Prognostic Aspects of DCE-MRI in Recurrent Rectal Cancer

• Published in: European radiology 2013-12, Vol.23 (12), p.3336-3344
• Main Authors: Gollub, M. J., Cao, K., Gultekin, D. H., Kuk, D., Gonen, M., Sohn, M., Schwartz, L. H., Weiser, M. R., Temple, L. K., Nash, G. M., Guillem, J. G., Wang, M., Garcia-Aguilar, J., Goodman, K., Paty, P. B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cancer therapies; Chemoradiotherapy; Clinical outcomes; Colorectal cancer; Contrast Media; Diagnostic Radiology; Female; Gastrointestinal; Humans; Image Enhancement - methods; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Morphology; Neoadjuvant Therapy; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Neuroradiology; Patients; Preoperative Care; Prognosis; Proportional Hazards Models; Radiology; Rectal Neoplasms - diagnosis; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Reoperation; Retrospective Studies; Surgery; Survival Rate; Treatment Outcome; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-013-2984-x

Objective To explore whether pre-reoperative dynamic contrast-enhanced (DCE)-MRI findings correlate with clinical outcome in patients who undergo surgical treatment for recurrent rectal carcinoma. Methods A retrospective study of DCE-MRI in patients with recurrent rectal cancer was performed after obtaining an IRB waiver. We queried our PACS from 1998 to 2012 for examinations performed for recurrent disease. Two radiologists in consensus outlined tumour regions of interest on perfusion images. We explored the correlation between K trans , K ep , V e , AUC90 and AUC180 with time to re-recurrence of tumour, overall survival and resection margin status. Univariate Cox PH models were used for survival, while univariate logistic regression was used for margin status. Results Among 58 patients with pre-treatment DCE-MRI who underwent resection, 36 went directly to surgery and 18 had positive margins. K trans (0.55, P  = 0.012) and K ep (0.93, P  = 0.04) were inversely correlated with positive margins. No significant correlations were noted between K trans , K ep , V e , AUC90 and AUC180 and overall survival or time to re-recurrence of tumour. Conclusion K trans and K ep were significantly associated with clear resection margins; however overall survival and time to re-recurrence were not predicted. Such information might be helpful for treatment individualisation and deserves further investigation. Key Points • Morphological MRI features are not sufficiently predictive of complete rectal tumour resection . • Survival and time to re-recurrence of tumour were not predicted by DCE-MRI. • But perfusion data from dynamic enhanced MRI may provide more helpful information. • Ktrans/Kep were shown to be significantly associated with clear resection margins. • Functional information from DCE-MRI might be helpful for treatment individualisation.