Abstract
Objective
To evaluate the accuracy of MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor.
Materials and methods
Thirty-seven patients with rectal tumor underwent preoperative MDCT. Two radiologists evaluated the depth of tumor invasion (T staging), regional lymph node involvement (N staging) and mesorectal fascia involvement on axial, sagittal, and coronal multiplanar reconstruction images in consensus. MDCT findings were compared with pathologic results, which served as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed.
Results
Overall accuracy was 86% in T staging, 84% in N staging, 89% in International Union Against Cancer (UICC) Staging, and 94.5% in the prediction of mesorectal fascia involvement.
Conclusion
MDCT with multiplanar reconstruction is an accurate technique in the preoperative local staging of rectal tumor.
Similar content being viewed by others
References
Beets-Tan RG, Beets GL (2004) Rectal cancer: review with emphasis on MR imaging. Radiology 232:335–346
Tang R, Wang JY, Chen JS, et al. (1995) Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum. J Am Coll Surg 180:705–712
Adam IJ, Mohamdee MO, Martin IG, et al. (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711
Cecil TD, Sexton R, Moran BJ, Heald RJ (2004) Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Dis Colon Rectum 47:1145–1149 (discussion 1149–1150)
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482
Reynolds JV, Joyce WP, Dolan J, Sheahan K, Hyland JM (1996) Pathological evidence in support of total mesorectal excision in the management of rectal cancer. Br J Surg 83:1112–1115
Påhlman L, Glimelius B (1995) The value of adjuvant radio(chemo)therapy for rectal cancer. Eur J Cancer 31A:1347–1350
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646
Bipat S, Glas AS, Slors FJ, et al. (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging-a meta-analysis. Radiology 232:773–783
Hermanek P, Wiebelt H, Staimmer D, Riedl S (1995) Prognostic factors of rectum carcinoma-experience of the German Multicentre Study SGCRC. German Study Group Colo-Rectal Carcinoma. Tumori 81:60–64
Arbman G, Nilsson E, Hallböök O, Sjödahl R (1996) Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 83:375–379
Sauer R, Becker H, Hohenberger W, et al. (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740
Colorectal Cancer Collaborative Group (2001) Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet 358:1291–1304
Bianchi PP, Ceriani C, Rottoli M, et al. (2005) Endoscopic ultrasonography and magnetic resonance in preoperative staging of rectal cancer: comparison with histologic findings. J Gastrointest Surg 9:1222–1227 (discussion 1227–1228)
Taylor A, Sheridan M, McGee S, Halligan S (2005) Preoperative staging of rectal cancer by MRI; results of a UK survey. Clin Radiol 60:579–586
Ganai S, Kanumuri P, Rao RS, Alexander AI (2006) Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers. Ann Surg Oncol 13:547–556
Gualdi GF, Casciani E, Guadalaxara A, et al. (2000) Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings. Dis Colon Rectum 43:338–345
Akasu T, Sugihara K, Moriya Y, Fujita S (1997) Limitations and pitfalls of transrectal ultrasonography for staging of rectal cancer. Dis Colon Rectum 40:10–15
Merkel S, Mansmann U, Siassi M, et al. (2001) The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Colorectal Dis 16:298–304
Sinha R, Verma R, Rajesh A, Richards CJ (2006) Diagnostic value of multidetector row CT in rectal cancer staging: comparison of multiplanar and axial images with histopathology. Clin Radiol 61:924–931
Kulinna C, Eibel R, Matzek W, et al. (2004) Staging of rectal cancer: diagnostic potential of multiplanar reconstructions with MDCT. AJR Am J Roentgenol 183:421–427
Filippone A, Ambrosini R, Fuschi M, et al. (2004) Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography-initial experience. Radiology 231:83–90
Quirke P, Dixon MF (1988) The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorectal Dis 3:127–131
Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357
Vliegen R, Dresen R, Beets G, et al. (2008) The accuracy of Multi-detector row CT for the assessment of tumor invasion of the mesorectal fascia in primary rectal cancer. Abdom Imaging 33:604–610
Taylor A, Slater A, Mapstone N, Taylor S, Halligan S (2007) Staging rectal cancer: MRI compared to MDCT. Abdom Imaging 32:323–327
Slater A, Halligan S, Taylor SA, Marshall M (2006) Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin. Clin Radiol 61:65–70
Kulinna C, Scheidler J, Strauss T, et al. (2004) Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound. J Comput Assist Tomogr 28:123–130
Chung DJ, Huh KC, Choi WJ, Kim JK (2005) CT colonography using 16-MDCT in the evaluation of colorectal cancer. AJR Am J Roentgenol 184:98–103
Ethical standards.
The experiments comply with the current laws of our country.
Conflict of interest.
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ahmetoğlu, A., Cansu, A., Baki, D. et al. MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. Abdom Imaging 36, 31–37 (2011). https://doi.org/10.1007/s00261-009-9591-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-009-9591-y