluated by assessing its impact on change in surgical planning, concordance with pathologic staging, and prediction of surgical margins. Results A total of 30 patients were included in the study; 67% had clinical stage III and 33% had stage II disease based on pre-CRT MRI. Post-CRT MRI findings did not lead to a change in the originally outlined surgical plan in any patient. Compared to pre-CRT MRI, post-CRT MRI was not significantly more accurate in predicting T stage (k = 0.483), N stage (k = 0.268), or positive surgical margins (k = 0.839). Conclusions Due to poor concordance with pathologic staging, inability to more accurately predict surgical margin status and the absence of a demonstrable change in surgical treatment, post-CRT restaging with MRI, in its current form, appears to be of limited clinical utility.
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Affiliation(s)
- Mahmoud Aryan
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Thomas Read
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Lindsey Goldstein
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Nathan Burriss
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, USA
| | - Patricia Moser
- Department of Radiology, University of Florida College of Medicine, Gainesville, USA
| | - Thomas J George
- Department of Hematology and Oncology, University of Florida College of Medicine, Gainesville, USA
| | - Sanda Tan
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Atif Iqbal
- Department of Surgery, University of Florida College of Medicine, Gainesville, USA
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8
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Zhou Y, Yang R, Wang Y, Zhou M, Zhou X, Xing J, Wang X, Zhang C. Histogram analysis of diffusion-weighted magnetic resonance imaging as a biomarker to predict LNM in T3 stage rectal carcinoma. BMC Med Imaging 2021; 21:176. [PMID: 34809615 PMCID: PMC8609786 DOI: 10.1186/s12880-021-00706-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/08/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Preoperative identification of rectal cancer lymph node status is crucial for patient prognosis and treatment decisions. Rectal magnetic resonance imaging (MRI) plays an essential role in the preoperative staging of rectal cancer, but its ability to predict lymph node metastasis (LNM) is insufficient. This study explored the value of histogram features of primary lesions on multi-parametric MRI for predicting LNM of stage T3 rectal carcinoma. METHODS We retrospectively analyzed 175 patients with stage T3 rectal cancer who underwent preoperative MRI, including diffusion-weighted imaging (DWI) before surgery. 62 patients were included in the LNM group, and 113 patients were included in the non-LNM group. Texture features were calculated from histograms derived from T2 weighted imaging (T2WI), DWI, ADC, and T2 maps. Stepwise logistic regression analysis was used to screen independent predictors of LNM from clinical features, imaging features, and histogram features. Predictive performance was evaluated by receiver operating characteristic (ROC) curve analysis. Finally, a nomogram was established for predicting the risk of LNM. RESULTS The clinical, imaging and histogram features were analyzed by stepwise logistic regression. Preoperative carbohydrate antigen 199 level (p = 0.009), MRN stage (p < 0.001), T2WIKurtosis (p = 0.010), DWIMode (p = 0.038), DWICV (p = 0.038), and T2-mapP5 (p = 0.007) were independent predictors of LNM. These factors were combined to form the best predictive model. The model reached an area under the ROC curve (AUC) of 0.860, with a sensitivity of 72.8% and a specificity of 85.5%. CONCLUSION The histogram features on multi-parametric MRI of the primary tumor in rectal cancer were related to LN status, which is helpful for improving the ability to predict LNM of stage T3 rectal cancer.
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Affiliation(s)
- Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Rui Yang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang Province, China
| | - Yuan Wang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang Province, China
| | - Meng Zhou
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang Province, China
| | - Xueyan Zhou
- School of Technology, Harbin University, Harbin, Heilongjiang Province, China
| | - JiQing Xing
- Department of Physical Education, Harbin Engineering University, Harbin, 150001, Heilongjiang Province, China
| | - Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin, 150001, Heilongjiang Province, China.
| | - Chunhui Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.
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9
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Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
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Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
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10
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Li J, Wang P, Zhou Y, Liang H, Luan K. Application of Deep Transfer Learning to the Classification of Colorectal Cancer Lymph Node Metastasis. J Imaging Sci Technol 2021. [DOI: 10.2352/j.imagingsci.technol.2021.65.3.030401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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11
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Zhao AH, Matalon SA, Shinagare AB, Lee LK, Boland GW, Khorasani R. Improving the completeness of structured MRI reports for rectal cancer staging. Abdom Radiol (NY) 2021; 46:885-893. [PMID: 32949276 DOI: 10.1007/s00261-020-02754-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Assess the impact of a multifaceted intervention to improve the completeness of structured MRI reports for patients undergoing initial staging for rectal cancer. METHODS This Institutional Review Board-approved retrospective study was performed at a large academic hospital. MRI reports for initial staging of rectal cancer in 2017 and 2019 were analyzed pre- and post-implementation of multiple quality improvement interventions in 2018, including harmonizing MRI protocols across the institution, educational conferences and modules, and requiring second opinion consultation for all MRI rectal cancer examinations. The primary outcome measure was the completeness of rectal cancer staging MRI reports, classified as optimal, satisfactory, or unsatisfactory based on the inclusion of 15 quality measures pre-defined by a consensus of abdominal and cancer imaging subspecialists, colorectal surgeons, and radiation oncologists at our institution, based on published recommendations. Fisher's exact test was used to evaluate changes in report quality and documentation of each quality measure. RESULTS The study included 138 MRI reports, of which 72 (52%) were completed in 2017 pre-intervention. Post intervention, the proportion of optimal reports increased significantly from 52.8% (38/72) to 71.2% (47/66) (p = 0.035). Documentation of 1 quality measure (N stage) increased post intervention from 91.7% (66/72) to 100% (66/66) (p = 0.029). Documentation of 7 quality measures was 100% post intervention, with a documentation rate of > 95% for all quality measures except radial location of tumor. CONCLUSION A combination of educational and system-wide interventions was associated with an improvement in the completeness of structured MRI reports for rectal cancer staging.
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Affiliation(s)
- Anna H Zhao
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Shanna A Matalon
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Atul B Shinagare
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Leslie K Lee
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Giles W Boland
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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12
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Ding L, Liu G, Zhang X, Liu S, Li S, Zhang Z, Guo Y, Lu Y. A deep learning nomogram kit for predicting metastatic lymph nodes in rectal cancer. Cancer Med 2020; 9:8809-8820. [PMID: 32997900 PMCID: PMC7724302 DOI: 10.1002/cam4.3490] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Preoperative diagnoses of metastatic lymph nodes (LNs) by the most advanced deep learning technology of Faster Region‐based Convolutional Neural Network (Faster R‐CNN) have not yet been reported. Materials and Methods In total, 545 patients with pathologically confirmed rectal cancer between January 2016 and March 2019 were included and were randomly allocated with a split ratio of 2:1 to the training and validation sets, respectively. The MRI images for metastatic LNs were evaluated by Faster R‐CNN. Multivariate regression analyses were used to develop the predictive models. Faster R‐CNN nomograms were constructed based on the multivariate analyses in the training sets and were validated in the validation sets. Results The Faster R‐CNN nomogram for predicting metastatic LN status contained predictors of age, metastatic LNs by Faster R‐CNN and differentiation degrees of tumors, with areas under the curves (AUCs) of 0.862 (95% CI: 0.816‐0.909) and 0.920 (95% CI: 0.876‐0.964) in the training and validation sets, respectively. The Faster R‐CNN nomogram for predicting LN metastasis degree contained predictors of metastatic LNs by Faster R‐CNN and differentiation degrees of tumors, with AUCs of 0.859 (95% CI: 0.804‐0.913) and 0.886 (95% CI: 0.822‐0.950) in the training and validation sets, respectively. Calibration plots and decision curve analyses demonstrated good calibrations and clinical utilities. The two nomograms were used jointly as a kit for predicting metastatic LNs. Conclusion The Faster R‐CNN nomogram kit exhibits excellent performance in discrimination, calibration, and clinical utility and is convenient and reliable for predicting metastatic LNs preoperatively. Clinical trial registration: ChiCTR‐DDD‐17013842.
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Affiliation(s)
- Lei Ding
- Department of Epidemiology and Health Statistics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Quality Management and Evaluation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangwei Liu
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao University, Qingdao, Shandong, China.,Department of Outpatient Administration, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xianxiang Zhang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shanglong Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuai Li
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Zhengdong Zhang
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Yuting Guo
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Yun Lu
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao University, Qingdao, Shandong, China.,Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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13
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Zhao X, Xie P, Wang M, Li W, Pickhardt PJ, Xia W, Xiong F, Zhang R, Xie Y, Jian J, Bai H, Ni C, Gu J, Yu T, Tang Y, Gao X, Meng X. Deep learning-based fully automated detection and segmentation of lymph nodes on multiparametric-mri for rectal cancer: A multicentre study. EBioMedicine 2020; 56:102780. [PMID: 32512507 PMCID: PMC7276514 DOI: 10.1016/j.ebiom.2020.102780] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 12/16/2022] Open
Abstract
Background Accurate lymph nodes (LNs) assessment is important for rectal cancer (RC) staging in multiparametric magnetic resonance imaging (mpMRI). However, it is incredibly time-consumming to identify all the LNs in scan region. This study aims to develop and validate a deep-learning-based, fully-automated lymph node detection and segmentation (auto-LNDS) model based on mpMRI. Methods In total, 5789 annotated LNs (diameter ≥ 3 mm) in mpMRI from 293 patients with RC in a single center were enrolled. Fused T2-weighted images (T2WI) and diffusion-weighted images (DWI) provided input for the deep learning framework Mask R-CNN through transfer learning to generate the auto-LNDS model. The model was then validated both on the internal and external datasets consisting of 935 LNs and 1198 LNs, respectively. The performance for LNs detection was evaluated using sensitivity, positive predictive value (PPV), and false positive rate per case (FP/vol), and segmentation performance was evaluated using the Dice similarity coefficient (DSC). Findings For LNs detection, auto-LNDS achieved sensitivity, PPV, and FP/vol of 80.0%, 73.5% and 8.6 in internal testing, and 62.6%, 64.5%, and 8.2 in external testing, respectively, significantly better than the performance of junior radiologists. The time taken for model detection and segmentation was 1.3 s/case, compared with 200 s/case for the radiologists. For LNs segmentation, the DSC of the model was in the range of 0.81–0.82. Interpretation This deep learning–based auto-LNDS model can achieve pelvic LNseffectively based on mpMRI for RC, and holds great potential for facilitating N-staging in clinical practice.
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Affiliation(s)
- Xingyu Zhao
- University of Science and Technology of China, No.96 Jinzhai Road, Hefei, Anhui, 230026, China; Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China
| | - Peiyi Xie
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, No.26 Yuancunerheng Road, Guangzhou, Guangdong 510655, China
| | - Mengmeng Wang
- University of Science and Technology of China, No.96 Jinzhai Road, Hefei, Anhui, 230026, China; Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China
| | - Wenru Li
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, No.26 Yuancunerheng Road, Guangzhou, Guangdong 510655, China
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Wei Xia
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China
| | - Fei Xiong
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, No.26 Yuancunerheng Road, Guangzhou, Guangdong 510655, China
| | - Rui Zhang
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China
| | - Yao Xie
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, No.26 Yuancunerheng Road, Guangzhou, Guangdong 510655, China
| | - Junming Jian
- University of Science and Technology of China, No.96 Jinzhai Road, Hefei, Anhui, 230026, China; Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China
| | - Honglin Bai
- University of Science and Technology of China, No.96 Jinzhai Road, Hefei, Anhui, 230026, China; Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China
| | - Caifang Ni
- The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China
| | - Jinhui Gu
- Chinese Academy of Traditional Chinese Medicine, No. 16, Inner South Street, Dongzhimen, Beijing 100700, China; Guiyang College of Traditional Chinese Medicine, NO.50 Shi Dong Road, Guiyang, Guizhou 550002, China; The People's Hospital of Suzhou National Hi-Tech District, 215129, China
| | - Tao Yu
- Beijing Hospital General Surgery Department, National Center of Gerontology, No. 1, Donghua Dahua Road, Beijing 100730, China
| | - Yuguo Tang
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China
| | - Xin Gao
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, No. 88, Keling Road, Suzhou, Jiangsu 215163, China.
| | - Xiaochun Meng
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, No.26 Yuancunerheng Road, Guangzhou, Guangdong 510655, China.
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14
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Abstract
In recent years, rectal MRI has become a central diagnostic tool in rectal cancer staging. Indeed, rectal MR has the ability to accurately evaluate a number of important findings that may impact patient management, including distance of the tumor to the mesorectal fascia, presence of extramural vascular invasion (EMVI), presence of lymph nodes, and involvement of the peritoneum/anterior peritoneal reflection. Many of these findings are difficult to assess in nonexpert hands. In this review, we present a practical approach for radiologists to provide high-quality interpretations at initial baseline exams, based on recent guidelines from the Society of Abdominal Radiology, Rectal and Anal Cancer Disease Focused Panel. Practical pearls and pitfalls are discussed, focusing on optimization of technique including, patient preparation and protocol recommendations, interpretation, and essentials of reporting.
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15
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Elliot AH, Blomqvist L, Sigurdsson A, Martling A, Johansson H, Glimelius B, Nilsson PJ. An audit of performance, interpretation, and influence of pretherapeutic MRI in rectal cancer: a Swedish population-based cohort study. Acta Radiol 2019; 60:955-961. [PMID: 30322292 DOI: 10.1177/0284185118806638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The performance of magnetic resonance imaging (MRI) interpretation and communication of findings and its implication on treatment decisions has not fully been explored in rectal cancer. Purpose To investigate in a region the adherence to MRI protocol standards and the relation between MRI interpretation and selection to preoperative therapy in rectal cancer. Material and Methods Data on consecutive patients who underwent elective rectal cancer surgery in the region from January to June 2010 were obtained from the National Colorectal Cancer Registry. Pretherapeutic MRI images were re-evaluated. Agreement between the original reports and the re-evaluation was compared using Cohen’s kappa coefficient. Results Among the 94 patients included, 81 (86%) had pretherapeutic MRI in accordance with defined imaging guidelines. In 34% of the original MR reports, data on extramural venous invasion (mrEMVI) and mrT category were not reported. Complete tumor staging was not possible because of missing data in 33 (35%) of the patients. The agreement between the original MR reports and the re-evaluation regarding tumor stage was moderate (κ = 0.48). For decided treatment compared to recommended preoperative treatment according to the re-evaluation, the agreement was fair (κ = 0.33). Conclusion Established MRI protocol standards were not universally applied. Missing data and inadequacies in original MRI reports resulted in moderate agreement between the original report and the re-evaluation indicating a risk of inappropriate treatment selection. The results call for further educational efforts in rectal cancer MRI acquisition and repeated audits of image protocol adherence and interpretation quality.
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Affiliation(s)
- Anders H Elliot
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Lennart Blomqvist
- 2 Department of Molecular Medicine and Surgery, Karolinska Institutet, Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Martling
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- 4 Karolinska Institutet, Department of Oncology-Pathology (OnkPat), Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Glimelius
- 5 Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Per J Nilsson
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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16
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Artificial intelligence system of faster region-based convolutional neural network surpassing senior radiologists in evaluation of metastatic lymph nodes of rectal cancer. Chin Med J (Engl) 2019; 132:379-387. [PMID: 30707177 PMCID: PMC6595714 DOI: 10.1097/cm9.0000000000000095] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND An artificial intelligence system of Faster Region-based Convolutional Neural Network (Faster R-CNN) is newly developed for the diagnosis of metastatic lymph node (LN) in rectal cancer patients. The primary objective of this study was to comprehensively verify its accuracy in clinical use. METHODS Four hundred fourteen patients with rectal cancer discharged between January 2013 and March 2015 were collected from 6 clinical centers, and the magnetic resonance imaging data for pelvic metastatic LNs of each patient was identified by Faster R-CNN. Faster R-CNN based diagnoses were compared with radiologist based diagnoses and pathologist based diagnoses for methodological verification, using correlation analyses and consistency check. For clinical verification, the patients were retrospectively followed up by telephone for 36 months, with post-operative recurrence of rectal cancer as a clinical outcome; recurrence-free survivals of the patients were compared among different diagnostic groups, by methods of Kaplan-Meier and Cox hazards regression model. RESULTS Significant correlations were observed between any 2 factors among the numbers of metastatic LNs separately diagnosed by radiologists, Faster R-CNN and pathologists, as evidenced by rradiologist-Faster R-CNN of 0.912, rPathologist-radiologist of 0.134, and rPathologist-Faster R-CNN of 0.448 respectively. The value of kappa coefficient in N staging between Faster R-CNN and pathologists was 0.573, and this value between radiologists and pathologists was 0.473. The 3 groups of Faster R-CNN, radiologists and pathologists showed no significant differences in the recurrence-free survival time for stage N0 and N1 patients, but significant differences were found for stage N2 patients. CONCLUSION Faster R-CNN surpasses radiologists in the evaluation of pelvic metastatic LNs of rectal cancer, but is not on par with pathologists. TRIAL REGISTRATION www.chictr.org.cn (No. ChiCTR-DDD-17013842).
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17
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Alessandrino F, Cristiano L, Cinnante CM, Tartaglione T, Gerevini S, Verdolotti T, Colafati GS, Ghione E, Vitale R, Peverelli L, Brogna C, Berardinelli A, Moggio M, Mercuri EM, Pichiecchio A. Value of structured reporting in neuromuscular disorders. Radiol Med 2019; 124:628-635. [DOI: 10.1007/s11547-019-01012-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/21/2019] [Indexed: 11/27/2022]
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18
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Standardised reports with a template format are superior to free text reports: the case for rectal cancer reporting in clinical practice. Eur Radiol 2019; 29:5121-5128. [PMID: 30796574 PMCID: PMC6682848 DOI: 10.1007/s00330-019-06028-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/03/2019] [Accepted: 01/21/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Rectal cancer staging with magnetic resonance imaging (MRI) allows accurate assessment and preoperative staging of rectal cancers. Therefore, complete MRI reports are vital to treatment planning. Significant variability may exist in their content and completeness. Template-style reporting can improve reporting standards, but its use is not widespread. Given the implications for treatment, we have evaluated current clinical practice amongst specialist gastrointestinal (GI) radiologists to measure the quality of rectal cancer staging MRI reports. MATERIALS AND METHODS Sixteen United Kingdom (UK) colorectal cancer multi-disciplinary teams (CRC-MDTs) serving a population over 5 million were invited to submit up to 10 consecutive rectal cancer primary staging MRI reports from January 2016 for each radiologist participating in the CRC-MDT. Reports were compared to a reference standard based on recognised staging and prognostic factors influencing case management RESULTS: Four hundred ten primary staging reports were submitted from 41 of 42 (97.6%) eligible radiologists. Three hundred sixty reports met the inclusion criteria, of these, 81 (22.5%) used a template. Template report usage significantly increased recording of key data points versus non-template reports for extra-mural venous invasion (EMVI) status (98.8% v 51.6%, p < 0.01) and circumferential resection margin (CRM) status (96.3% v 65.9%, p < 0.01). Local tumour stage (97.5% v 93.5%, NS) and nodal status (98.8% v 96.1%, NS) were reported and with similar frequency. CONCLUSION Rectal cancer primary staging reports do not meet published standards. Template-style reports have significant increases in the inclusion of key tumour descriptors. This study provides further support for their use to improve reporting standards and outcomes in rectal cancer. KEY POINTS • MRI primary staging of rectal cancer requires detailed tumour descriptions as these alter the neoadjuvant and surgical treatments. • Currently, rectal cancer MRI reports in clinical practice do not provide sufficient detail on these tumour descriptors. • The use of template-style reports for primary staging of rectal cancer significantly improves report quality compared to free-text reports.
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19
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Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017. Abdom Radiol (NY) 2018; 43:2893-2902. [PMID: 29785540 DOI: 10.1007/s00261-018-1642-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To propose guidelines based on an expert-panel-derived unified approach to the technical performance, interpretation, and reporting of MRI for baseline and post-treatment staging of rectal carcinoma. METHODS A consensus-based questionnaire adopted with permission and modified from the European Society of Gastrointestinal and Abdominal Radiologists was sent to a 17-member expert panel from the Rectal Cancer Disease-Focused Panel of the Society of Abdominal Radiology containing 268 question parts. Consensus on an answer was defined as ≥ 70% agreement. Answers not reaching consensus (< 70%) were noted. RESULTS Consensus was reached for 87% of items from which recommendations regarding patient preparation, technical performance, pulse sequence acquisition, and criteria for MRI assessment at initial staging and restaging exams and for MRI reporting were constructed. CONCLUSION These expert consensus recommendations can be used as guidelines for primary and post-treatment staging of rectal cancer using MRI.
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20
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Lu Y, Yu Q, Gao Y, Zhou Y, Liu G, Dong Q, Ma J, Ding L, Yao H, Zhang Z, Xiao G, An Q, Wang G, Xi J, Yuan W, Lian Y, Zhang D, Zhao C, Yao Q, Liu W, Zhou X, Liu S, Wu Q, Xu W, Zhang J, Wang D, Sun Z, Gao Y, Zhang X, Hu J, Zhang M, Wang G, Zheng X, Wang L, Zhao J, Yang S. Identification of Metastatic Lymph Nodes in MR Imaging with Faster Region-Based Convolutional Neural Networks. Cancer Res 2018; 78:5135-5143. [PMID: 30026330 DOI: 10.1158/0008-5472.can-18-0494] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/15/2018] [Accepted: 07/09/2018] [Indexed: 12/25/2022]
Abstract
MRI is the gold standard for confirming a pelvic lymph node metastasis diagnosis. Traditionally, medical radiologists have analyzed MRI image features of regional lymph nodes to make diagnostic decisions based on their subjective experience; this diagnosis lacks objectivity and accuracy. This study trained a faster region-based convolutional neural network (Faster R-CNN) with 28,080 MRI images of lymph node metastasis, allowing the Faster R-CNN to read those images and to make diagnoses. For clinical verification, 414 cases of rectal cancer at various medical centers were collected, and Faster R-CNN-based diagnoses were compared with radiologist diagnoses using receiver operating characteristic curves (ROC). The area under the Faster R-CNN ROC was 0.912, indicating a more effective and objective diagnosis. The Faster R-CNN diagnosis time was 20 s/case, which was much shorter than the average time (600 s/case) of the radiologist diagnoses.Significance: Faster R-CNN enables accurate and efficient diagnosis of lymph node metastases. Cancer Res; 78(17); 5135-43. ©2018 AACR.
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Affiliation(s)
- Yun Lu
- Affiliated Hospital of Qingdao University, Qingdao, China. .,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Qiyue Yu
- Affiliated Hospital of Qingdao University, Qingdao, China. .,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Yuanxiang Gao
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunpeng Zhou
- Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Guangwei Liu
- Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Qian Dong
- Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China
| | - Jinlong Ma
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Ding
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Gang Xiao
- Beijing Hospital & National Center of Gerontology, Beijing. China
| | - Qi An
- Beijing Hospital & National Center of Gerontology, Beijing. China
| | - Guiying Wang
- Fourth Hospital of Hebei Medical University, Hebei, China
| | - Jinchuan Xi
- Fourth Hospital of Hebei Medical University, Hebei, China
| | - Weitang Yuan
- First Affiliated Hospital of Zhengzhou University, Zhenzhou, China
| | - Yugui Lian
- First Affiliated Hospital of Zhengzhou University, Zhenzhou, China
| | | | | | - Qin Yao
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Liu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoming Zhou
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuhao Liu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qingyao Wu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjian Xu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianli Zhang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dongshen Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhenqing Sun
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuan Gao
- Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Jilin Hu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Maoshen Zhang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guanrong Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuefeng Zheng
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Wang
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jie Zhao
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shujian Yang
- Affiliated Hospital of Qingdao University, Qingdao, China
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Do MRI Structured Reports for Multiple Sclerosis Contain Adequate Information for Clinical Decision Making? AJR Am J Roentgenol 2018; 210:24-29. [DOI: 10.2214/ajr.17.18451] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Structured Reporting of Rectal Magnetic Resonance Imaging in Suspected Primary Rectal Cancer: Potential Benefits for Surgical Planning and Interdisciplinary Communication. Invest Radiol 2017; 52:232-239. [PMID: 27861230 DOI: 10.1097/rli.0000000000000336] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of structured reports (SRs) in comparison to nonstructured, free-text (FT) rectal magnetic resonance imaging (MRI) reports in patients with histologically proven rectal cancer and potential effects of both types of reporting on referring surgeons' satisfaction, interdisciplinary communication, and further clinical decision making. MATERIALS AND METHODS The institutional review board approved this retrospective study with waiver of informed consent. Forty-nine patients with histologically proven rectal cancer were included in this study. All patients underwent rectal MRI for local rectal cancer staging before surgery. Free-text reports and SRs for local MR staging of rectal cancer were generated for all subjects by radiologists. Two experienced abdominal surgeons evaluated a questionnaire that included 9 questions regarding satisfaction with content, presence of reported key features, effort for information extraction, and report quality. RESULTS Structured reports achieved significantly higher satisfaction rates with report content and clarity, and included significantly more of the 13 predefined key features compared with FT reports (SRs: mean ± SD, 12.2 ± 4.6 [range, 9-13] versus FT reports: mean ± SD, 9.2 ± 10.8 [range, 5-13]) (P < 0.001). Definite further clinical decision making (surgery vs neoadjuvant radiochemotherapy) was possible in 96% of SRs and only in 60% of FT reports (P < 0.001). In case of surgery, the reported information was considered to be sufficient for surgical planning in 94% of SRs versus only 38% in FT reports (P < 0.001). Structured report received a significantly higher overall report quality rated on a Likert scale from 1 to 6 (1, insufficient; 6, excellent) with a mean of 5.8 ± 0.42 (range, 5-6) in comparison to FT reports with 3.6 ± 1.19 (range, 1-5) (P < 0.001). CONCLUSIONS Structured reporting of rectal MRI in patients with rectal cancer facilitates surgical planning and leads to a higher satisfaction level of referring surgeons in comparison to FT reports. Abdominal surgeons were more confident about report correctness and further clinical decision making on the basis of SRs.
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23
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An audit comparing the reporting of staging MRI scans for rectal cancer with the London Cancer Alliance (LCA) guidelines. Eur J Surg Oncol 2017; 43:2093-2104. [DOI: 10.1016/j.ejso.2017.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/30/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023] Open
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24
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Op de Beeck B, Smeets P, Penninckx F, Pattyn P, Silversmit G, Van Eycken E. Accuracy of pre-treatment locoregional rectal cancer staging in a national improvement project. Acta Chir Belg 2017; 117:104-109. [PMID: 27881048 DOI: 10.1080/00015458.2016.1259883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to assess the accuracy, particularly the predictive value, of locoregional clinical rectal cancer staging (cTN) and its variability in a national improvement project. METHODS cTN stages and the distance between tumour and mesorectal fascia (MRF) were compared with histopathological findings in 1168 patients who underwent radical resection without neoadjuvant treatment. Data were registered prospectively from 2006 to 2014. RESULTS Agreement between clinical and histopathological TN stages was 50%, independent of tumour location. Inter-hospital variability was within 99% prediction limits. Magnetic resonance imaging (MRI) was increasingly applied, but staging accuracy did not improve. Stage II-III was correctly predicted in 69% and pStage I was over-staged in 35%. The positive predictive value of endorectal ultrasonography (ERUS) for T1 lesions was 57%. MRI-based distances to MRF correlated poorly with the circumferential resection margin (r = 0.26). A negative resection margin was achieved in 91% when the distance to the MRF was >1 mm. CONCLUSIONS The accuracy of rectal cancer staging in general practice should be improved to avoid under- or overtreatment. Training and expert review of pre-treatment MR imaging could be helpful. A second ERUS is justified when transanal local resection for early lesions is planned.
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Affiliation(s)
| | - Peter Smeets
- Department of Radiology, University Hospital, Gent, Belgium
| | - Freddy Penninckx
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, University Hospital, Gent, Belgium
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25
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Tarulli E, Thipphavong S, Jhaveri K. A structured approach to reporting rectal cancer with magnetic resonance imaging. ACTA ACUST UNITED AC 2016; 40:3002-11. [PMID: 26239398 DOI: 10.1007/s00261-015-0518-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Rectal cancers are the second most common GI carcinoma. Prognosis and therapeutic decisions hinge on the extent of disease. We present a comprehensive structured approach for staging rectal cancer using MRI to ensure the clear, concise, and standardized communication of disease extent to guide optimal treatment planning. CONCLUSION MRI is crucial for local staging of rectal cancer. A standardized approach to reporting of rectal MRI focused on communication of essential treatment planning and prognostic indicators ensures maximal added value to referring physicians to guide appropriate management.
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Affiliation(s)
- Emidio Tarulli
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, 263 McCaul Street - 4th Floor, Toronto, ON, M5T 1W7, Canada.
| | - Seng Thipphavong
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, 263 McCaul Street - 4th Floor, Toronto, ON, M5T 1W7, Canada.,Joint Department of Medical Imaging, University Health Network, Mt. Sinai and WCH, 610 University Ave, 3-957, Toronto, ON, M5G 2M9, Canada
| | - Khartik Jhaveri
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, 263 McCaul Street - 4th Floor, Toronto, ON, M5T 1W7, Canada.,Joint Department of Medical Imaging, University Health Network, Mt. Sinai and WCH, 610 University Ave, 3-957, Toronto, ON, M5G 2M9, Canada
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26
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Impact of a Structured Report Template on the Quality of MRI Reports for Rectal Cancer Staging. AJR Am J Roentgenol 2015; 205:584-8. [PMID: 26295645 DOI: 10.2214/ajr.14.14053] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to assess the impact of implementing a structured report template on the quality of MRI reports for rectal cancer staging. MATERIALS AND METHODS After excluding examinations performed after surgery or neoadjuvant therapy, we analyzed all rectal cancer staging MRI reports finalized at an academic medical center 12 months before and after an intervention consisting of implementing a structured report template integrated into the institution's speech recognition system. The primary outcome measure was the quality of rectal cancer staging MRI reports classified as optimal, satisfactory, or unsatisfactory, on the basis of the documentation of 14 quality measures predefined by a consensus of the institution's abdominal radiology subspecialists. Chi-square and t tests were used to assess differences in report quality and documentation of each discrete quality measure before and after the intervention. RESULTS The study cohort included 106 MRI reports from 104 patients (mean age, 60 years; 58.5% male); 52 (49.1%) of the reports were completed before implementation of the structured report template. After implementation, the proportion of total reports classified as optimal or satisfactory increased from 38.5% (20/52) to 70.4% (38/54) (p = 0.0010). No reports generated before the intervention were classified as optimal, whereas 40.7% (22/54) of reports were classified as optimal after the intervention. CONCLUSION Implementation and voluntary use of a structured report template improved the quality of MRI reports for rectal cancer staging compared with free-text format.
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Frenkel JL, Marks JH. Predicting the risk of lymph node metastasis in early rectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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28
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Utility of reassessment after neoadjuvant therapy and difficulties in interpretation. Diagn Interv Imaging 2014; 95:495-503. [DOI: 10.1016/j.diii.2014.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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29
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Attenberger UI, Pilz LR, Morelli JN, Hausmann D, Doyon F, Hofheinz R, Kienle P, Post S, Michaely HJ, Schoenberg SO, Dinter DJ. Multi-parametric MRI of rectal cancer - do quantitative functional MR measurements correlate with radiologic and pathologic tumor stages? Eur J Radiol 2014; 83:1036-1043. [PMID: 24791649 DOI: 10.1016/j.ejrad.2014.03.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/27/2014] [Accepted: 03/11/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study is two-fold. First, to evaluate, whether functional rectal MRI techniques can be analyzed in a reproducible manner by different readers and second, to assess whether different clinical and pathologic T and N stages can be differentiated by functional MRI measurements. MATERIALS AND METHODS 54 patients (38 men, 16 female; mean age 63.2 ± 12.2 years) with pathologically proven rectal cancer were included in this retrospective IRB-approved study. All patients were referred for a multi-parametric MRI protocol on a 3 Tesla MR-system, consisting of a high-resolution, axial T2 TSE sequence, DWI and perfusion imaging (plasma flow -s PFTumor) prior to any treatment. Two experienced radiologists evaluated the MRI measurements, blinded to clinical data and outcome. Inter-reader correlation and the association of functional MRI parameters with c- and p-staging were analyzed. RESULTS The inter-reader correlation for lymph node (ρ 0.76-0.94; p<0.0002) and primary tumor (ρ 0.78-0.92; p<0.0001) apparent diffusion coefficient and plasma flow (PF) values was good to very good. PFTumor values decreased with cT stage with significant differences identified between cT2 and cT3 tumors (229 versus 107.6 ml/100ml/min; p=0.05). ADCTumor values did not differ significantly. No substantial discrepancies in lymph node ADCLn values or short axis diameter were found among cN1-3 stages, whereas PFLn values were distinct between cN1 versus cN2 stages (p=0.03). In the patients without neoadjuvant RCT no statistically significant differences in the assessed functional parameters on the basis of pathologic stage were found. CONCLUSION This study illustrates that ADC as well as MR perfusion values can be analyzed with good interobserver agreement in patients with rectal cancer. Moreover, MR perfusion parameters may allow accurate differentiation of tumor stages. Both findings suggest that functional MRI parameters may help to discriminate T and N stages for clinical decision making.
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Affiliation(s)
- U I Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany
| | - L R Pilz
- Medical Faculty Mannheim, University of Heidelberg, Germany
| | - J N Morelli
- Scott & White Memorial Hospital and Clinic, Temple, TX, USA
| | - D Hausmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany.
| | - F Doyon
- Department of Surgery, University Medical Center Mannheim, Germany
| | - R Hofheinz
- Department of Oncology, University Medical Center Mannheim, Germany
| | - P Kienle
- Department of Surgery, University Medical Center Mannheim, Germany
| | - S Post
- Department of Surgery, University Medical Center Mannheim, Germany
| | - H J Michaely
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany
| | - S O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany
| | - D J Dinter
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany
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