The potential predictive value of MRI and PET-CT in mucinous and nonmucinous rectal cancer to identify patients at high risk of metastatic disease

Brunella Barbaro, Claudio Coco, Roberto Persiani, Sergio Alfieri, Maria Antonietta Gambacorta, Vincenzo Valentini, Alessandro Giordano, Lucia Leccisotti, Fabio Maria Vecchio, Marialuisa Di Matteo, Marco Salsano, Andrea Poscia, Lorenzo Bonomo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

14 Citazioni (Scopus)

Abstract

Objective: To correlate imaging parameters from baseline MRI diffusion-weighted imaging (DWI) and fludeoxyglucose (FDG) positron emission tomography (PET)-CT with synchronous and metachronous metastases in mucinous carcinoma (MC) and non-mucinous carcinoma (NMC) rectal cancer. Methods: 111 patients with extraperitoneal locally advanced rectal cancer, who underwent pelvic MRI, DWI and FDG PET-CT, were stratified into MC (n523) and NMC (n588). We correlated adverse morphologic features on MRI [mT4, mesorectal fascia involvement, extramural venous invasion (mEMVI), mN2] and quantitative imaging parameters [minimum apparent diffusion coefficient (ADCmin), maximum standardized uptake value, total lesion glycolysis, metabolic tumour volume, T2 weighted and DWI tumour volumes] with the presence of metastatic disease. All patients underwent preoperative chemoradiation therapy (CRT); 100/111 patients underwent surgery after CRT and were classified as pathological complete response (PCR) and no PCR [tumour regression grade (TRG)1 vs TRG2-5] and as ypN0 and ypN1-2. Median follow-up time was 48 months. Metastases were confirmed on FDG PET-CT and contrastenhanced multidetector CT. Results: The percentage of mucin measured by MRI correlates with that quantified by histology. On multivariate analysis, the synchronous metastases were correlated with mEMVI [odds ratio (OR) 5 21.48, p,0.01] and low ADCmin (OR50.04, p50.038) in NMC. The difference of metachronous recurrence between the MC group (10-90% mucin) and NMC group was significant (p,0.01) (OR521.67, 95% confidence interval 3.8-120.5). Metachronous metastases were correlated with ypN2 (OR58.24, p50.01) in MC and in NMC. In NMC, mEMVI correlated with no PCR (p50.018) and ypN2 (p,0.01). Conclusion: mEMVI could identify patients with NMC, who are at high risk of synchronous metastases. The MC group is at a high risk of developing metachronous metastases. Advances in knowledge: Patients at high risk of metastases are more likely to benefit from more aggressive neoadjuvant therapy.
Lingua originaleEnglish
pagine (da-a)20150836-N/A
RivistaBritish Journal of Radiology
Volume90
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Radiology, Nuclear Medicine and Imaging

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