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Title: Primary and post-chemoradiotherapy staging using MRI in rectal cancer: the role of diffusion imaging in the assessment of perirectal infiltration
Authors: Fornell-Perez, Roberto
Perez-Alonso, Esteban 
Porcel-de-Peralta, Gabriela
Duran-Castellon, Alfonso
Vivas-Escalona, Valentina
Aranda-Sanchez, Joel
Gonzalez-Dominguez, Maria Carmen
Rubio-Garcia, Jano
Alemán-Flores, Patricia
Lozano-Rodriguez, Alvaro
Orihuela-de-la-Cal, Maria Elena
Loro-Ferrer, Juan Francisco 
UNESCO Clasification: 32 Ciencias médicas
Keywords: Diffusion-Weighted Imaging
Magnetic Resonance Imaging
Neoadjuvant Chemoradiotherapy
Rectal Neoplasms
Issue Date: 2019
Journal: Abdominal Radiology 
Abstract: Purpose: To analyze changes in MRI diagnostic accuracy in main rectal tumor (T) evaluation resulting from the use of diffusion-weighted imaging (DWI), according to the degree of experience of the radiologist. Methods: This is a cross-sectional study of a database including one hundred 1.5 T MRI records (2011–2016) from patients with biopsy-proven rectal cancer, including primary staging and post-chemoradiotherapy follow-up. All cases were individually blindedly reviewed by ten radiologists: three experienced in rectal cancer, three specialized in other areas, and four residents. Each case was assessed twice to detect perirectal infiltration: first, evaluating just high-resolution T2-weighted sequences (HRT2w); second, evaluation of DWI plus HRT2w sequences. Results were pooled by experience, calculating accuracy (area under ROC curve), sensitivity and specificity, predictive values, likelihood ratios, and overstaging/understaging. Histology of surgical specimens provided the reference standard. Results: DWI significantly improved specificity by experienced radiologists in primary staging (63.2% to 75.9%) and, to a lesser extent, positive likelihood ratio (2.06 to 2.87); minimal changes were observed post-chemoradiotherapy, with a slight decrease of accuracy (0.657 to 0.626). Inexperienced radiologists showed a similar pattern, but with slight enhancement post-chemoradiotherapy (accuracy 0.604 to 0.621). Residents experienced small changes, with increased sensitivity/decreased specificity in both primary (69% to 72%/67.2% to 64.7%) and post-chemoradiotherapy (68.1% to 73.6%/47.3% to 44.6%) staging. Conclusions: Adding DWI to HRT2w significantly improved specificity for the detection of perirectal infiltration at primary staging by experienced radiologists and also by inexperienced ones, although to a lesser extent. In the post-neoadjuvant treatment subgroup, only minimal changes were observed.
ISSN: 2366-004X
DOI: 10.1007/s00261-019-02139-4
Source: Abdominal Radiology [ISSN 2366-004X], v. 44 (11), p. 3674-3682
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