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CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2022; 05(01): 001-015
DOI: 10.1055/s-0041-1726662
Original Article

Accuracy of High Resolution Multidetector Computed Tomography in the Local Staging of Rectal Cancer

Rochita Venkata Ramanan
1   Department of Radiology, Apollo Hospitals, Chennai, Tamil Nadu, India
,
Venkatesh Munikrishnan
2   Department of Colorectal Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India
,
Akash Venkataramanan
3   Madras Medical College, Park Town, Chennai, Tamil Nadu, India
,
Sudeepta Kumar Swain
2   Department of Colorectal Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India
,
Kaveripattu Sathiyamurthy Sunilkumar
4   Department of Pathology, Apollo Hospitals, Chennai, Tamil Nadu, India
,
Vadanika Venu
1   Department of Radiology, Apollo Hospitals, Chennai, Tamil Nadu, India
,
Muthuswamy Hariharan
5   Department of Medical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
,
Mohammad Zehran Saipillai
6   Department of Medical Oncology, Apollo Cancer Centre, Teynampet, Chennai, Tamil Nadu, India
,
Asfar Ahamed
2   Department of Colorectal Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India
› Author Affiliations Funding None.
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Abstract

Background Magnetic resonance imaging (MRI) is the gold standard for local staging of rectal cancer. Advanced computed tomography (CT) machines are now capable of high-resolution images of rectal cancer and utilized for CT perfusion. The possibility of local staging of rectal cancer by CT needs to be explored.

Purpose The aim of the study is to evaluate accuracy of high-resolution CT for local rectal cancer staging.

Methods A high-resolution CT was performed for local staging of rectal cancer in our study group of 93 patients, where 64 underwent primary surgery and 29 underwent surgery post neoadjuvant chemoradiotherapy (NACRT).

Results In differentiating stages T2-and-less than T2 from T3–T4 rectal cancer, accuracy, sensitivity, specificity, and kappa score in overall patients were 91%, 87%, 94%, and 0.8; in primary surgery group were 89%, 76%, 94%, and 0.7; in NACRT group were 97%, 100%, 94%, and 0.9; in low rectal group were 94%, 89%, 97%, and 0.82, respectively.

Conclusion High resolution CT is an accurate tool for local staging of rectal cancer.

Keywords

accuracy of CT staging - rectal cancer - mesorectal fascia - histopathology


Publication History

Article published online:
30 April 2021

© 2021. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Raman SP, Chen Y, Fishman EK. Evolution of imaging in rectal cancer: multimodality imaging with MDCT, MRI, and PET. J Gastrointest Oncol 2015; 6 (02) 172-184
    PubMedGoogle Scholar
  • 2 Mathur P, Smith JJ, Ramsey C. et al. Comparison of CT and MRI in the pre-operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI. Colorectal Dis 2003; 5 (05) 396-401
    CrossrefPubMedGoogle Scholar
  • 3 Beets-Tan RG, Beets GL. Local staging of rectal cancer: a review of imaging. J Magn Reson Imaging 2011; 33 (05) 1012-1019
    CrossrefPubMedGoogle Scholar
  • 4 Li XT, Zhang XY, Sun YS, Tang L, Cao K. Evaluating rectal tumor staging with magnetic resonance imaging, computed tomography, and endoluminal ultrasound: a meta-analysis. Medicine (Baltimore) 2016; 95 (44) e5333
    CrossrefPubMedGoogle Scholar
  • 5 Shida D, Iinuma G, Komono A. et al. Preoperative T staging using CT colonography with multiplanar reconstruction for very low rectal cancer. BMC Cancer 2017; 17 (01) 764
    CrossrefPubMedGoogle Scholar
  • 6 Goh V, Glynne-Jones R. Perfusion CT imaging of colorectal cancer. Br J Radiol 2014; 87 (10/34) 20130811
    CrossrefPubMedGoogle Scholar
  • 7 Raman SP, Fishman EK. Abnormalities of the distal common bile duct and ampulla: diagnostic approach and differential diagnosis using multiplanar reformations and 3D imaging. AJR Am J Roentgenol 2014; 203 (01) 17-28
    CrossrefPubMedGoogle Scholar
  • 8 Zhu H, Zhang L, Wang Y. et al. Improved image quality and diagnostic potential using ultra-high-resolution computed tomography of the lung with small scan FOV: a prospective study. PLoS One 2017; 12 (02) e0172688
    CrossrefPubMedGoogle Scholar
  • 9 Nishiharu T, Yamashita Y, Ogata I, Sumi S, Mitsuzaki K, Takahashi M. Spiral CT of the pancreas. The value of small field-of-view targeted reconstruction. Acta Radiol 1998; 39 (01) 60-63
    CrossrefPubMedGoogle Scholar
  • 10 Sheedy SP, Kolbe AB, Fletcher JG, Fidler JL. Computed tomography enterography. Radiol Clin North Am 2018; 56 (05) 649-670
    CrossrefPubMedGoogle Scholar
  • 11 Sharma R, Madhusudhan KS, Ahuja V. Intestinal tuberculosis versus Crohn’s disease: clinical and radiological recommendations. Indian J Radiol Imaging 2016; 26 (02) 161-172
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Sinha R, Verma R, Rajesh A, Richards CJ. Diagnostic value of multidetector row CT in rectal cancer staging: comparison of multiplanar and axial images with histopathology. Clin Radiol 2006; 61 (11) 924-931
    CrossrefPubMedGoogle Scholar
  • 13 Ippolito D, Drago SG, Franzesi CT, Fior D, Sironi S. Rectal cancer staging: multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion. World J Gastroenterol 2016; 22 (20) 4891-4900
    CrossrefPubMedGoogle Scholar
  • 14 Karlo CA, Leschka S, Stolzmann P, Glaser-Gallion N, Wildermuth S, Alkadhi H. A systematic approach for analysis, interpretation, and reporting of coronary CTA studies. Insights Imaging 2012; 3 (03) 215-228
    CrossrefPubMedGoogle Scholar
  • 15 Al-Sukhni E, Milot L, Fruitman M. et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 2012; 19 (07) 2212-2223
    CrossrefPubMedGoogle Scholar
  • 16 Flor N, Mezzanzanica M, Rigamonti P. et al. Contrast-enhanced computed tomography colonography in preoperative distinction between T1-T2 and T3-T4 staging of colon cancer. Acad Radiol 2013; 20 (05) 590-595
    CrossrefPubMedGoogle Scholar
  • 17 Wolberink SV, Beets-Tan RG, de Haas-Kock DF, van de Jagt EJ, Span MM, Wiggers T. Multislice CT as a primary screening tool for the prediction of an involved mesorectal fascia and distant metastases in primary rectal cancer: a multicenter study. Dis Colon Rectum 2009; 52 (05) 928-934
    CrossrefPubMedGoogle Scholar
  • 18 Vliegen R, Dresen R, Beets G. et al. The accuracy of multi-detector row CT for the assessment of tumor invasion of the mesorectal fascia in primary rectal cancer. Abdom Imaging 2008; 33 (05) 604-610
    CrossrefPubMedGoogle Scholar
  • 19 de Jong EA, ten Berge JC, Dwarkasing RS, Rijkers AP, van Eijck CH. The accuracy of MRI, endorectal ultrasonography, and computed tomography in predicting the response of locally advanced rectal cancer after preoperative therapy: a metaanalysis. Surgery 2016; 159 (03) 688-699
    CrossrefPubMedGoogle Scholar
  • 20 van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology 2013; 269 (01) 101-112
    CrossrefPubMedGoogle Scholar
  • 21 Rössler O, Betge J, Harbaum L, Mrak K, Tschmelitsch J, Langner C. Tumor size, tumor location, and antitumor inflammatory response are associated with lymph node size in colorectal cancer patients. Mod Pathol 2017; 30 (06) 897-904
    CrossrefPubMedGoogle Scholar
  • 22 Koh DM, Chau I, Tait D, Wotherspoon A, Cunningham D, Brown G. Evaluating mesorectal lymph nodes in rectal cancer before and after neoadjuvant chemoradiation using thin-section T2-weighted magnetic resonance imaging. Int J Radiat Oncol Biol Phys 2008; 71 (02) 456-461
    CrossrefPubMedGoogle Scholar
  • 23 Kaur H, Choi H, You YN. et al. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. Radiographics 2012; 32 (02) 389-409
    CrossrefPubMedGoogle Scholar
  • 24 Burlin S, Favaro LR, Bretas EA. et al. Using computed tomography enterography to evaluate patients with Crohn’s disease: what impact does examiner experience have on the reproducibility of the method?. Radiol Bras 2017; 50 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 25 Maas M, Lambregts DM, Lahaye MJ. et al. T-staging of rectal cancer: accuracy of 3.0 Tesla MRI compared with 1.5 Tesla. Abdom Imaging 2012; 37 (03) 475-481
    CrossrefPubMedGoogle Scholar
  • 26 Wnorowski AM, Menias CO, Pickhardt PJ, Kim DH, Hara AK, Lubner MG. Mucin-containing rectal carcinomas: overview of unique clinical and imaging features. AJR Am J Roentgenol 2019; 213 (01) 26-34
    CrossrefPubMedGoogle Scholar
  • 27 Scheele J, Schmidt SA, Tenzer S, Henne-Bruns D, Kornmann M. Overstaging: a challenge in rectal cancer treatment. Visc Med 2018; 34 (04) 301-306
    CrossrefPubMedGoogle Scholar
  • 28 Maizlin ZV, Brown JA, So G. et al. Can CT replace MRI in preoperative assessment of the circumferential resection margin in rectal cancer?. Dis Colon Rectum 2010; 53 (03) 308-314
    CrossrefPubMedGoogle Scholar
  • 29 Dar RA, Chowdri NA, Parray FQ, Shaheen F, Wani SH, Mushtaque M. Pre-operative staging of rectal cancer using multi-detector row computed tomography with multiplanar reformations: single center experience. Indian J Cancer 2014; 51 (02) 170-175
    CrossrefPubMedGoogle Scholar
  • 30 Brian Arthur W. The mechanisms of evolution. In: The Nature of Technology. What It Is and How It Evolves 1st ed.. London, Great Britain: Penguin books; 2010. 167– 189
    Google Scholar