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Title: Primary and post-chemoradiotherapy MRI detection of extramural venous invasion in rectal cancer: the role of diffusion-weighted imaging
Authors: Fornell-Perez, Roberto
Vivas-Escalona, Valentina
Aranda-Sanchez, Joel
Gonzalez-Dominguez, M. Carmen
Rubio-Garcia, Jano
Alemán-Flores, Patricia
Lozano-Rodriguez, Alvaro
Porcel-de-Peralta, Gabriela
Loro Ferrer, Juan Francisco 
UNESCO Clasification: 320101 Oncología
320111 Radiología
Keywords: Vascular Invasion
Disease, et al
Issue Date: 2020
Journal: Radiologia Medica 
Abstract: Objective: To assess the added value of diffusion-weighted imaging (DWI) to high-resolution T2-weighted sequences (HRT2w) in MRI detection of extramural venous infiltration (EMVI), according to the previous experience of radiologists. Methods: A cross-sectional study of a retrospective database including 1.5 T MRI records from 100 patients with biopsy-proven rectal cancer (2011-2016; 75 male/25 female, average 63 y/o), which included primary staging (54) and post-chemoradiotherapy follow-up MRIs (46). The reference standard was histology of surgical specimens. All cases were individually blindly reviewed by ten radiologists: three specialists in abdominal radiology, three specialized in different areas and four residents. In each case, the presence of EMVI was assessed twice: first, using just HRT2w; second, with DWI added to HRT2w. The results were pooled by experience, analyzing sensitivity, specificity, accuracy (area under ROC curve), likelihood ratios, predictive values and overstaging/understaging. Results Addition of DWI improved diagnostic performance by specialists radiologists, particularly post-chemoradiotherapy (accuracy 0.74-0.84; positive likelihood ratio 3.9-9.1; overstaging 16-8%), less so at primary staging (specificity 76-87.2%; overstaging 21-11%). Non-specialist radiologists also improved, but only at primary staging (accuracy 0.59-0.63). Residents showed small changes, except for notably increased sensitivity in both primary staging (35.7-43%) and post-chemoradiotherapy (41.7-58.3%) staging, at the expense of increased overstaging. Conclusions: The addition of DWI improved the diagnostic performance of EMVI by experienced radiologists, downgrading overstaging, especially in post-chemoradiotherapy follow-up. It resulted in fewer changes for inexperienced radiologists (enhanced primary staging) and residents (increased sensitivity).
ISSN: 0033-8362
DOI: 10.1007/s11547-020-01137-7
Source: Radiologia Medica [ISSN 0033-8362], v. 125, p. 522–530
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