| 1. Middleton PF, Sutherland LM, Maddern GJ. Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum. 2005;48(2):270-284. |
Meta-analysis |
3 studies |
To systematically review the evidence relating to the safety and efficacy of transanal endoscopic microsurgery, a relatively new technique used to locally excise rectal tumors, compared with existing techniques such as anterior resections and abdominoperineal resections or local excisions. |
Three comparative studies (including one randomized, controlled trial) and 55 case series were included. The first area of study was the safety and efficacy of adenomas. In the randomized, controlled trial, no difference could be detected in the rate of early complications between transanal endoscopic microsurgery (10.3 percent) and direct local excision (17 percent) (relative risk, 0.61; 95 percent confidence interval, 0.29-1.29). Transanal endoscopic microsurgery resulted in less local recurrence (6/98; 6 percent) than direct local excision (20/90; 22 percent) (relative risk, 0.28; 95 percent confidence interval, 0.12-0.66). The 6 percent rate of local recurrence for transanal endoscopic microsurgery in this trial is consistent with the rates found in case series of transanal endoscopic microsurgery (median, 5 percent). The second area of study was the safety and efficacy of carcinomas. In the randomized, controlled trial, no difference could be detected in the rate of complications between transanal endoscopic microsurgery and direct local excision (relative risk for overall early complication rates, 0.56; 95 percent confidence interval, 0.22-1.42). No differences in survival or local recurrence rate between transanal endoscopic microsurgery and anterior resection could be detected in either the randomized, controlled trial (hazard ratio,1.02 for survival) or the nonrandomized, comparative study. There were 2 of 25 (8 percent) transanal endoscopic microsurgery recurrences in the randomized, controlled trial, but no figures were given for recurrence after anterior resection. In the case series, the median local recurrence rate for transanal endoscopic microsurgery was 8.4 percent, ranging from 0 percent to 50 percent. The third comparison was cost of the procedures. Transanal endoscopic microsurgery had both a lower recurrence rate and a lower cost than local excision or anterior resection for adenomas. Although the effectiveness of transanal endoscopic microsurgery could not be established for carcinomas, costs were lower than those for either anterior resection or abdominoperineal resection. |
M |
| 2. Pricolo VE. Rectal cancer: the good, the bad, and the ugly. Arch Surg 2011;146:544. |
Review/Other-Dx |
N/A |
Comment on rectal cancer. |
No results reported in abstract. |
4 |
| 3. Nogue M, Salud A, Vicente P, et al. Addition of bevacizumab to XELOX induction therapy plus concomitant capecitabine-based chemoradiotherapy in magnetic resonance imaging-defined poor-prognosis locally advanced rectal cancer: the AVACROSS study. Oncologist. 2011;16(5):614-620. |
Observational-Tx |
47 patients |
To assess the efficacy and toxicity of adding bevacizumab to induction chemotherapy followed by preoperative bevacizumab-based chemoradiotherapy in patients with locally advanced rectal cancer. |
Between July 2007 and July 2008, 47 patients were recruited. Among 45 patients who underwent surgery, pCR was achieved in 16 patients (36%; 95% confidence interval: 22.29%-51.27%), and an additional 17 patients (38%) had Dworak tumor regression grade 3. R0 resection was performed in 44 patients (98%). Most grade 3/4 adverse events occurred during the induction phase and included diarrhea (11%), asthenia (4%), neutropenia (6%), and thrombocytopenia (4%). Eleven patients (24%) required surgical reintervention. |
1 |
| 4. Velenik V, Ocvirk J, Music M, et al. Neoadjuvant capecitabine, radiotherapy, and bevacizumab (CRAB) in locally advanced rectal cancer: results of an open-label phase II study. Radiat Oncol. 2011;6:105. |
Observational-Tx |
61 patients |
To assess the safety and efficacy of the addition of bevacizumab to capecitabine and concurrent radiotherapy for LARC. |
61 patients were enrolled (median age 60 years [range 31-80], 64% male). Twelve patients (19.7%) had T3N0 tumours, 1 patient T2N1, 19 patients (31.1%) T3N1, 2 patients (3.3%) T2N2, 22 patients (36.1%) T3N2 and 5 patients (8.2%) T4N2. Median tumour distance from the anal verge was 6 cm (range 0-11). Grade 3 adverse events included dermatitis (n = 6, 9.8%), proteinuria (n = 4, 6.5%) and leucocytopenia (n = 3, 4.9%). Radical resection was achieved in 57 patients (95%), and 42 patients (70%) underwent sphincter-preserving surgery. TRG 4 (pCR) was recorded in 8 patients (13.3%) and TRG 3 in 9 patients (15.0%). T-, N- and overall downstaging rates were 45.2%, 73.8%, and 73.8%, respectively. |
2 |
| 5. Boland PM, Fakih M. The emerging role of neoadjuvant chemotherapy for rectal cancer. J Gastrointest Oncol. 2014;5(5):362-373. |
Review/Other-Tx |
N/A |
To review the emerging role of neoadjuvant chemotherapy for rectal cancer. |
Locally advanced rectal cancer remains a substantial public health problem. Historically, the disease has been plagued by high rates of both distant and local recurrences. The standardization of pre-operative chemoradiation and transmesorectal excision (TME) have greatly lowered the rates of local recurrence. Efforts to improve treatment through use of more effective radiosensitizing therapies have proven unsuccessful in rectal cancer. Presently, due to improved local therapies, distal recurrences represent the dominant problem in this disease. Adjuvant chemotherapy is currently of established benefit in colorectal cancer. As such, adjuvant chemotherapy, consisting of fluoropyrimidine and oxaliplatin, represent the standard of care for many patients. However, after pre-operative chemoradiotherapy and rectal surgery, the administration of highly effective chemotherapy regimens has proven difficult. For this reason, novel neoadjuvant approaches represent appealing avenues for investigation. Strategies of neoadjuvant chemotherapy alone, neoadjuvant chemotherapy followed by chemoradiation and neoadjuvant chemoradiation followed by chemotherapy are under investigation. Initial encouraging results have been noted, though definitive phase III data is lacking. |
4 |
| 6. Glynne-Jones R, Tan D, Goh V. Pelvic MRI for guiding treatment decisions in rectal cancer. Oncology (Williston Park). 2014;28(8):667-677. |
Review/Other-Dx |
N/A |
To discuss the features that predict LR and distant metastasis, and review the features that can be imaged on MRI to allow decision making regarding the best neoadjuvant treatment in LARC. |
Fluoropyrimidine-based chemoradiation (CRT) is used routinely for locally advanced rectal cancer to shrink the tumor preoperatively, improve lateral surgical clearance at total mesorectal excision, prevent local recurrence, and preserve organ function. In Northern Europe, short-course preoperative radiotherapy (SCPRT) is preferred to achieve locoregional control. However, with recent improvements in the quality of surgery, in magnetic resonance imaging (MRI), and in pathologic reporting, we question whether "routine" CRT or SCPRT should be offered indiscriminately for all patients.MRI is considered the optimal modality for locoregional staging and evaluation of the potential for an involved circumferential resection margin. MRI also provides detailed anatomic information for surgical planning, and may identify poor prognostic features, which influence the way in which the pathologist processes specimens. MRI can predict the likelihood of good/poor tumor response to neoadjuvant CRT and can categorize responders/nonresponders following treatment.Using MRI to define the risk of both local recurrence and metastatic spread allows clinicians to determine which patients might benefit from or safely avoid neoadjuvant treatment. |
4 |
| 7. Barbaro B, Fiorucci C, Tebala C, et al. Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology. 2009;250(3):730-739. |
Observational-Dx |
53 patients |
To prospectively differentiate, at magnetic resonance (MR) imaging, patients with locally advanced nonmucinous rectal cancer who will respond to long-course chemotherapy and radiation therapy (CRT) from those who will not respond, with histopathologic results as the reference standard. |
Morphologic response assessment with MR imaging achieved a positive predictive value (PPV) of 84.2% (32 of 38) and a negative predictive value (NPV) of 66.7% (10 of 15). Volume reduction extent (> or = 70%) was significantly different between patients in whom disease was downstaged and those in whom it was not downstaged (P = .000005) and showed additional diagnostic value, with an overall accuracy of 86.8% (46 of 53). Presurgical MR imaging and histopathologic tumor length did not show a significant difference. MR imaging accuracy for lymph node (N) stage was 86.8% (46 of 53) on the basis of morphologic criteria. |
2 |
| 8. Perez RO, Pereira DD, Proscurshim I, et al. Lymph node size in rectal cancer following neoadjuvant chemoradiation--can we rely on radiologic nodal staging after chemoradiation? Dis Colon Rectum. 2009;52(7):1278-1284. |
Observational-Tx |
31 patients |
To determine the difference in size between metastatic and nonmetastatic nodes and the critical lymph node size after neoadjuvant chemoradiation therapy. |
There was a mean of 6.5 lymph nodes per patient and 12 positive nodes of the 201 recovered (6%). Ninety-five percent of all lymph nodes were <5 mm, whereas 50% of positive lymph nodes were <3 mm. Metastatic lymph nodes were significantly greater in size (5.0 vs. 2.5mm; P = 0.02). Lymph nodes >4.5 mm had a greater risk of harboring metastases (P = 0.009). |
2 |
| 9. Yu SK, Chand M, Tait DM, Brown G. Magnetic resonance imaging defined mucinous rectal carcinoma is an independent imaging biomarker for poor prognosis and poor response to preoperative chemoradiotherapy. Eur J Cancer. 50(5):920-7, 2014 Mar. |
Observational-Dx |
330 patients |
To compare outcomes between magnetic resonance imaging (MRI) detected rectal mucinous carcinoma and adenocarcinomas. |
60/330 (18%) patients were correctly diagnosed with mucinous rectal cancer based on pre treatment MRI compared with 15/330 (5%) on initial biopsy (diagnostic odds ratio=4.67, p<0.05). All 60 (100%) patients undergoing surgery for mrMucinous tumours were confirmed as such on final histopathology. Significantly fewer mrMucinous tumours showed ypT downstaging when compared with non-mucinous tumours (14/60 (23%) versus 111/270 (40%), p=0.01). Three-year survival outcomes for patients for MRI detected mucinous tumours were significantly worse: disease free survival (DFS) was 48% versus 71%, p=0.006 and OS was 69% versus 79% p=0.04. MRI Mucin was an independent variable for poor DFS (hazard ratios (HR)) 0.58 95% Confidence interval (CI) 0.38-0.89). |
3 |
| 10. Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 90(3):355-64, 2003 Mar. |
Observational-Dx |
98 patients |
To determine the accuracy of preoperative magnetic resonance imaging (MRI) in the evaluation of pathological prognostic factors that influence local recurrence and survival in rectal cancer. |
There was 94 per cent weighted agreement (weighted kappa = 0.67) between MRI and pathology assessment of T stage. Agreement between MRI and histological assessment of nodal status was 85 per cent (kappa = 0.68). Although involvement of small veins by tumour was not discernible using MRI, large (calibre greater than 3 mm) extramural venous invasion was identified correctly in 15 of 18 patients (kappa = 0.64). MRI predicted circumferential resection margin involvement with 92 per cent agreement (kappa = 0.81). Seven of nine patients with peritoneal perforation by tumour (stage T4) were identified correctly using MRI. |
3 |
| 11. Akgun E, Ozkok S, Tekin M, et al. The effects of chemoradiotherapy on recurrence and survival in locally advanced rectal cancers with curative total mesorectal excision: a prospective, nonrandomized study. World J Surg Oncol. 15(1):205, 2017 Nov 22. |
Observational-Dx |
336 patients |
To compare the effects of preoperative versus postoperative chemoradiotherapy on recurrence and survival rates in LARC patients. |
The mean follow-up period was 60.4 (range 12 to 168) months. Five-year cumulative incidence of locoregional recurrence (LR) was 7.4% in the preoperative group and 13.4% in the postoperative group (p = 0.021). Five-year cancer-specific survival (CSS) was 87.5% in the preoperative group and 80% in the postoperative group (p = 0.022). Overall survival (OS) was 79.8 versus 74.7% (p = 0.064), disease-free survival (DFS) was 75.2 versus 64.8% (p = 0.062), and severe late toxicity was 7.4 versus 13.2% (p = 0.002), respectively. The rate of patient compliance was higher in the preoperative group (p < 0.001). |
3 |
| 12. Appelt AL, Pløen J, Harling H, et al. High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study. The Lancet Oncology 2015;16:919-27. |
Observational-Dx |
55 patients |
To assess whether high-dose radiotherapy with concomitant chemotherapy followed by observation (watchful waiting) was successful for non-surgical management of low rectal cancer. |
Median follow-up for local recurrence in the observation group was 23·9 months (IQR 15·3–31·0). Local recurrence in the observation group at 1 year was 15·5% (95% CI 3·3–26·3). The most common acute grade 3 adverse event during treatment was diarrhoea, which affected four (8%) of 51 patients. Sphincter function in the observation group was excellent, with 18 (72%) of 25 patients at 1 year and 11 (69%) of 16 patients at 2 years reporting no faecal incontinence at all and a median Jorge-Wexner score of 0 (IQR 0–0) at all timepoints. The most common late toxicity was bleeding from the rectal mucosa; grade 3 bleeding was reported in two (7%) in 30 patients at 1 year and one (6%) of 17 patients at 2 years. |
3 |
| 13. Martens MH, Maas M, Heijnen LA, et al. Long-term Outcome of an Organ Preservation Program After Neoadjuvant Treatment for Rectal Cancer. J Natl Cancer Inst 2016;108. |
Observational-Dx |
100 patients |
To establish the oncological and functional results of organ preservation with a watch-and-wait approach (W&W) and selective transanal endoscopic microsurgery (TEM) in patients with a clinical complete or near-complete response (cCR) after neoadjuvant chemoradiation for rectal cancer. |
One hundred patients were included, with median follow-up of 41.1 months. Sixty-one had cCR at initial response assessment. Thirty-nine had near cCR, of whom 24 developed cCR at the second assessment and 15 patients underwent TEM (9 ypT0, 1 ypT1, 5 ypT2). Fifteen patients developed a local regrowth (12 luminal, 3 nodal), all salvageable and within 25 months. Five patients developed metastases, and five patients died. Three-year overall survival was 96.6% (95% confidence interval [CI] = 89.9% to 98.9%), distant metastasis-free survival was 96.8% (95% CI = 90.4% to 99.0%), local regrowth-free survival was 84.6% (95% CI = 75.8% to 90.5%), and disease-free survival was 80.6% (95% CI = 70.9% to 87.4%). Colostomy-free survival was 94.8% (95% CI = 88.0% to 97.8%), with a good continence after watch-and-wait (Vaizey = 3.4, SD = 3.9) and moderate after TEM (Vaizey = 9.7, SD = 5.1). |
3 |
| 14. Maas M, Lambregts DM, Nelemans PJ, et al. Assessment of Clinical Complete Response After Chemoradiation for Rectal Cancer with Digital Rectal Examination, Endoscopy, and MRI: Selection for Organ-Saving Treatment. Ann Surg Oncol 2015;22:3873-80. |
Observational-Dx |
50 patients |
To evaluate the value of clinical examination (endoscopy with or without biopsy and DRE), T2W-MRI, and diffusion-weighted MRI (DWI) for the detection of CR after CRT. |
Seventeen (34 %) of 50 patients had a CR. Areas under the curve were 0.88 (0.78-1.00) for clinical assessment and 0.79 (0.66-0.92) for T2W-MRI and DWI. Combining the modalities led to a posttest probability for predicting a CR of 98 %. Conversely, when all modalities indicated residual tumor, 15 % of patients still experienced CR. |
3 |
| 15. Seymour MT, Morton D, Investigators obotIFT. FOxTROT: an international randomised controlled trial in 1052 patients (pts) evaluating neoadjuvant chemotherapy (NAC) for colon cancer. Journal of Clinical Oncology 2019;37:3504-04. |
Observational-Dx |
1052 |
To evaluate neoadjuvant chemotherapy (NAC) for colon cancer |
NAC was well tolerated and safe, with no increase in perioperative morbidity and a trend toward fewer serious postoperative complications. Evidence of histological regression was seen in 59% pts after NAC, including some pCRs. This resulted in marked histological downstaging and a halving of the rate of incomplete resections. We observed an improvement in 2-yr failure rate (HR=0.77), but this fell short of statistical significance (p=0.11). NAC for colon cancer improves surgical outcomes and can now be considered as a treatment option; longer follow-up and further trials are required to confirm the long-term benefits, refine its use and optimise case selection. |
2 |
| 16. Bernini A, Deen KI, Madoff RD, Wong WD. Preoperative adjuvant radiation with chemotherapy for rectal cancer: its impact on stage of disease and the role of endorectal ultrasound. Annals of Surgical Oncology. 3(2):131-5, 1996 Mar. |
Observational-Dx |
43 patients |
To assess the impact of preoperative adjuvant therapy in patients judged by endorectal US to have extramural invasion of rectal cancer and/or regional lymph node involvement. |
Downstaging was seen in 23 (53%) patients with wall invasion and in 23 (72%) of 32 patients with lymph node involvement. Overall, downstaging was achieved in 30 (70%). PPV of US after irradiation were 72% and 56% for wall penetration and lymph node status, respectively. NPV of US after irradiation were 100% and 82%, respectively. |
3 |
| 17. Bhattacharjya S, Bhattacharjya T, Baber S, Tibballs JM, Watkinson AF, Davidson BR. Prospective study of contrast-enhanced computed tomography, computed tomography during arterioportography, and magnetic resonance imaging for staging colorectal liver metastases for liver resection. Br J Surg 2004;91:1361-9. |
Observational-Dx |
120 patients |
Prospective study to compare the value of contrast-enhanced helical CT, CT during arterioportography, and contrast-enhanced MRI for staging patients with colorectal liver metastases. |
The sensitivity and specificity were 73.0% and 96.5% for CT, 87.1 and 89.3% for CT arterioportography, and 81.9% and 93.2% for MRI. PPV were 89.7%, 87.5% and 87.5%, respectively. The diagnostic accuracy of spiral CT, MRI and CT arterioportography was similar. Combining modalities did not improve accuracy. |
3 |
| 18. Farouk R, Nelson H, Radice E, Mercill S, Gunderson L. Accuracy of computed tomography in determining resectability for locally advanced primary or recurrent colorectal cancers. Am J Surg 1998;175:283-7. |
Observational-Dx |
84 patients |
To determine the accuracy of CT in determining tumor resectability in patients with locally advanced primary (T4) or locally recurrent colorectal cancer. |
At surgery, disease was confined to the pelvis in 63 patients, the abdomen in 7 and both the pelvis and abdomen in 14. CT correctly identified tumor in 87% of patients, with 89% and 80% accuracies for pelvic and abdominal disease, respectively. CT is generally reliable at identifying disease as being confined to one region, and for predicting the need for adjacent organ resection. It is less discriminating for predicting local tumor resectability. |
1 |
| 19. Ahmetoglu A, Cansu A, Baki D, et al. MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. Abdom Imaging 2011;36:31-7. |
Observational-Dx |
37 patients |
To evaluate the accuracy of MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. |
Overall accuracy was 86% in T staging, 84% in N staging, 89% in International Union Against Cancer (UICC) Staging, and 94.5% in the prediction of mesorectal fascia involvement. |
3 |
| 20. Anderson EM, Betts M, Slater A. The value of true axial imaging for CT staging of colonic cancer. Eur Radiol. 21(6):1286-92, 2011 Jun. |
Observational-Dx |
50 consecutive datasets |
To assess the effect of true axial computed tomography on the accuracy of staging of colonic cancers. |
The overall accuracy for tumour staging was 56% for reader 1, 48% for reader 2 and 64% for reader 3 for standard axial CT. This improved to 72% (p = 0.012), 66% (p = 0.012) and 80% (p = 0.021) when the true axial images were added. For nodal staging, overall accuracy improved from 56% to 70% (p = 0.065) for reader 1, 58% to 76% (p = 0.012) for reader 2 and 60% to 76% (p = 0.021) for reader 3 between reads. |
2 |
| 21. Zhou XC, Chen QL, Huang CQ, Liao HL, Ren CY, He QS. The clinical application value of multi-slice spiral CT enhanced scans combined with multiplanar reformations images in preoperative T staging of rectal cancer. Medicine (Baltimore). 98(28):e16374, 2019 Jul. |
Observational-Dx |
168 patients |
To evaluate the diagnostic accuracy and clinical application value of multi-slice spiral CT (MSCT) enhanced scans combined with multiplanar reformations (MPRs) images compared with postoperative pathological results in preoperative T staging of rectal cancer. |
Compared with postoperative pathology, T staging using MSCT enhanced scans combined with MPRs had overall accuracy of 85.7%. Consistency between MSCT enhanced scans combined with MPRs and postoperative pathological staging was effective for T staging (Kappa = 0.658, chi = 4.200, P = .122). |
4 |
| 22. Low G, Tho LM, Leen E, et al. The role of imaging in the pre-operative staging and post-operative follow-up of rectal cancer. Surgeon 2008;6:222-31. |
Review/Other-Dx |
N/A |
Review role of imaging in the preoperative staging and postoperative follow-up of rectal cancer. |
Endorectal US is useful for T staging and CT for detecting metastases. PET/CT has been a major recent development. It has superior utility in detecting recurrent disease, including when conventional imaging is negative, detects occult metastases and may significantly enhance ability to deliver accurate radiotherapy. Imaging has also opened up avenues for guided therapies aimed at ablating liver metastases. Radiofrequency ablation, in particular, is being used successfully and can improve survival of stage four patients. |
4 |
| 23. Ju H, Xu D, Li D, Chen G, Shao G. Comparison between endoluminal ultrasonography and spiral computerized tomography for the preoperative local staging of rectal carcinoma. Biosci Trends 2009;3:73-6. |
Observational-Dx |
78 patients |
To compare the efficacy of endoluminal US and spiral CT in preoperative local staging of rectal carcinoma. |
For T staging, accuracy was 84.6% for endoluminal US, 70.5% for spiral CT (P<0.05). For N staging, accuracy was 64.1% for endoluminal US, 61.5% for spiral CT (P>0.05). Endoluminal US is superior to spiral CT in judging tumor infiltrate depth, but neither could provide satisfactory assessments of lymph node metastases. |
3 |
| 24. da Fonte AC, Chojniak R, de Oliveira Ferreira F, Pinto PN, dos Santos Neto PJ, Bitencourt AG. Inclusion of computed tomographic colonography on pre-operative CT for patients with colorectal cancer. Eur J Radiol. 81(3):e298-303, 2012 Mar. |
Observational-Dx |
25 patients |
To evaluate the impact of the inclusion of computed tomographic colonography (CTC) involving faecal tagging and no laxatives on the computed tomography (CT) study routinely used in staging patients with colorectal cancer. |
All exams were well-tolerated, and only one had unsatisfactory quality. CTC identified all the carcinomas and had an overall accuracy of 80%, 60.1% and 100% for the evaluation of tumour depth, lymph nodes and metastases respectively. CTC identified all polyps greater than 9 mm. Following CTC, changes to surgical plans were observed in 20.8% of the cases, all with incomplete optical colonoscopies. |
3 |
| 25. Duman M, Tas S, Mecit EA, et al. Preoperative local staging of colorectal cancer patients with MDCT. Hepatogastroenterology 2012;59:1108-12. |
Observational-Dx |
73 patients |
To evaluate tumor invasion (T staging) and lymph node metastasis (N staging) of colorectal cancer preoperatively by using multi-detector computerized tomography (MDCT) and to compare with the histopathological findings. |
In this study, the best accuracy results had been acquired for T1 and T2 tumors as 90.4% and 73.9%, respectively. For both histopathologically staged N0 and N1 patients, the accuracy results were 61.6%. The distant metastases were not detected in this study. |
2 |
| 26. Stabile Ianora AA, Moschetta M, Pedote P, Scardapane A, Angelelli G. Preoperative local staging of colosigmoideal cancer: air versus water multidetector-row CT colonography. Radiol Med (Torino). 117(2):254-67, 2012 Mar. |
Experimental-Dx |
70 patients |
To evaluate the diagnostic accuracy of multidetector-row computed tomography (MDCT) performed with two different hypodense endoluminal contrast agents for the preoperative staging of colosigmoideal cancer. |
The overall diagnostic accuracy of MDCT was 68.6% for water and 62.8% for air colonography. In the evaluation of the T parameter, the accuracy values were 88.6% for water and 80% for air colonography. In staging of the N parameter, the accuracy values were 77.1% and 74.3% for water and air MDCT colonography, respectively. |
3 |
| 27. Shida D, Iinuma G, Komono A, et al. Preoperative T staging using CT colonography with multiplanar reconstruction for very low rectal cancer. BMC Cancer. 17(1):764, 2017 Nov 14. |
Observational-Dx |
45 patients |
To evaluate the accuracy of preoperative T staging using CT colonography (CTC) with multiplanar reconstruction (MPR), in which with the newest workstation the images can be analyzed with a slice thickness of 0.5 mm. |
Overall accuracy of T staging was 89% (41/45) for CTC with MPR and 71% (24/34) for MRI. CTC with MPR was particularly sensitive for pT2 tumors (82%; 14/17), whereas MRI tended to overstage pT2 tumors and its sensitivity for pT2 was 53% (8/15). |
3 |
| 28. Hotta M, Minamimoto R, Yano H, Gohda Y, Shuno Y. Diagnostic performance of 18F-FDG PET/CT using point spread function reconstruction on initial staging of rectal cancer: a comparison study with conventional PET/CT and pelvic MRI. Cancer Imaging. 18(1):4, 2018 Jan 30. |
Observational-Dx |
59 patients |
To evaluate the effectiveness of (18)F-FDG PET/CT with PSF reconstruction for initial staging in rectal cancer compared with conventional PET/CT and pelvic MRI. |
For N staging, PSF-PET/CT provided higher sensitivity (78.6%) than conventional PET/CT (64.3%), and pelvic MRI (57.1%), and all techniques showed high specificity (PSF-PET: 95.4%, conventional PET: 96.7%, pelvic MRI: 93.5%). SUVmax and L/B ratio were significantly higher in PSF-PET/CT than conventional-PET/CT (p < 0.001). The accuracy for T staging in PSF-PET/CT (69.4%) was not significantly different to conventional PET/CT (73.5%) and pelvic MRI (73.5%). MTVs of PSF and conventional PET showed a significant difference among T stages (p < 0.001), with higher values in advanced stages. In M staging, both PSF and conventional PET/CT diagnosed all distant metastases correctly. |
4 |
| 29. Cerny M, Dunet V, Prior JO, et al. Initial Staging of Locally Advanced Rectal Cancer and Regional Lymph Nodes: Comparison of Diffusion-Weighted MRI With 18F-FDG-PET/CT. Clin Nucl Med. 41(4):289-95, 2016 Apr. |
Observational-Dx |
24 patients |
To compare diffusion-weighted MRI (DW-MRI) parameters with 18F-FDG PET/CT in primary locally advanced rectal cancer (LARC). |
Regarding tumors (n = 24), we found a significant negative correlation between SUVmean and corresponding ADCmean values (rho = -0.61, P = 0.0017) and between ADCmin and SUVmax (rho = -0.66, P = 0.0005). Regarding the lymph nodes (n = 63), there was a significant negative correlation between ADCmean and SUVmean values (rho = -0.38, P = 0.0021), but not between ADCmin and SUVmax values (rho = -0.11, P = 0.41). Neither ADCmean nor ADCmin values helped distinguish pathological from benign lymph nodes (AUC of 0.24 [confidence interval, 0.10-0.38] and 0.41 [confidence interval, 0.22-0.60], respectively). |
3 |
| 30. Sani F, Foresti M, Parmiggiani A, et al. 3-T MRI with phased-array surface coil in the local staging of rectal cancer. Radiol Med 2011;116:375-88. |
Observational-Dx |
30 patients |
To evaluate the diagnostic accuracy of surface-coil 3T magnetic resonance (MR) imaging in the preoperative study of patients with rectal cancer. |
In the patients who underwent MR imaging before and after radiotherapy (group 1), the diagnostic accuracy of 3T MR imaging was 88% for T2, 94% for T3 and 88% for T4 cancers. In those who underwent surgical treatment without preoperative radiotherapy (group 2), the diagnostic accuracy was 90% for T2, 87% for T3 and 87% for T4 cancers. |
3 |
| 31. Wong EM, Leung JL, Cheng CS, Lee JC, Li MK, Chung CC. Effect of endorectal coils on staging of rectal cancers by magnetic resonance imaging. Hong Kong Med J 2010;16:421-6. |
Observational-Dx |
50 patients; 13 examinations in patients having endorectal coil, 2 blinded reviewers |
Retrospective study to compare the use of endorectal plus phased-array coils with use of phased-array coil alone with respect to the accuracy of MRI for detecting mesorectal involvement of rectal cancer. |
Overall accuracy of MRI in detecting mesorectal tumor involvement was 80%. Subgroup analysis showed higher accuracy in the group with endorectal coils than in those with phased-array coils alone. Over-detection of mesorectal involvement was noted in 12% of the cases, with lower rate being observed in patients with endorectal coils. Under-detection of mesorectal tumor involvement was only noted in the group without endorectal coils. With the use of endorectal coils, the sensitivity reached 100% and the specificity increased to 86%. Use of endorectal coil in staging MRI of the rectum improves diagnostic accuracy. Whenever feasible, endorectal coil use is therefore recommendable to enhance diagnostic accuracy. The study results substantiate the understanding of staging by MRI of rectal cancer in the local Chinese population. |
2 |
| 32. Karatag O, Karatag GY, Ozkurt H, et al. The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results. Diagn Interv Radiol 2012;18:20-6. |
Observational-Dx |
24 patients |
To evaluate the accuracy of phased-array magnetic resonance imaging (MRI) for preoperative local tumor staging in primary rectal cancer and emphasized the importance of the preoperative differentiation of T2 tumors from T3 tumors so the appropriate treatment can be applied. |
Histopathological examination of the tumors revealed adenocarcinoma. When the tumors were staged, there was one patient with a pT1 tumor, six patients with pT2 tumors, and 17 patients with pT3 tumors. Using MRI, four patients with pT2 were overstaged as T3, and one patient with pT3 was overstaged as T4. In the remaining cases (one pT1, two pT2, and 16 pT3), MRI correctly assessed the stage of transmural invasion. The accuracy of T staging and metastatic lymph node detection with MRI was calculated as 79.2% and 58.5%, respectively. |
3 |
| 33. 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;37:475-81. |
Observational-Dx |
13 patients |
To determine whether 3T-MRI compared with 1.5 Tesla-(1.5T)-MRI improves the accuracy for the discrimination between T1-2 and borderline T3 rectal tumors and to evaluate reproducibility. |
Seven patients had pT1-2 tumors and six had pT3 tumors. AUCs ranged from 0.66 to 0.87 at 1.5T vs. 0.52-0.82 at 3T. Mean overstaging rate was 43% at 1.5T and 57% at 3T (P = 0.23). Inter-observer agreement was kappa 0.50-0.71 at 1.5T vs. 0.15-0.68 at 3T. Intra-observer agreement was kappa 0.71 at 1.5T and 0.76 at 3T. |
2 |
| 34. 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(7):2212-2223. |
Meta-analysis |
21 studies |
To determine the accuracy of phased array MRI for T category (T1-2 vs. T3-4), lymph node metastases, and circumferential resection margin (CRM) involvement in primary rectal cancer. |
Twenty-one studies were included in the analysis. There was notable heterogeneity among studies. MRI specificity was significantly higher for CRM involvement [94%, 95% confidence interval (CI) 88-97] than for T category (75%, 95% CI 68-80) and lymph nodes (71%, 95% CI 59-81). There was no significant difference in sensitivity between the three elements as a result of wide overlapping CIs. Diagnostic odds ratio was significantly higher for CRM (56.1, 95% CI 15.3-205.8) than for lymph nodes (8.3, 95% CI 4.6-14.7) but did not differ significantly from T category (20.4, 95% CI 11.1-37.3). |
M |
| 35. Rafaelsen SR, Vagn-Hansen C, Sorensen T, Ploen J, Jakobsen A. Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer. World J Gastroenterol 2012;18:5021-6. |
Observational-Dx |
86 consecutive patients |
To evaluate the agreement between transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) in classification of >/= T3 rectal tumors. |
RUS found 51 patients to have an early >/= T3 tumors and 35 to have an advanced tumor, whereas MRI categorized 48 as early >/= T3 tumors and 38 as advanced tumors. No patients with tumors classified as advanced by TRUS were found to be early on MRI. The kappa value in classifying early versus advanced T3 rectal tumors was 0.93 (95% CI: 0.85-1.00). We found a kappa value of 0.74 (95% CI: 0.63-0.86) for the total sub-classification between the two methods. The mean maximal tumor outgrowth measured by TRUS, 5.5 mm +/- 5.63 mm and on MRI, 6.3 mm +/- 6.18 mm, P = 0.004. In 19 of the 86 patients the following CT scan or surgery revealed distant metastases; of the 51 patients in the ultrasound ab group three (5.9%) had metastases, whereas 16 (45.7%) of 35 in the cd group harbored distant metastases, P = 0.00002. The odds ratio of having distant metastases in the ultrasound cd group compared to the ab group was 13.5 (95% CI: 3.5-51.6), P = 0.00002. The mean maximal ultrasound measured outgrowth was 4.3 mm (95% CI: 3.2-5.5 mm) in patients without distant metastases, while the mean maximal outgrowth was 9.5 mm (95% CI: 6.2-12.8 mm) in the patients with metastases, P = 0.00004. Using the MRI classification three (6.3%) of 48 in the MRI ab group had distant metastases, while 16 (42.1%) of the 38 in the MRI cd group, P = 0.00004. The MRI odds ratio was 10.9 (95% CI: 2.9-41.4), P = 0.00008. The mean maximal MRI measured outgrowth was 4.9 mm (95% CI: 3.7-6.1 mm) in patients without distant metastases, while the mean maximal outgrowth was 11.5 mm (95% CI: 7.8-15.2 mm) in the patients with metastases, P = 0.000006. |
2 |
| 36. Fernandez-Esparrach G, Ayuso-Colella JR, Sendino O, et al. EUS and magnetic resonance imaging in the staging of rectal cancer: a prospective and comparative study. Gastrointest Endosc. 2011;74(2):347-354. |
Observational-Dx |
90 patients |
To prospectively compare the performance of EUS and MRI in the locoregional staging of rectal cancer in a large series of patients. |
Ninety patients (54 men and 36 women with a mean age of 68 +/- 12 years; range 33-87 years) constitute the final sample of this study. Most of the tumors were stages T2-T3 (85%; 95% CI, 77%-92%). Twenty of them (22%; 95% CI, 14%-32%) were stenotic and 24 (27%; 95% CI, 18%-37%) had polypoid morphology. The accuracy of T staging was very similar for EUS and MRI for stage T2 (76%; 95% CI, 65%-84% and 77%; 95% CI, 67%-85%, respectively; P = not significant) and stage T3 (76%; 95% CI, 65%-84% and 83%, 95% CI, 73%-90%, respectively; P = not significant). MRI was not able to visualize any T1 tumor, whereas EUS understaged all T4 tumors. The univariate analysis showed that the polypoid morphology of the tumor inversely correlated with T staging on MRI. The accuracy of MRI for N staging was higher than that of EUS, although the difference did not reach statistical significance (79%; 95% CI, 65%-88% and 65%; 95% CI, 51%-78%, respectively). When performing the univariate analysis to assess the reasons for this difference, the presence of a stenotic tumor was the only parameter significantly related to a poorer performance of EUS in N staging. |
1 |
| 37. Phang PT, Gollub MJ, Loh BD, et al. Accuracy of endorectal ultrasound for measurement of the closest predicted radial mesorectal margin for rectal cancer. Dis Colon Rectum 2012;55:59-64. |
Observational-Dx |
52 patients |
To assess endorectal ultrasound identification of mesorectal margins and the measurement of the closest predicted radial tumor-mesorectal margin. |
Fifty-two patients were studied with an average rectal cancer distance to the anal verge of 6.8 cm. Interobserver correlation coefficients of endorectal ultrasound mesorectal dimensions ranged from 0.47 to 0.53 (p < 0.01). MR and endorectal ultrasound measurements of the closest predicted radial mesorectal margin were correlated r = 0.56 (p < 0.0001). MR and endorectal ultrasound determination of margin involvement agreed in 81% of cases. |
2 |
| 38. Li JC, Liu SY, Lo AW, et al. The learning curve for endorectal ultrasonography in rectal cancer staging. Surg Endosc 2010;24:3054-9. |
Observational-Dx |
50 patients |
To prospectively analyze results of ERUS staging for rectal cancer, aiming to determine its accuracy and to define the learning curve of the procedure. |
In the 26-month study period, 50 patients (36 males) with median age of 67 years (range 47-89 years) underwent ERUS staging. The overall accuracy rates of uT and uN staging were 86 and 66%. For uT staging, 10% of tumors were overstaged and 4% were understaged. For uN staging, 22% of patients were overstaged and 12% were understaged. With experience accumulation from early group to late group, accuracy improvement was observed in uN staging (52 vs. 80%, P = 0.037), while the accuracy rate remained consistently high in uT staging (84 vs. 88%, P = 1.0). |
3 |
| 39. Del Vescovo R, Trodella LE, Sansoni I, et al. MR imaging of rectal cancer before and after chemoradiation therapy. Radiol Med 2012;117:1125-38. |
Observational-Dx |
39 patients |
To determine the diagnostic accuracy of magnetic resonance (MR) imaging in patients with rectal carcinoma by comparing post-chemoradiation MR imaging with pathological specimens. |
Following neoadjuvant chemoradiation therapy, the analysis of MR images showed 23 (59%) patients with a rectal disease staged </=T2 and 16 (41%) with a disease staged >T2. Post-treatment histological staging (TNM) revealed 13 patients with a disease >T2 and 26 patients with a disease </=T2. Cohen's kappa to measure concordance between post-chemoradiation MR staging and histological response showed 83.6% concordance for disease confined to the serosa (</=T3): concordance was 97.22% for disease </=N1 and 33.33% for disease >N1. |
3 |
| 40. Engelen SM, Maas M, Lahaye MJ, et al. Modern multidisciplinary treatment of rectal cancer based on staging with magnetic resonance imaging leads to excellent local control, but distant control remains a challenge. Eur J Cancer 2013;49:2311-20. |
Observational-Tx |
296 patients |
To evaluate whether a differentiated treatment of primary rectal cancer based on magnetic resonance imaging (MRI) can reduce the number of incomplete resections and local recurrences and improve recurrence-free and overall survival. |
Overall 228 patients underwent treatment with curative intent: 49 with surgery only, 86 with 5 x 5 Gy and surgery and 93 with chemoradiation and surgery. The number of complete resections (margin>1mm) was 218 (95.6%). At a median follow-up of 41 months the three-year local recurrence rate, disease-free survival rate and overall survival rate is 2.2%, 80% and 84.5%, respectively. |
1 |
| 41. Mercury Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 2007;243:132-9. |
Observational-Dx |
679 consecutive patients |
To prospectively evaluate the accuracy of MRI in depicting the extramural depth of tumor invasion in patients who have rectal cancer, with histopathologic results as the reference standard. Study performed by Magnetic Resonance Imaging and Rectal Cancer European Equivalence (MERCURY) Study Group, which is a multicenter multidisciplinary collaboration. |
Tumor extramural depth (EMD) measurements obtained at both MRI and histopathologic analysis were available for 295 (95%) of 311 patients after primary surgery. Mean tumor extramural depths were 2.80 mm +/- 4.60 (standard deviation) and 2.81 mm +/- 4.28 at MRI and histopathologic analysis, respectively. The mean difference between the MR-derived and histopathologically derived tumor extramural depths was –0.05 mm +/- 3.85 (95% CI, –0.49 mm, 0.40 mm). Therefore, MRI and histopathologic assessments of tumor spread were considered equivalent to within 0.5 mm. Demonstration of accurate measurement of the depth of extramural tumor spread in the MERCURY Study enabled accurate preoperative prognostication. |
1 |
| 42. Kim SH, Lee JM, Park HS, Eun HW, Han JK, Choi BI. Accuracy of MRI for predicting the circumferential resection margin, mesorectal fascia invasion, and tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging 2009;29:1093-101. |
Observational-Dx |
65 consecutive patients, 2 independent reviewers |
Retrospective blinded study to evaluate the diagnostic accuracy of MRI for predicting the circumferential resection margin, mesorectal fascia invasion, and the tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. |
The measured circumferential resection margin was not significantly different from the reference standard (mean difference, –1.4 mm; 95% limits of agreement, –8.3-5.4 mm; interclass correlation coefficient, 0.82). The diagnostic accuracy (A(z)) for determining mesorectal fascia invasion was 0.890 for reviewer 1 (95% CI, 0.788-0.954) and 0.829 for reviewer 2 (95% CI, 0.715-0.911). The A(z) for predicting complete or near-complete regression was 0.791 for reviewer 1 (95% CI, 0.672-0.882) and 0.735 for reviewer 2 (95% CI, 0.611-0.837). MRI provides accurate information regarding the circumferential resection margin of locally advanced rectal cancer after neoadjuvant chemoradiotherapy; it also shows relatively high accuracy for predicting mesorectal fascia invasion and moderate accuracy for assessing tumor response. |
2 |
| 43. Wieder HA, Rosenberg R, Lordick F, et al. Rectal cancer: MR imaging before neoadjuvant chemotherapy and radiation therapy for prediction of tumor-free circumferential resection margins and long-term survival. Radiology 2007;243:744-51. |
Observational-Dx |
68 patients, 2 reviewers |
To retrospectively evaluate the prognostic importance of involvement of the circumferential resection margin predicted by using MRI before neoadjuvant treatment in patients with rectal cancer. |
MRI led to accurate prediction of a histologically involved circumferential resection margin (sensitivity, 100%; specificity, 88%). The rates for local recurrence (group 1, 33%; group 2, 5%; group 3, 6%; P<.02) and 5-year overall survival (group 1, 39%; group 2, 70%; group 3, 90%; P<.001) differed significantly among the predefined groups. The distance to the mesorectal fascia was an independent prognostic parameter in multivariate analysis (P<.001), and histopathologic response to treatment provided no additional information. Prediction of the tumor-free circumferential resection margin assessed with MRI before initiation of neoadjuvant chemotherapy and radiation therapy proved to be a prognostic factor in rectal cancer. |
3 |
| 44. Purkayastha S, Tekkis PP, Athanasiou T, Tilney HS, Darzi AW, Heriot AG. Diagnostic precision of magnetic resonance imaging for preoperative prediction of the circumferential margin involvement in patients with rectal cancer. Colorectal Dis 2007;9:402-11. |
Meta-analysis |
9 studies evaluating 529 patients |
Meta-analysis comparing MRI with histology after total mesorectal excision. To evaluate the diagnostic precision of MRI for the preoperative evaluation of circumferential margin involvement in patients with rectal cancer. |
MRI can accurately predict circumferential margin involvement preoperatively for rectal cancer in single units. |
M |
| 45. Videhult P, Smedh K, Lundin P, Kraaz W. Magnetic resonance imaging for preoperative staging of rectal cancer in clinical practice: high accuracy in predicting circumferential margin with clinical benefit. Colorectal Dis 2007;9:412-9. |
Observational-Dx |
91 patients, 5 observers |
Retrospective study to determine agreement between staging of rectal cancer made by MRI and histopathological examination and the influence of MRI on choice of radiotherapy and surgical procedure. |
MRI predicted circumferential resection margin with high accuracy in rectal cancer. MRI could be used as a clinical guidance with high reliability. |
3 |
| 46. Chang GJ, You YN, Park IJ, et al. Pretreatment high-resolution rectal MRI and treatment response to neoadjuvant chemoradiation. Dis Colon Rectum 2012;55:371-7. |
Observational-Dx |
62 patients |
To evaluate the ability of pretreatment rectal MRI to classify tumor response to neoadjuvant chemoradiation. |
Tumor response was good in 25 (40.3%) and poor in 37 (59.7%). Median interval from MRI to surgery was 7.9 weeks (interquartile range, 7.0-9.0). MRI tumor depth was <1 mm in 10 (16.9%), 1 to 5 mm in 30 (50.8%), and >5 mm in 21 (33.9%). Lymph node status was positive in 40 (61.5%), and vascular invasion was present in 16 (25.8%). Tumor response was associated with MRI tumor depth (p = 0.001), MRI lymph node status (p < 0.001) and vascular invasion (p = 0.009). Multivariate regression indicated >5 mm MRI tumor depth (OR = 0.08; 95% CI = 0.01-0.93; p = 0.04) and MRI lymph node positivity (OR = 0.12; 95% CI = 0.03-0.53; p = 0.005) were less likely to achieve a good response to neoadjuvant chemoradiotherapy. |
2 |
| 47. Hunter CJ, Garant A, Vuong T, et al. Adverse features on rectal MRI identify a high-risk group that may benefit from more intensive preoperative staging and treatment. Ann Surg Oncol 2012;19:1199-205. |
Review/Other-Dx |
236 patients |
To determine the incidence of synchronous metastatic disease according to MRI risk features |
Imaging data were available for 230 (97.5%) of 236 patients. Incidence of confirmed distant metastases was significantly greater in the MRI high-risk group, with 28 (20.7%) of 135 (95% confidence interval [CI] 14.8-28.3), versus the low-risk group, with 4 (4.2%) of 95 (95% CI 1.7-10.3) (odds ratio 6.0, 95% CI 2.0-17.6, P<0.001). |
4 |
| 48. Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 2011;29:3753-60. |
Observational-Dx |
111 patients |
To assess magnetic resonance imaging (MRI) and pathologic staging after neoadjuvant therapy for rectal cancer in a prospectively enrolled, multicenter study. |
On multivariate analysis, the MRI-assessed TRG (mrTRG) hazard ratios (HRs) were independently significant for survival (HR, 4.40; 95% CI, 1.65 to 11.7) and disease-free survival (DFS; HR, 3.28; 95% CI, 1.22 to 8.80). Five-year survival for poor mrTRG was 27% versus 72% (P = .001), and DFS for poor mrTRG was 31% versus 64% (P = .007). Preoperative MRI-predicted CRM independently predicted local recurrence (LR; HR, 4.25; 95% CI, 1.45 to 12.51). Five-year survival for poor post-treatment pathologic T stage (ypT) was 39% versus 76% (P = .001); DFS for the same was 38% versus 84% (P = .001); and LR for the same was 27% versus 6% (P = .018). The 5-year survival for involved pCRM was 30% versus 59% (P = .001); DFS, 28 versus 62% (P = .02); and LR, 56% versus 10% (P = .001). Pathology node status did not predict outcomes. |
2 |
| 49. Shihab OC, Taylor F, Salerno G, et al. MRI predictive factors for long-term outcomes of low rectal tumours. Ann Surg Oncol 2011;18:3278-84. |
Observational-Dx |
101 patients |
To analyse the prognostic values of pre-operative, pre-treatment factors (MRI low rectal stage, tumour position, MRI-predicted margin involvement), pre-operative post-treatment factors (MRI-measured TRG and MRI-predicted margin involvement), and post-operative factors (pathological CRM involvement, pathological T- and N-stage and operation performed). |
On univariate analysis, advanced MRI low rectal tumour stage correlated with greater incidence of recurrence (p=0.013) and death (p=0.029) compared with earlier stage tumours. Good MRI TRG score (good response to pre-operative therapy) correlated with significantly reduced tumour recurrence rates (p=0.008) and increased survival (p=0.008) versus the poor MRI TRG score group. On multivariate analysis, good MRI TRG score was associated with reduced recurrence (p=0.003) but not survival rates. |
3 |
| 50. Strassburg J, Ruppert R, Ptok H, et al. MRI-based indications for neoadjuvant radiochemotherapy in rectal carcinoma: interim results of a prospective multicenter observational study. Ann Surg Oncol 2011;18:2790-9. |
Observational-Tx |
230 patients |
To evaluate the use of circumferential resection margin status in preoperative MRI (mrCRM) as an indication for neoadjuvant radiochemotherapy (nRCT) in rectal carcinoma patients. |
Of 230 patients that met the inclusion criteria, 96 (41.7%) received a long course of nRCT and 134 (58.3%) were primarily operated on. The pCRM was positive in 13 of 230 (5.7%) (primarily operated on, 2 of 134 [1.5%]; after nRCT, 11 of 96 [11%]). In 1 of 134 (0.7%) case, the mrCRM was falsely negative. Patients at participating centers varied in terms of preoperative stage but not in pCRM positivity (0%-13%, P = .340). The plane of surgery was mesorectal (good) in 209 of 230 (90.9%), intramesorectal (moderate) in 16 of 230 (7%), and the muscularis propria plane (poor) in 2.2% (5 of 230). |
2 |
| 51. Taylor FG, Quirke P, Heald RJ, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg 2011;253:711-9. |
Review/Other-Dx |
374 patients |
To assess local recurrence, disease-free survival, and overall survival in magnetic resonance imaging (MRI)-predicted good prognosis tumors treated by surgery alone. |
Of 374 patients followed up in the MERCURY study, 122 (33%) were defined as "good prognosis" stage III or less on MRI. Overall and disease-free survival for all patients with MRI "good prognosis" stage I, II and III disease at 5 years was 68% and 85%, respectively. The local recurrence rate for this series of patients predicted to have a good prognosis tumor on MRI was 3%. |
4 |
| 52. Peng Y, Li Z, Tang H, et al. Comparison of reduced field-of-view diffusion-weighted imaging (DWI) and conventional DWI techniques in the assessment of rectal carcinoma at 3.0T: Image quality and histological T staging. J Magn Reson Imaging. 47(4):967-975, 2018 04. |
Observational-Dx |
81 patients |
To compare image quality (IQ) of reduced field-of-view (rFOV) and full FOV (fFOV) diffusion-weighted imaging (DWI) sequences at 3T, with histological T staging of rectal cancer as a reference standard. |
CNR was significantly higher in rFOV DWI than in fFOV DWI (7.15 +/- 2.77 vs. 5.39 +/- 2.08, P < 0.001). SNR was significantly higher in rFOV DWI than in fFOV DWI (44.17 +/- 11.01 vs. 34.76 +/- 13.30, P < 0.001). The subjective IQ parameters of rFOV DWI sequence were rated superior to those of fFOV DWI sequence by both readers (P < 0.001). No significant differences between mean tumor ADC values of both sequences (0.991 +/- 0.121 vs. 0.100 +/- 0.126 x 10(-3) mm(2) /s, P = 0.617) were noted. Apart from T1 stage, T staging of rectal cancer was inversely correlated with ADC values of rFOV DWI (r = -0.688, P < 0.001) and fFOV DWI sequences (r = -0.641, P < 0.001). |
3 |
| 53. Kim DJ, Kim JH, Ryu YH, Jeon TJ, Yu JS, Chung JJ. Nodal staging of rectal cancer: high-resolution pelvic MRI versus (1)(8)F-FDGPET/CT. J Comput Assist Tomogr. 2011;35(5):531-534. |
Observational-Dx |
30 patients |
To compare high-resolution pelvic magnetic resonance imaging (MRI) with positron emission tomography (PET)/computed tomography (CT) for the preoperative assessment of nodal staging in rectal cancer. |
The accuracies of nodal status prediction from MR and PET/CT were 83% and 70%, respectively. Magnetic resonance imaging had a sensitivity of 94% and a specificity of 67%, whereas PET/CT had a sensitivity of 61% and a specificity of 83%. A combination of MRI and PET/CT revealed a sensitivity of 94%, a specificity of 83%, and an accuracy of 90%. |
3 |
| 54. Mizukami Y, Ueda S, Mizumoto A, et al. Diffusion-weighted magnetic resonance imaging for detecting lymph node metastasis of rectal cancer. World J Surg 2011;35:895-9. |
Observational-Dx |
129 patients |
To study the accuracy of lymph node staging by DWI + conventional MRI. |
Fifty-nine (46%) patients had metastatic lymph nodes on histopathologic examinations. Two hundred twenty (18%) of 1,250 lymph nodes were pathologically positive for tumor metastasis. The overall patient-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DWI + conventional MRI were 93, 81, 81, 93, and 87%, respectively. Corresponding values of CT were 73, 79, 74, 77, and 76%, respectively. The overall node-based sensitivity, specificity, PPV, NPV, and accuracy of DWI + conventional MRI were 97, 81, 52, 99, and 84%, respectively. Corresponding values of CT were 86, 80, 48, 96, and 81%, respectively. |
3 |
| 55. Grone J, Loch FN, Taupitz M, Schmidt C, Kreis ME. Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer with Magnetic Resonance Imaging. J Gastrointest Surg. 22(1):146-153, 2018 01. |
Observational-Dx |
60 patients |
To determine the sensitivity and specificity of different morphological criteria in nodal staging. |
68.3% of patients with nodal metastasis (pN+) were correctly identified by size with a cutoff value of 7.2 mm. This, however, was not inferior to the 76.7% identified using the inhomogeneous morphological signal intensity and spiculated/indistinct border contour criteria (p = 0.096). 3.3 versus 5% were overstaged, and 28.3 versus 18.3% understaged by these criteria. Sensitivities/specificities for (a) size, (b) spiculated/indistinct border contour, and (c) inhomogeneous signal intensity and spiculated/indistinct border contour were (a) 32%/94%, (b) 56%/86%, and (c) 56%/91%, respectively. |
4 |
| 56. Faletti R, Gatti M, Arezzo A, et al. Preoperative staging of rectal cancer using magnetic resonance imaging: comparison with pathological staging. Minerva Chir. 73(1):13-19, 2018 Feb. |
Observational-Dx |
52 patients |
To evaluate the accuracy of magnetic resonance (MR) in loco-regional staging of rectal cancer by comparing the MR results with histologic findings, considered as standard reference. |
MR correctly assessed T stage in 47/52 cases (90.4%; kw=0.89+/-0.06), with inter-operator concordance of k=0.81+/-0.08. For Ln staging, concordance between estimate of high probability malignancy and pathology was kw=0.62+/-0.11. ADC was significantly different for the three grades of estimated malignancy probability (P=0.0003), decreasing from 1.227+/-0.298x10-3 mm2/s (low) to 1.120+/-0.306x10-3 mm2/s (moderate) and finally to 0.818+/-0.168x10-3 mm2/s (high). The ROC curve procedure established the good ability of ADC to discriminate high malignancy Ln's (AUC=0.88) with cut-off at <1x10-3 mm2/s. The percentage of high malignancy Ln's in the lateral pelvic space was higher than in other sites (55.6% vs. 17.6%, P=0.0003). |
3 |
| 57. Tersteeg JJC, Gobardhan PD, Crolla RMPH, et al. Improving the Quality of MRI Reports of Preoperative Patients With Rectal Cancer: Effect of National Guidelines and Structured Reporting. AJR Am J Roentgenol. 210(6):1240-1244, 2018 Jun. |
Observational-Dx |
492 MRI exams |
To evaluate the completeness of MRI reports of rectal cancer and the effect of implementation of the new guidelines and standardized reporting on the completeness of these reports. |
Before implementation of the new guidelines, a median of 4 of 10 items (interquartile range [IQR], 3-6 items) were described in each MRI report. After implementation of the new guidelines, the number of items described improved significantly (median, 7 items; IQR, 6-8 items; p < 0.001). Implementation of a standardized report led to further significant improvement (median, 9 items; IQR, 9-10 items; p < 0.001). The items scored most frequently were distance between the tumor and the anal verge (85.6%) and length of the tumor (87.6%). The items scored least were presence or absence of extramural venous invasion (21.1%) and morphologic features of the tumor (24.6%). |
3 |
| 58. Yimei J, Ren Z, Lu X, Huan Z. A comparison between the reference values of MRI and EUS and their usefulness to surgeons in rectal cancer. Eur Rev Med Pharmacol Sci 2012;16:2069-77. |
Observational-Dx |
69 patients received MRI and 60 patients received EUS |
To assess the reference value to surgeons of magnetic resonance imaging (MRI) and endorectal ultrasound (EUS) in local staging of rectal cancer. |
EUS had higher sensitivity in T1 (p = 0.044 < 0.05) and specificity in T2 (p = 0.039 < 0.05) than MRI. MRI had higher sensitivity in N staging (p = 0.046 < 0.05) and was more accurate in pT1~4N1~2 (p < 0.05) than EUS. Reference values for surgery (comparing appropriate rates of Str.1 with Str.3) of MRI and EUS were 79.7% vs. 76. 7%, respectively (p > 0.05). The actual treatment accuracy (comparing appropriate rates of Str.2 with Str.3) was increased up to 94.2% vs. 91.7%, respectively (p > 0.05). |
3 |
| 59. Jurgensen C, Teubner A, Habeck JO, Diener F, Scherubl H, Stolzel U. Staging of rectal cancer by EUS: depth of infiltration in T3 cancers is important. Gastrointest Endosc 2011;73:325-8. |
Observational-Dx |
83 patients |
To assess the accuracy of T and N staging by EUS with attention to infiltration depth as provided by EUS. |
Accuracy of T staging and N status was 76% and 63%, respectively. Overstaging by EUS was more common in minimally invasive T3 by EUS (uT3) (8 of 16 [50%]) compared with advanced uT3 tumors (1 of 24 [4%]) (P=.01). Accuracy of EUS discrimination between T1/2 and T3/4 in rectal cancer for all but minimally invasive uT3 rectal tumors was 88%. |
3 |
| 60. Badger SA, Devlin PB, Neilly PJ, Gilliland R. Preoperative staging of rectal carcinoma by endorectal ultrasound: is there a learning curve? Int J Colorectal Dis 2007;22:1261-8. |
Observational-Dx |
95 patients |
To determine if a learning curve exists in preoperative staging of rectal cancer since the accuracy in the assessment of disease staging may be dependent on operator experience. |
Overall accuracy for T staging was 71.6%. No improvement with experience was noted (P>0.05). For T staging, endorectal US tended to overstage more frequently than understage (24.2% vs 4.2%). The sensitivity, specificity, PPV and NPV of uT3 staging were 96.6%, 33.3%, 70.4% and 85.7%, respectively. Overall accuracy of uN staging was 68.8%. Endorectal US tended to overstage nodal disease more frequently than understage (16.1% vs 15.1%). Sensitivity, specificity, PPV and NPV were calculated for US-detected nodal disease (73.2%, 62.2%, 74.5% and 60.5%, respectively). Nodal staging accuracy improved from 50% after assessment of 10 cases to 77% after 30 cases were examined. Endorectal US is an accurate method for staging rectal cancer preoperatively. |
3 |
| 61. Ashraf S, Hompes R, Slater A, et al. A critical appraisal of endorectal ultrasound and transanal endoscopic microsurgery and decision-making in early rectal cancer. Colorectal Dis 2012;14:821-6. |
Observational-Dx |
494 patients |
To report its accuracy and impact for patients entered on the UK TEM database. |
ERUS was performed in 165 of 494 patients who underwent TEM for rectal cancer. It inaccurately staged rectal cancer in 44.8% of tumours: 32.7% were understaged and 12.1% were overstaged. There was no significant difference in the depth of TEM excision or R1 rate between the patients who underwent ERUS before TEM and those who did not (P = 0.73). |
3 |
| 62. Oien K, Forsmo HM, Rosler C, Nylund K, Waage JE, Pfeffer F. Endorectal ultrasound and magnetic resonance imaging for staging of early rectal cancers: how well does it work in practice?. Acta Oncol. 58(sup1):S49-S54, 2019. |
Observational-Dx |
500 patients |
To investigate the accuracy of staging by magnetic resonance imaging (MRI) and endorectal ultrasound (ERUS) in a clinical setting. |
ERUS distinguished between adenomas and early rectal cancer with 88% accuracy (95% CI: 0.68-0.96), while MRI achieved 75% accuracy (95% CI: 0.54-0.88). ERUS tended to overstage T1 tumors as T2-T3 (16/24). MRI overstaged most adenomas to T1-T2 tumors (18/22). Neither ERUS nor MRI distinguished between T1 and T2 tumors. |
3 |
| 63. Lin S, Luo G, Gao X, et al. Application of endoscopic sonography in preoperative staging of rectal cancer: six-year experience. J Ultrasound Med 2011;30:1051-7. |
Observational-Dx |
192 patients |
To evaluate our experience with the application of endoscopic sonography in preoperative staging of rectal cancer. |
The accuracy of overall T staging was 86.5%, and for T1, T2, T3, and T4, the accuracy rates were 86.7%, 94.0%, 86.2%, and 65.5%, respectively. The accuracy of T staging for ulcerated lesions was significantly lower than that for nonulcerated lesions (P = .013). The accuracy of T staging between nontraversable stenotic lesions and traversable lesions was also significantly different (P = .002). The accuracy of N staging was 77.8%, and the specificity and sensitivity were 85.6% and 74.2%, respectively. |
3 |
| 64. Ravizza D, Tamayo D, Fiori G, et al. Linear array ultrasonography to stage rectal neoplasias suitable for local treatment. Dig Liver Dis 2011;43:636-41. |
Observational-Dx |
92 patients with 92 neoplasias |
To evaluate the diagnostic accuracy of endorectal ultrasonography in the staging of neoplasias suitable for local treatment. |
The sensitivity, specificity, overall accuracy rate, positive predictive value, and negative predictive value of endorectal ultrasonography for pT0-1 were 86%, 95.6%, 91.3%, 94.9% and 88.7%. Those for nodal involvement were 45.4%, 95.5%, 83%, 76.9% and 84%, with 3 false positive results and 12 false negative. For combined pT0-1 and pN0, endorectal ultrasonography showed an 87.5% sensitivity, 95.9% specificity, 92% overall accuracy rate, 94.9% positive predictive value and 90.2% negative predictive value. |
3 |
| 65. Landmann RG, Wong WD, Hoepfl J, et al. Limitations of early rectal cancer nodal staging may explain failure after local excision. Dis Colon Rectum 2007;50:1520-5. |
Observational-Dx |
938 consecutive patients had endorectal US; 134 treated with radical resection, without neoadjuvant therapy |
To examine the accuracy of endorectal US in determining nodal stage based on depth of penetration of the primary lesion (T stage). |
Overall accuracy of endorectal US nodal staging was 70%, with a 16% false-positive rate and 14% false-negative rate. |
3 |
| 66. Moriya Y, Sugihara K, Akasu T, Fujita S. Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 1997;21:728-32. |
Review/Other-Tx |
448 patients |
To review patients with advanced lower rectal cancer who underwent curative wide lymphadenectomy with autonomic nerve preservation with respect to surgical techniques, operative burdens, node status, survival rate, and mode of recurrence. |
Operative time and blood loss in patients who underwent lateral dissection were much greater than those encountered with conventional resection. According to the direction of lymphatic spread in patients with Dukes C disease, the incidence of upward spread was 94% and lateral spread 27%. The overall incidence of lateral metastasis was 14%. The overall 5-year survival was 70%. According to the Dukes classification, the 5-year survival rates were 92% for Dukes A, 79% for Dukes B, and 55% for Dukes C, whereas it was 43% in patients with lateral node metastasis. An analysis of the survival rate was carried out with regard to the number of node metastases, direction of lymphatic spread, and autonomic nerve preservation. The overall incidence of local recurrence was 9.3% and amounted to 16.0% in patients with Dukes C disease. The case of advanced lower rectal cancer was characterized by positive lymph nodes or circular lesions around the circumference (both diagnosed by endorectal ultrasonography). We recommend extended lymphadenectomy with lateral node dissection, as it preserves the autonomic nerve. |
4 |
| 67. Pomerri F, Pucciarelli S, Maretto I, et al. Prospective assessment of imaging after preoperative chemoradiotherapy for rectal cancer. Surgery. 149(1):56-64, 2011 Jan. |
Observational-Dx |
90 patients |
To assess the accuracy of imaging techniques in predicting pathologic tumor (ypT), node (ypN) stages and the circumferential resection margin (ypCRM) status of rectal cancers after preoperative chemoradiotherapy (CRT). |
The accuracy of ypT staging was low, whatever the imaging technique used (37% by CT, 34% by MRI, and 27% by ERUS), the most frequent inaccuracy being overstaging. Imaging showed a good specificity and good negative predictive values (NPV) when mural staging was grouped into ypT </= 3 and ypT4 categories; in particular, ERUS achieved a 92% specificity and 95% NPV. CRM involvement was correctly predicted in 71% of patients by CT (74% specificity; 93% NPV) and in 85% by MRI (88% specificity; 95% NPV). The accuracy for nodal staging was 62%, 68%, and 65% by CT, MRI and ERUS, respectively; the corresponding NPV were 88%, 78%, and 76%. |
3 |
| 68. Lee CT, Chow NH, Liu YS, et al. Computed tomography with histological correlation for evaluating tumor regression of rectal carcinoma after preoperative chemoradiation therapy. Hepatogastroenterology. 59(120):2484-9, 2012 Nov-Dec. |
Observational-Dx |
91 patients |
To evaluate the correlation of tumor response evaluated using CT according to response evaluation criteria in solid tumors (RECIST) with the histo-logical tumor regression grade (TRG) |
TRG was positively correlated with the CT-assessed tumor response (r=0.276, p=0.009). Thickened fibrotic areas and muscle disarray caused by fibrosis were more frequently seen in cases of patients over-diagnosed as having residual tumors. The ycT status was positively correlated with ypT status (r=0.44, p<0.001;accuracy=61.5%). Downstaging of cT status was cor-related with a lower TRG (p=0.001). |
4 |
| 69. Huh JW, Park YA, Jung EJ, Lee KY, Sohn SK. Accuracy of endorectal ultrasonography and computed tomography for restaging rectal cancer after preoperative chemoradiation. J Am Coll Surg. 207(1):7-12, 2008 Jul. |
Observational-Dx |
181 patients |
To compare the restaging accuracy of repeat fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan with pelvic magnetic resonance imaging (MRI) in patients with rectal cancer who have undergone preoperative chemoradiation. |
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of pelvic MRI for predicting pathologic CR were 38.5, 58.1, 13.3, 84.9, and 55.2%, respectively. In terms of FDG-PET/CT, pretreatment tumor size and pathologic stage were significantly correlated with the RI values. Using a RI value of 63.6% as the cutoff threshold, it was possible to discriminate the CR from the non-CR with a sensitivity of 73.1%, a specificity of 64.5%, a PPV of 25.7%, a NPV of 93.5%, and an accuracy of 65.7% (area under the curve = 0.723, 95% confidence interval 0.619-0.828, P < 0.001). |
3 |
| 70. Yoo C, Ryu MH, Jo J, Park I, Ryoo BY, Kang YK. Efficacy of Imatinib in Patients with Platelet-Derived Growth Factor Receptor Alpha-Mutated Gastrointestinal Stromal Tumors. Cancer Res. Treat.. 48(2):546-52, 2016 Apr. |
Observational-Dx |
823 patients |
To investigate the role and efficacy of imatinib in the incidence of gastrointestinal stromal tumors (GISTs) harboring platelet-derived growth factor receptor alpha (PDGFRA) mutations. |
KIT and PDGFRA genotyping in 823 patients identified 18 patients (2%) with PDGFRA mutations who were treated with first-line imatinib. Exon 18 D842V substitution, non-D842V exon 18 mutations, and exon 12 mutations were detected in nine (50%), four (22%), and five (28%) patients, respectively. Objective response rate differed significantly between patients with the D842V mutation and those with non-D842V mutations (0% [0/5] vs. 71% [5/7], p=0.03). In all patients, median progression-free survival (PFS) and overall survival (OS) was 24.8 months (95% confidence interval [CI], 0.0 to 57.2) and 51.2 months (95% CI, 37.1 to 65.3), respectively. Significantly, poorer PFS was observed for patients with D842V-mutant GISTs than those with non-D842V PDGFRA-mutant GISTs: median 3.8 months (95% CI, 1.4 to 6.3) versus 29.5 months (95% CI, 18.3 to 40.7) (p < 0.001). Patients with the D842V mutation had poorer OS than those with non-D842V PDGFRA mutations: median 25.2 months (95% CI, 12.7 to 37.8) versus 59.8 months (95% CI, 43.0 to 76.5) (p=0.02). |
4 |
| 71. Davids JS, Alavi K, Andres Cervera-Servin J, et al. Routine preoperative restaging CTs after neoadjuvant chemoradiation for locally advanced rectal cancer are low yield: A retrospective case study. International Journal of Surgery 2014;12:1295-99. |
Observational-Dx |
182 patients |
To determine how often restaging CTs identified disease progression or regression that altered management. |
Eighty-three out of 91 patients (91%) had restaging CTs. Four patients (5%) had new lesions suspicious for distant metastasis (2 lung, 2 liver) on restaging CT scan reports (1 of these was present on initial staging CT but not reported). All 4 patients had node-positive disease. In no case did restaging CT result in a change in surgical management. Discussion: Because of the financial costs and established risks of intravenous contrast and cumulative radiation exposure, it may be advisable to take a more selective approach to preoperative imaging. Larger, prospective studies may enable identification of an at-risk cohort who would benefit most from restaging CT. |
4 |
| 72. Schneider DA, Akhurst TJ, Ngan SY, et al. Relative Value of Restaging MRI, CT, and FDG-PET Scan After Preoperative Chemoradiation for Rectal Cancer. Dis Colon Rectum. 59(3):179-86, 2016 Mar. |
Observational-Dx |
199 patients |
To assess the relative impact of restaging after preoperative chemoradiation with FDG-PET scan, CT, and MRI in the management of patients with rectal cancer. |
The stage at presentation was T2, 8.04%; T3, 65.33%; T4, 26.63%; N0, 17.09%; N1, 47.74%; N2, 34.67%; M0, 81.91%; and M1, 18.09%. Changes in disease stage postneoadjuvant chemoradiation were observed in 99 patients (50%). The management plans of 29 patients (15%) were changed. The impact of each restaging modality on management for all of the patients was positron emission tomography, 11%; CT, 4%; and MRI, 4%. In patients with metastatic disease at primary staging, the relative impact of each restaging modality in changing management was positron emission tomography, 32%; CT, 18%; and MRI, 6%. |
3 |
| 73. Sanli Y, Kuyumcu S, Ozkan ZG, et al. The utility of FDG-PET/CT as an effective tool for detecting recurrent colorectal cancer regardless of serum CEA levels. Ann Nucl Med. 26(7):551-8, 2012 Aug. |
Observational-Dx |
235 patients |
To evaluate the diagnostic performance of FDG-PET/CT in patients with suspected recurrence of CRC by comparing PET/CT performance in patients with normal CEA levels with PET/CT performance in patients with elevated CEA levels. |
Of the 235 patients, 172 (73.1 %) had disease recurrence confirmed by a pathological examination (either biopsy or surgical exploration) or clinical follow-up studies. The FDG-PET/CT study yielded a true positive in detecting recurrence in 169 (71.9 %) patients, a true negative in 53 (22.5 %) patients, a false negative in 3 (1.2 %) patients and a false positive in 10 (4.2 %) patients. CRC recurrence was detected in 64.4 % (76/118) and 88 % (103/117) patients in Group 1 and Group 2 with FDG-PET/CT, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the FDG-PET/CT study for establishing recurrence were 100, 84, 89.4, 100 and 93.2 %, respectively, for Group 1; by contrast, these parameters were 97.1, 84.6, 98, 78.5 and 95.7 %, respectively, for Group 2. The number of patients with hepatic and extra-hepatic metastases, such as lung and abdominal lymph node metastasis, detected with FDG-PET/CT was significantly different in Group 1 than in Group 2; however, the number of patients with local recurrence and peritoneal implants detected with FDG-PET/CT was not different between the two groups. |
3 |
| 74. Nishimura J, Hasegawa J, Ogawa Y, et al. (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) for the early detection of response to neoadjuvant chemotherapy for locally advanced rectal cancer. SURG. TODAY. 46(10):1152-8, 2016 Oct. |
Observational-Dx |
15 patients |
To evaluate tumor response prospectively in the early course of preoperative chemotherapy. |
The TRG was assessed as TRG1 in one patient, TRG2 in five patients, and TRG3 in nine patients. We divided the patients into two groups: non-responders (NR) included the TRG1 and TRG2 patients, and responders (R) included the TRG3 patients. The tumor size before surgery was significantly smaller in the R group than in the NR group. The SUVmax at the end of the first cycle of chemotherapy and before surgical resection was significantly lower in the R group than in the NR group. |
4 |
| 75. Tsunoda Y, Ito M, Fujii H, Kuwano H, Saito N. Preoperative diagnosis of lymph node metastases of colorectal cancer by FDG-PET/CT. Jpn J Clin Oncol. 38(5):347-53, 2008 May. |
Observational-Dx |
88 patients |
To assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for lymph node (LN) metastasis of colorectal cancer. |
The mean SUV of the malignant LNs was significantly higher than that of the benign LNs. The sensitivity, specificity and accuracy of diagnosis by abnormal uptake were 28.6, 92.9 and 75.0%, those by nodal diameter using cutoff value of 10 mm were 30.6, 95.3 and 74.4% and those by SUV using cutoff value of 1.5 were 53.1, 90.6 and 80.1%, respectively. The sensitivity, specificity and accuracy of diagnosis based on optimal SUV were 51.2, 85.1 and 69.3% in the proximal site and 62.5, 92.5 and 89.7%, respectively, in the distant site. |
3 |
| 76. Thomas A.. 125 years of radiological research-BJR's history is radiology's history. Br J Radiol. 93(1105):20209002, 2020 Jan 01. |
Review/Other-Dx |
N/A |
To present an editorial of BJR's history of radiological research. |
No results stated in abstract. |
4 |
| 77. Okitsu T, Nakazawa D, Nakagawa K, Okano T, Wada A. Synthesis and biological evaluation of 9Z-retinoic acid analogs having 2-substituted benzo[b]furan. Chem Pharm Bull (Tokyo). 58(3):418-22, 2010 Mar. |
Review/Other-Dx |
N/A |
To review the synthesis and biological evaluation of 9Z-retinoic acid analogs having 2-substituted benzo[b]furan. |
No results stated in abstract. |
4 |
| 78. Sorenson E, Lambreton F, Yu JQ, et al. Impact of PET/CT for Restaging Patients With Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiation. J Surg Res. 243:242-248, 2019 11. |
Observational-Dx |
125 patients |
To evaluate pre- and post-CRT PET-CT imaging to predict pCR and prognosis in this set of patients undergoing resection after neoadjuvant therapy. |
pCR rate was 28%, and follow-up was 48 mo. On multivariable analysis, patients who had a pCR had lower median post-CRT maximal standardized uptake value (SUVmax) (3.2 versus 5.2, P = 0.009) and higher median %SUV decrease (72 versus 58%, P = 0.009). ROC curves were generated for %SUVmax decrease (AUC = 0.70) and post-CRT SUV (AUC = 0.69). Post-CRT SUVmax <4.3 and %SUVmax decrease of >66% were equally predictive of pCR with a sensitivity of 65%, specificity of 72%, PPV of 44%, and NPV of 86%. Median 5-y overall and relapse-free survival were improved for patients with post-CRT SUV <4.3 (OS: 86 versus 66%, P = 0.01; RFS: 75 versus 52%, P = 0.01) or %SUV decrease of >66% (OS, 82 versus 66%, P = 0.05; RFS, 75 versus 54%, P = 0.01). |
3 |
| 79. Huh JW, Kwon SY, Lee JH, Kim HR. Comparison of restaging accuracy of repeat FDG-PET/CT with pelvic MRI after preoperative chemoradiation in patients with rectal cancer. J Cancer Res Clin Oncol. 141(2):353-9, 2015 Feb. |
Observational-Dx |
181 patients |
To compare the restaging accuracy of repeat fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan with pelvic magnetic resonance imaging (MRI) in patients with rectal cancer who have undergone preoperative chemoradiation. |
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of pelvic MRI for predicting pathologic CR were 38.5, 58.1, 13.3, 84.9, and 55.2%, respectively. In terms of FDG-PET/CT, pretreatment tumor size and pathologic stage were significantly correlated with the RI values. Using a RI value of 63.6% as the cutoff threshold, it was possible to discriminate the CR from the non-CR with a sensitivity of 73.1%, a specificity of 64.5%, a PPV of 25.7%, a NPV of 93.5%, and an accuracy of 65.7% (area under the curve = 0.723, 95% confidence interval 0.619-0.828, P < 0.001). |
2 |
| 80. van den Broek JJ, van der Wolf FS, Lahaye MJ, et al. Accuracy of MRI in Restaging Locally Advanced Rectal Cancer After Preoperative Chemoradiation. Dis Colon Rectum. 60(3):274-283, 2017 Mar. |
Observational-Dx |
48 patients |
To determine the accuracy of MRI in restaging locally advanced rectal cancer after preoperative chemoradiation. |
T stage was correctly predicted by the 3 readers in 47% to 68% and N stage in 68% to 70%. Overstaging was more common than understaging. Positive predictive values (PPV) among the 3 readers for T0 were 0%, and negative predictive values (NPVs) varied from 84% to 85%. For T1/2, PPVs and NPVs were 50% to 67% and 72% to 90%, and for T3/4 they were 54% to 62% and 33% to 78%. PPVs and NPVs for N0 stage were 81% to 95% and 58% to 73%. Tumor regression grade on MRI did not correspond with histopathologic tumor regression grade; PPVs for good response (tumor regression grade on MRI 1-2) were 48% to 61%, and NPVs were 42% to 58%. Interobserver agreement was fair to moderate for T stage, N stage, and tumor response (kappa = 0.20-0.41) and fair to substantial for the relation with the mesorectal fascia (kappa = 0.33-0.77). In none of the patients was the surgical plan changed after the restaging MRI. |
4 |
| 81. Kim H, Kim HM, Koom WS, et al. Profiling of rectal cancers MRI in pathological complete remission states after neoadjuvant concurrent chemoradiation therapy. Clin Radiol. 71(3):250-7, 2016 Mar. |
Observational-Dx |
120 patients |
To fully characterise the magnetic resonance imaging (MRI) traits of rectal cancers in a large sample of patients, each experiencing pathological complete remission (pCR) after neoadjuvant concurrent chemoradiation therapy (CCRT). |
Tumour volume declined sharply after CCRT (pre-CCRT, 21.5 +/- 22.4 cm(3); post-CCRT, 6.6 +/- 8.4 cm(3); p<0.001). TRG distribution was as follows: G1 (clinical CR), 3; G2, 38; G3, 78; G4, 1; and G5 (marked progression), 0. Downstaging of T-stage (34%,16/47) and MRF status (19.7%,13/66) did occur; but on post-CCRT MRI, 25.8% (31/120) remained at T3 >/= 5 mm or T4 stage, and 44.2% (53/120) were MRF-positive. A majority (88.3%, 106/120) of patients displayed intermediate T2-SI prior to CCRT. Most converted to dark T2-SI after CCRT, with 12.5% (15/120) unchanged. On post-CCRT MRI, 11% (11/100) of patients showed diffusion restriction. |
4 |
| 82. Nahas SC, Rizkallah Nahas CS, Sparapan Marques CF, et al. Pathologic Complete Response in Rectal Cancer: Can We Detect It? Lessons Learned From a Proposed Randomized Trial of Watch-and-Wait Treatment of Rectal Cancer. Dis Colon Rectum. 59(4):255-63, 2016 Apr. |
Observational-Dx |
118 patients |
To verify our ability to identify complete clinical response in patients with rectal cancer based on clinical and radiologic criteria. |
Six patients were considered clinic complete responders (2 randomly assigned for surgery (1 ypT0N0 and 1 ypT2N0) and 4 patients randomly assigned for observation (3 sustained clinic complete response and 1 had tumor regrowth)). The 112 clinic incomplete responders underwent total mesorectal excision, and 18 revealed pathologic complete response. These 18 patients were not considered complete responders at restaging because they presented at least 1 of the following conditions: mucosal ulceration and/or deformity and/or substenosis of rectal lumen at digital rectal examination and colonoscopy (n = 16), ymrT1 to T4 (n = 16), ymrN+ (n = 2), involvement of circumferential resection margin on MRI (n = 3), extramural vascular invasion on MRI (n = 4), MRI tumor response grade 2 to 4 (n = 15), and pelvic side wall lymph node involvement on MRI (n = 1). Sensitivity for identification of ypT0N0 or sustained clinic complete response was 18.2%. |
3 |
| 83. Fowler KJ, Kaur H, Cash BD, et al. ACR Appropriateness Criteria((R)) Pretreatment Staging of Colorectal Cancer. J Am Coll Radiol 2017;14:S234-S44. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for pretreatment staging of colorectal cancer. |
No results stated in abstract. |
4 |
| 84. Wei MZ, Zhao ZH, Wang JY. The Diagnostic Accuracy of Magnetic Resonance Imaging in Restaging of Rectal Cancer After Preoperative Chemoradiotherapy: A Meta-Analysis and Systematic Review. [Review]. J Comput Assist Tomogr. 44(1):102-110, 2020 Jan/Feb. |
Meta-analysis |
19 studies |
To evaluate the overall diagnostic value of magnetic resonance imaging (MRI) in restaging of rectal cancer after preoperative chemoradiotherapy based on qualified studies. |
The diagnostic accuracy of MRI in T3-T4 rectal cancer was as follows: sensitivity, 81% (95% confidence interval [CI], 67%-90%); specificity, 67% (95% CI, 51%-80%); positive likelihood ratio, 2.48 (95% CI, 1.57-3.91); negative likelihood ratio, 0.28 (95% CI, 0.15-0.52); global DOR, 6.86 (95% CI, 3.07-15.30); the area under the SROC was high (0.81; 95% CI, 0.78-0.84). The diagnostic accuracy of MRI in lymphatic metastasis of rectal cancer was as follows: sensitivity, 77% (95% CI, 65%-86%); specificity, 77% (95% CI, 63%-87%); positive likelihood ratio, 3.40 (95% CI, 2.07-5.59); negative likelihood ratio, 0.30 (95% CI, 0.20-0.45); DOR, 10.81 (95% CI, 4.99-23.39); area under the SROC was high (0.84; 95% CI, 0.80-0.87). |
Good |
| 85. Beets-Tan RGH, Lambregts DMJ, Maas M, et al. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. [Review]. Eur Radiol. 28(4):1465-1475, 2018 Apr. |
Review/Other-Dx |
N/A |
To update the 2012 ESGAR consensus guidelines on the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. |
Consensus was reached for 226 (92 %) of items. From these recommendations regarding hardware, patient preparation, imaging sequences and acquisition, criteria for MR imaging evaluation and reporting structure were constructed. The main additions to the 2012 consensus include recommendations regarding use of diffusion-weighted imaging, criteria for nodal staging and a recommended structured report template. |
4 |
| 86. Blazic IM, Campbell NM, Gollub MJ. MRI for evaluation of treatment response in rectal cancer. Br J Radiol. 89(1064):20150964, 2016 Aug. |
Review/Other-Dx |
N/A |
To discuss the current status of multiparametric MRI in the post-treatment setting and the challenges facing imaging in general in the accurate determination of treatment response. |
No results stated in abstract. |
4 |
| 87. Foti PV, Privitera G, Piana S, et al. Locally advanced rectal cancer: Qualitative and quantitative evaluation of diffusion-weighted MR imaging in the response assessment after neoadjuvant chemo-radiotherapy. Eur J Radiol Open. 3:145-52, 2016. |
Observational-Dx |
31 patients |
To investigate the added value of qualitative and quantitative evaluation of diffusion weighted (DW) magnetic resonance (MR) imaging in response assessment after neoadjuvant chemo-radiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). |
addition of DWI to conventional T2-weighted sequences improved diagnostic performance of MRI in the evaluation of ypCR. A low tumor ADC value in the pre-CRT examination, a high ADC value in the post-CRT examination, a high Delta ADC post-ADC pre [>0.3 (x10(-3) mm(2)/s)] were predictive of ypCR |
3 |
| 88. Song I, Kim SH, Lee SJ, Choi JY, Kim MJ, Rhim H. Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison with T2 weighted and PET/CT imaging. Br J Radiol 2012;85:577-86. |
Observational-Dx |
50 patients |
To evaluate the added value of diffusion-weighted imaging (DWI) in combination with T(2) weighted imaging (T2WI) compared with T2WI alone or positron emission tomography (PET)/CT for detecting viable tumour after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer. |
For detecting viable tumours, DWI with T2WI improved diagnostic accuracies (Reviewer 1 detected 90%; Reviewer 2, 86%) over T2WI alone (Reviewer 1 detected 76%, p=0.5; Reviewer 2, 64%, p=0.013) or PET/CT (48%, p<0.001). The sensitivity of DWI with T2WI (Reviewer 1 detected 98%; Reviewer 2, 91%) was significantly higher than those of T2WI alone (Reviewer 1 detected 77%; Reviewer 2, 64%) or PET-CT (43%, p<0.05). Only for Reviewer 2 was the NPV of DWI with T2WI (43%) significantly different from that of PET/CT (17%, p<0.05). The specificities and PPVs of DWI with T2WI were not improved over those of T2WI alone or of PET/CT (both p>0.05). The mean ADC of the viable tumour group (0.93 x 10(-3) mm(2) sc(-1)) was significantly lower than that of the non-viable tumour group (1.55 x 10(-3) mm(2) sc(-1), p<0.0001). |
2 |
| 89. Son IT, Kim YH, Lee KH, et al. Oncologic relevance of magnetic resonance imaging-detected threatened mesorectal fascia for patients with mid or low rectal cancer: A longitudinal analysis before and after long-course, concurrent chemoradiotherapy. Surgery. 162(1):152-163, 2017 07. |
Observational-Dx |
196 patients |
To evaluate the oncologic relevance of threatened mesorectal fascia detected with consecutive magnetic resonance imaging performed before and after long-course, concurrent chemoradiotherapy (LCRT) for mid or low rectal cancer. |
The pathologic positivity of the circumferential resection margin was greater for threatened mesorectal fascia than for clear mesorectal fascia (pre-LCRT, 14.8% vs 3.0%, P = .004; post-LCRT, 15.4% vs 4.5%, P = .025). At a median follow-up of 68 months, 3-year disease-free survival was worse for threatened mesorectal fascia than for clear mesorectal fascia (pre-LCRT, 77.0% vs 88.1%, P = .023; post-LCRT, 76.9% vs 86.6%, P = .029). On multivariate analyses, threatened mesorectal fascia on pre-LCRT magnetic resonance imaging was an independent factor for poor disease-free survival (hazard ratio = 2.153, 95% confidence interval, 1.07-4.32, P = .031), whereas threatened mesorectal fascia on post-LCRT magnetic resonance imaging was not (hazard ratio = 1.689, 95% confidence interval, 0.77-3.66, P = .189). |
3 |
| 90. Chung E, Kang D, Lee HS, et al. Accuracy of pelvic MRI in measuring tumor height in rectal cancer patients with or without preoperative chemoradiotherapy. Eur J Surg Oncol. 45(3):324-330, 2019 03. |
Observational-Dx |
128 patients |
To investigate the accuracy of MRI for measuring tumor height. |
The tumor heights measured by RS and MRI demonstrated a positive relationship in the scatter plot (linear regression; R(2)=0.898; p<0.001 in the initial group, R(2)=0.696; p<0.001 in the post-CRT group). With respect to difference of absolute value (DAV) between RS and MRI, the overall mean and standard deviation of DAV were 10.9+/-10mm in the initial group and 8+/-6mm in the post-CRT group. ICC comparison analysis revealed that inter-rater agreement of RS and MRI in the initial group was significantly better than that of the post-CRT group [ICC (95% CI) 0.946 (0.919-0.963) vs. 0.823 (0.621-0.917); p=0.004)]. |
3 |
| 91. Corines MJ, Nougaret S, Weiser MR, Khan M, Gollub MJ. Gadolinium-Based Contrast Agent During Pelvic MRI: Contribution to Patient Management in Rectal Cancer. Dis Colon Rectum. 61(2):193-201, 2018 Feb. |
Observational-Dx |
100 rectal MRIs |
To assess whether gadolinium-enhanced sequences, including dynamic contrast enhancement, change radiologic interpretation and clinical management of rectal cancer. |
At baseline, tumor downstaging occurred in 8 (16%) of 50 and upstaging in 4 (8%) of 50 with gadolinium. Postneoadjuvant treatment, upstaging occurred in 1 (2%) of 50 from T2 to T3a. At baseline, mean distances from tumor to anorectal ring, anal verge, and mesorectal fascia were not statistically different with gadolinium. However, in 7 patients, differences could have resulted in treatment changes, accounted for by changes in relationships to anterior peritoneal reflection (n = 4), anorectal ring (n = 2), or anal verge (n = 1). Postneoadjuvant treatment, distances to anorectal ring and anal verge (in centimeters) were statistically smaller with gadolinium (p = 0.0017 and p = 0.0151) but could not have resulted in clinically significant treatment changes. |
3 |
| 92. Lee ES, Kim MJ, Park SC, et al. Magnetic Resonance Imaging-Detected Extramural Venous Invasion in Rectal Cancer before and after Preoperative Chemoradiotherapy: Diagnostic Performance and Prognostic Significance. Eur Radiol. 28(2):496-505, 2018 Feb. |
Observational-Dx |
200 patients |
To evaluate the diagnostic performance of magnetic resonance imaging (MRI) in terms of identifying extramural venous invasion (EMVI) in rectal cancer patients with preoperative chemoradiotherapy (CRT) and its prognostic significance. |
The sensitivity and specificity of yMR-EMVI were 76.19% and 79.75% (area under the curve: 0.830), respectively. In univariate analysis, yMR-EMVI was the only significant MRI factor in DFS (P = 0.027). The mean DFS for yMR-EMVI (+) patients was significantly less than for yMR-EMVI (-) patients: 57.56 months versus 72.46 months. |
3 |
| 93. Kalisz KR, Enzerra MD, Paspulati RM. MRI Evaluation of the Response of Rectal Cancer to Neoadjuvant Chemoradiation Therapy. [Review]. Radiographics. 39(2):538-556, 2019 Mar-Apr. |
Review/Other-Dx |
N/A |
To review the role of MRI in the response of rectal cancer to neoadjuvant chemoradiation therapy. |
No results stated in abstract. |
4 |
| 94. Jia X, Zhang Y, Wang Y, et al. MRI for Restaging Locally Advanced Rectal Cancer: Detailed Analysis of Discrepancies With the Pathologic Reference Standard. AJR Am J Roentgenol. 213(5):1081-1090, 2019 11. |
Observational-Dx |
57 patients |
To analyze causes of discrepancies between restaging MRI and pathologic findings in the assessment of morphologic indicators of tumor response in patients with rectal cancer who have undergone neoadjuvant treatment. |
The sensitivity of MRI in determining tumor regression grades 3?5 was 77.1%; T3 and T4 category, 100.0%; node-positive disease, 75.0%; circumferential resection margin, 87.5%; and extramural vascular invasion, 91.7%. The specificity values were 72.7%, 62.5%, 70.7%, 85.7%, and 64.4%. Overstaging was mainly caused by misinterpretation of fibrotic areas as residual tumor. Inflammatory cell infiltration could appear as high signal intensity in fibrotic areas on DW images, an appearance similar to that of residual tumor. Edematous mucosa and submucosa adjacent to the tumor and muscularis propria could also be mistaken for residual tumor because of their intermediate signal intensity on T2-weighted MR images. |
3 |
| 95. Chand M, Evans J, Swift RI, et al. The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer. Ann Surg. 261(3):473-9, 2015 Mar. |
Observational-Dx |
188 patients |
To determine the prognostic significance of extramural venous invasion (EMVI) after chemoradiotherapy (CRT) by both magnetic resonance imaging (MRI) (ymrEMVI) and histopathology (ypEMVI). |
MRI detected significantly more patients with persistent EMVI than histopathology (53% vs 19%) but both were prognostic for worse survival-ymrEMVI (HR 1.97) and ypEMVI (HR 2.39). Patients with persistent ymrEMVI-positivity had significantly worse DFS at 3 years (42.7%) compared with ymrEMVI-negative tumors (79.8%); DFS for was 36.9% versus 65.9% positive and negative ypEMVI, respectively. |
3 |
| 96. Lahaye MJ, Beets GL, Engelen SM, et al. Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part II. What are the criteria to predict involved lymph nodes?. Radiology. 252(1):81-91, 2009 Jul. |
Observational-Dx |
39 patients |
To prospectively determine diagnostic performance of predictive criteria for nodal restaging after radiation therapy with concomitant chemotherapy by using ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance (MR) imaging in patients with rectal cancer. |
Lesion-by-lesion analysis was feasible in 201 lymph nodes. Area under the ROC curve (AUC) of border and short- and long-axis diameters for observer 1 were 0.85, 0.87, and 0.88 and for observer 2 were 0.70, 0.89, and 0.87, respectively. AUC for estimated percentage of white region within the node, Ratio(A), and SI(TN)/SI(GM) ratio for observer 1 were 0.98, 0.99, and 0.62 and for observer 2 were 0.97, 0.98, and 0.65, respectively. AUC for USPIO-enhanced MR criteria was significantly better than AUC for conventional MR criteria (P < .01). All criteria except border irregularity and SI(TN)/SI(GM) ratio showed high interobserver agreement (kappa > 0.79). |
4 |
| 97. Heijnen LA, Maas M, Beets-Tan RG, et al. Nodal staging in rectal cancer: why is restaging after chemoradiation more accurate than primary nodal staging?. Int J Colorectal Dis. 31(6):1157-62, 2016 Jun. |
Observational-Tx |
39 patients |
To explore the influence of chemoradiation treatment (CRT) on rectal cancer nodes and to generate hypotheses why nodal restaging post-CRT is more accurate than at primary staging. |
Eight hundred ninety-five nodes were found pre-CRT: 44 % disappeared and 40 % became smaller post-CRT. Disappearing nodes were initially significantly smaller than nodes that remained visible post-CRT: 2.9 mm vs. 3.8 mm. cN+ stage was predicted in 97 % pre-CRT and 36 % of patients had ypN+ post-CRT. ypN+ patients had significantly larger nodes than ypN0 patients both pre- and post-CRT. Optimal size cutoff for post-CRT ypN stage prediction was 2.5 mm (area under the curve (AUC) of 0.78) at MRI. |
3 |
| 98. Sprenger T, Rothe H, Homayounfar K, et al. Preoperative chemoradiotherapy does not necessarily reduce lymph node retrieval in rectal cancer specimens--results from a prospective evaluation with extensive pathological work-up. J Gastrointest Surg. 14(1):96-103, 2010 Jan. |
Observational-Dx |
64 patients |
To determine the effects of chemoradiation on mesorectal lymph node retrieval under terms of a meticulous histopathological evaluation. |
A total number of 2,021 lymph nodes were recovered (31.6 per specimen) within pathological work-up. There was no significant correlation between the number of retrieved nodes and patient- as well as tumor-dependent parameters. Lymph node size constantly amounted for less than 0.5 cm. Twenty patients (31.3%) had persistent nodal metastases. A considerable incidence of residual micrometastatic involvement in lymph nodes <0.3 cm (in 9.4% of all patients) was detected by extensive pathologic work-up. |
4 |
| 99. Malakorn S, Yang Y, Bednarski BK, et al. Who Should Get Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiation?. Dis Colon Rectum. 62(10):1158-1166, 2019 10. |
Observational-Tx |
64 patients |
To determine the indication for lateral pelvic lymph node dissection in post neoadjuvant chemoradiation rectal cancer |
The mean lateral pelvic lymph node size before and after neoadjuvant chemoradiation was 12.6 +/- 9.5 mm and 8.5 +/- 5.4 mm. The minimum size of positive lateral pelvic lymph node was 5 mm on post neoadjuvant chemoradiation imaging. Among 13 (20.3%) patients who had a <5 mm lateral pelvic lymph node after neoadjuvant chemoradiation, none were pathologically positive. Among 51 (79.7%) patients who had a >/=5 mm lateral pelvic lymph node after neoadjuvant chemoradiation, 33 patients (64.7%) were pathologically positive. Five-year overall survival and disease-specific survival were higher in the histologic lateral pelvic lymph node negative group than in the lateral pelvic lymph node positive group (overall survival 79.6% vs 61.8%, p = 0.122; disease-specific survival 84.5% vs 66.2%, p= 0.088). After a median 39 months of follow-up, there were no patients in the <5 mm group who died of cancer. There were no lateral compartment recurrences in the entire cohort. |
3 |
| 100. Loftas P, Sturludottir M, Hallbook O, Almlov K, Arbman G, Blomqvist L. Assessment of remaining tumour involved lymph nodes with MRI in patients with complete luminal response after neoadjuvant treatment of rectal cancer. Br J Radiol. 91(1087):20170938, 2018 Jul. |
Observational-Dx |
19 patients |
To assess the accuracy of MRI to predict remaining lymph node metastases in patients with complete pathological luminal response (ypT0) after neoadjuvant therapy. |
The average size of the largest lymph node on restaging MRI was significantly larger (4.5 mm) in the ypT0N+ group than in the ypT0N0 group (2.6 mm) (p = 0.04). Presence of ypN+ was correctly predicted by MRI in 7 of 19 patients. In patients without lymph node metastases (ypT0N0), these were correctly classified by MRI in 16 of 19 patients. All patients who had MR-identified lymph nodes larger than 8 mm at restaging were ypTN+. The sensitivity, specificity, positive predictive value and negative for prediction of remaining lymph node metastasis with MRI were 37, 84, 70 and 57%. |
3 |
| 101. Ogura A, Konishi T, Cunningham C, et al. Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer. J Clin Oncol. 37(1):33-43, 2019 01 01. |
Observational-Dx |
1216 patients |
To ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. |
On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). |
3 |
| 102. van Heeswijk MM, Lambregts DM, Palm WM, et al. DWI for Assessment of Rectal Cancer Nodes After Chemoradiotherapy: Is the Absence of Nodes at DWI Proof of a Negative Nodal Status?. AJR Am J Roentgenol. 208(3):W79-W84, 2017 Mar. |
Observational-Tx |
90 patients |
To test the hypothesis that the absence of nodes at DWI after CRT is concordant with a ypN0 status. |
Seventy-one patients had a yN0 status, and 19 had a yN-positive status. For 10 patients, no nodes were observed at DWI, which was concordant with a yN0 status in 100% of cases. In the other 61 patients with a yN0 status, the median number of nodes detected at DWI was three (range, 1-17 nodes). To differentiate between yN0 and yN-positive status, sensitivity was 100%, specificity was 14%, the positive predictive value was 24%, and the negative predictive value was 100%. |
3 |
| 103. Gollub MJ, Blazic I, Bates DDB, et al. Pelvic MRI after induction chemotherapy and before long-course chemoradiation therapy for rectal cancer: What are the imaging findings?. Eur Radiol. 29(4):1733-1742, 2019 Apr. |
Observational-Dx |
63 patients |
To determine the appearance of rectal cancer on MRI after oxaliplatin-based chemotherapy (ICT) and make a preliminary assessment of MRI's value in predicting response to total neoadjuvant treatment (TNT). |
Change in T2 volume was not associated with TNT response. Change in rT2SI showed correlation with TNT response for one reader only using selective regions of interest (ROIs) and borderline correlation with response using total volume ROI. There was a significant negative correlation between baseline and post-ICT node size and TNT response (r = -0.25, p = 0.05; r = -0.35, p = 0.005, readers 1 and 2, respectively). Both baseline and post-induction median node sizes were significantly smaller in complete responders (p = 0.03, 0.001; readers 1 and 2, respectively). Change in largest baseline node size and decrease in post-ICT node signal heterogeneity were associated with 100% tumour response (p = 0.04). Nodal sizes at baseline and post-ICT MRI correlated with DFS. |
3 |
| 104. Cote A, Florin FG, Mois E, et al. The accuracy of endorectal ultrasonography and high-resolution magnetic resonance imaging for restaging rectal cancer after neoadjuvant chemoradiotherapy. Ann Ital Chir. 89:168-176, 2018. |
Observational-Dx |
44 patients |
To determine which of the two imaging methods used in restaging rectal cancer has the highest accuracy. |
Fifty-four patients underwent n-CRT and 47 were restaged by both ERUS and HR-MRI. ERUS was accurate in tumor restaging after n-CRT in 29 cases (61.7%) and HR-MRI in 32 cases (68%). Regarding lymphatic node status, ERUS was accurate for 34 patients (72.3%) and had an overall rate of over-staging of 12.8% and 14.9% of under-staging. HR-MRI was accurate for 30 patients (63.8%) in restaging the lymph nodes after n-CRT and had an overall rate of over-staging of 25.5% and 10.7% of under-staging. |
3 |
| 105. Kye BH, Kim HJ, Kim G, Kim JG, Cho HM. Multimodal Assessments Are Needed for Restaging after Neoadjunvant Chemoradiation Therapy in Rectal Cancer Patients. Cancer Res. Treat.. 48(2):561-6, 2016 Apr. |
Observational-Dx |
270 patients |
To evaluate local restaging after neoadjuvant chemoradiation. |
Accuracy for prediction of ypT stage according to three imaging modalities was 45.2% (kappa=0.136, alpha=0.380) in APCT, 49.2% (kappa=0.259, alpha=0.514) in rectal MRI, and 57.9% (kappa=0.266, alpha=0.520) in TRUS. Accuracy for prediction of ypN stage was 66.0% (kappa=0.274, alpha=0.441) in APCT, 71.8% (kappa=0.401, alpha=0.549) in rectal MRI, and 66.1% (kappa=0.147, alpha=0.272) in TRUS. Of 270 patients, 37 (13.7%) were diagnosed as pathologic complete responder after nCRT. Rectal MRI for restaging did not predict complete response. On the other hand, TRUS did predict three complete responders (kappa=0.238, alpha=0.401). |
3 |
| 106. 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). 95(44):e5333, 2016 Nov. |
Meta-analysis |
89 studies |
To systematically compare the accuracy of the 3 imaging tools which are MRI, EUS and CT for rectal tumor staging |
This analysis included 89 studies. MRI, CT, and EUS yielded similar diagnostic accuracy. Better performance was observed with high-resolution MRI and 3.0-T MRI (P = 0.01 and 0.04, respectively). EUS showed lower diagnostic accuracy after preoperative therapies (P = 0.03). |
Good |
| 107. Liu S, Zhong GX, Zhou WX, et al. Can Endorectal Ultrasound, MRI, and Mucosa Integrity Accurately Predict the Complete Response for Mid-Low Rectal Cancer After Preoperative Chemoradiation? A Prospective Observational Study from a Single Medical Center. Dis Colon Rectum. 61(8):903-910, 2018 08. |
Observational-Dx |
124 patients |
To evaluate the accuracy of mucosal integrity, endorectal ultrasound, and rectal MRI to predict clinical complete response after chemoradiotherapy. |
A total of 124 patients were enrolled in this study, and postoperative pathology revealed that 20 patients (16.13%) achieved complete response (ypT0N0). The sensitivity of mucosal integrity, endorectal ultrasound, and MRI to predict clinical complete response was 25%. The specificity of mucosal integrity, endorectal ultrasound, and MRI was 94.23%, 93.90%, and 93.27%. The combination of each 2 or all 3 methods did not improve accuracy. Regression analysis showed that none of these methods could predict postoperative ypT0. |
2 |
| 108. Xiao Y, Xu D, Ju H, et al. Application value of biplane transrectal ultrasonography plus ultrasonic elastosonography and contrast-enhanced ultrasonography in preoperative T staging after neoadjuvant chemoradiotherapy for rectal cancer. Eur J Radiol. 104:20-25, 2018 Jul. |
Observational-Dx |
53 patients |
To determine the accuracy of biplane transrectal ultrasonography (TRUS) plus ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) in preoperative T staging after neoadjuvant chemoradiotherapy for rectal cancer. |
For patients with rectal cancer, ultrasonic T stages were lower after neoadjuvant chemoradiotherapy than before, with a statistically significant difference (P <0.05). The posttreatment downstaging rate was 39.6% (21/53). A total of 84.9% received correct staging with use of biplane TRUS plus UE and CEUS in the evaluation of preoperative T staging after neoadjuvant chemoradiotherapy for rectal cancer, which was highly consistent with that of pathological staging (kappa=0.768, P<0.05). Its sensitivities were 80.0%, 50.0%, 75.0%, 96.3%, and 100% in the diagnoses of stages T0 to T4 rectal cancers, respectively; the specificities were 95.4%, 97.9%, 95.1%, 88.5%, and 100% at stages T0 to T4, respectively. |
3 |
| 109. Gavioli M, Bagni A, Piccagli I, Fundaro S, Natalini G. Usefulness of endorectal ultrasound after preoperative radiotherapy in rectal cancer: comparison between sonographic and histopathologic changes. Dis Colon Rectum. 43(8):1075-83, 2000 Aug. |
Observational-Dx |
29 patients |
To assess the advantages of endorectal ultrasound after preoperative radiotherapy in rectal cancer, its reliability in tumoral staging, and its capacity to identify completely sterilized lesions. |
Morphologically and quantitatively, postradiation endorectal ultrasound showed the reappearance of anatomic cleavage planes, a considerable shrinkage of the tumor, and in low rectal tumors, an increase in the distance from the anorectal ring in more than 50 percent of the cases. These data had a direct influence on surgical treatment. Histologic examination showed that, in 28 out of 29 cases, fibrosis was the most dominant component of the irradiated lesions, varying by more than 50 to 100 percent of the lesion (four cases pTO). A comparison of postradiation endorectal ultrasound with histopathology revealed that fibrosis became the morphologic basis of ultrasound images; therefore, after radiotherapy, what endorectal ultrasound staged was no longer the tumor but the extent of fibrosis in the rectal wall. A histopathologic examination showed that the residual tumor, when present, was always within the fibrosis, never outside or separate from it. Postradiation endorectal ultrasound showed echo-pattern changes. Some of the changes (more echogenic and nonhomogeneous lesions) were histologically related to the persistence of the tumor to a considerable degree; other changes (reappearance of parietal layers) were related to complete sterilization of lesions in two of three cases. |
4 |
| 110. Kulemann V, Schima W, Tamandl D, et al. Preoperative detection of colorectal liver metastases in fatty liver: MDCT or MRI? Eur J Radiol 2011;79:e1-6. |
Observational-Dx |
20 patients |
To compare the diagnostic value of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative detection of colorectal liver metastases in diffuse fatty infiltration of the liver, associated with neoadjuvant chemotherapy. |
Overall, 51 metastases were found by histopathology of the resected liver segments/lobes. The size of the metastases ranged from 0.4 to 13 cm, with 18 (35%) being up to 1cm in diameter. In the overall rating, MDCT detected 33/51 lesions (65%), and MRI 45/51 (88%). For lesions up to 1cm, MDCT detected only 2/18 (11%) and MRI 12/18 (66%). One false positive lesion was detected by MDCT. Statistical analysis showed that MRI is markedly superior to MDCT, with a statistically significant difference (p<.001), particularly for the detection of small lesions (</= 1 cm; p<.004). There was no significant difference between the two modalities in the detection of lesions>1cm. |
2 |
| 111. van Kessel CS, van Leeuwen MS, van den Bosch MA, et al. Accuracy of multislice liver CT and MRI for preoperative assessment of colorectal liver metastases after neoadjuvant chemotherapy. Dig Surg. 2011; 28(1):36-43. |
Observational-Dx |
79 lesions in 15 patients |
To determine the best imaging modality for preoperative detection, characterization and measurement of colorectal liver metastases after neoadjuvant chemotherapy. |
Lesion detection rate was similar for multislice-CT and MRI (76% and 80%, respectively, P=0.648). Lesion characterization was significantly superior (P=0.021) at MRI (89%, kappa 0.747, P=0.001) compared to multislice-CT (77%, kappa 0.235, P=0.005). Interobserver variability for diameter measurement was not significant at MRI (P=0.909 [95% confidence interval; -1.245 to 1.395]), but significant at multislice-CT (P=0.028 [95% confidence interval; -3.349 to -2.007]). Differences in diameter measurement were independent of observer (P=0.131), and no statistical effect from imaging modality on diameter measurement was observed (P=0.095). |
3 |
| 112. Cance WG, Cohen AM, Enker WE, Sigurdson ER. Predictive value of a negative computed tomographic scan in 100 patients with rectal carcinoma. Dis Colon Rectum. 1991;34(9):748-751. |
Observational-Dx |
100 patients |
To evaluate the ability of a computed tomographic (CT) scan to predict accurately the absence of either periaortic nodal metastases or liver metastases in a group of patients with rectal carcinoma. |
Sixty-four patients (64 percent) had stage T3 or T4 tumors. Ten patients had unsuspected distant metastases for an overall negative predictive value of 90 percent. Seven patients had small liver metastases, and three had periaortic nodal metastases. Six of the patients with liver metastases had them completely resected at the original laparotomy. The predictive value of the CT scan diminished in the patients who were selected to receive full-dose preoperative radiation therapy and had a mean delay of 12 weeks between CT scan and laparotomy. The preoperative carcinoembryonic antigen levels were of no value in predicting the presence of distant metastases. |
3 |
| 113. Valls C, Andia E, Sanchez A, et al. Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology 2001;218:55-60. |
Experimental-Dx |
157 patients |
To prospectively evaluate helical computed tomography (CT) in the preoperative detection of hepatic metastases and assessment of resectability with surgical, intraoperative ultrasonographic (US), and histopathologic correlation. |
Intraoperative US, palpation, and histopathologic examination revealed 290 liver metastases; helical CT correctly depicted 247. Helical CT results were the following: overall detection rate, 85.1% (95% CI: 80.8%, 89.3%); positive predictive value, 96.1% (95% CI: 92.9%, 98.1%); and false-positive rate, 3.9% (10 of 257 findings; 95% CI: 1.9%, 7.1%). False-positive findings were related to hemangioendothelioma, hemangioma, hepatic peliosis, biliary adenoma, centrilobar hemorrhage, biliary hamartoma, periportal fibrosis, and normal liver parenchyma. Curative resection was performed in 112 instances with a resectability rate of 94.1%. Four-year patient survival rate was 58.6%. |
2 |
| 114. Numminen K, Isoniemi H, Halavaara J, et al. Preoperative assessment of focal liver lesions: multidetector computed tomography challenges magnetic resonance imaging. Acta Radiol 2005;46:9-15. |
Observational-Dx |
31 patients |
To investigate prospectively multidetector computed tomography (CT) (MDCT) and magnetic resonance (MR) imaging (MRI) in the preoperative assessment of focal liver lesions. |
At surgery, IOUS and palpation revealed 45 solid liver lesions. From these, preoperative MDCT detected 43 (96%) and MRI 35 (78%) deposits. MDCT performed statistically better than MRI in lesion detection (P=0.008). Assessment of lesion vascular proximity was correctly determined by MDCT in 98% of patients and by MRI in 87%. Statistical difference was found (P=0.002). IOUS and palpation changed the preoperative surgical plan as a result of extrahepatic disease in 8/31 (26%) cases. In MDCT as well in MRI extrahepatic involvement was suspected in two cases. |
3 |
| 115. Onishi H, Murakami T, Kim T, et al. Hepatic metastases: detection with multi-detector row CT, SPIO-enhanced MR imaging, and both techniques combined. Radiology 2006;239:131-8. |
Observational-Dx |
38 patients |
To retrospectively compare the accuracy in detection of hepatic metastases among contrast material-enhanced multi-detector row computed tomography (CT) alone, superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging alone, and a combination of contrast-enhanced CT and SPIO-enhanced MR imaging. |
The mean area under the AFROC curve for the combined approach (0.70) was significantly higher than that for SPIO-enhanced MR imaging alone (0.58, P < .05, Fisher protected least significant difference test), and there was no significant difference between each of them and that for contrast-enhanced CT alone (0.66). For all lesions, the mean sensitivity of combined imaging (0.59) was significantly higher than that of CT (0.48) or MR imaging (0.43) alone (P < .05, Fisher protected least significant difference test and generalized estimating equations). For all lesions, the mean positive predictive values were 0.82, 0.89, and 0.81, for combined MR and CT, CT alone, and MR alone, respectively. |
2 |
| 116. Soyer P, Poccard M, Boudiaf M, et al. Detection of hypovascular hepatic metastases at triple-phase helical CT: sensitivity of phases and comparison with surgical and histopathologic findings. Radiology 2004;231:413-20. |
Experimental-Dx |
32 patients with 59 hepatic metastases |
To compare the respective sensitivities of unenhanced, arterial-dominant, and portal-dominant phase helical computed tomography (CT) in the preoperative depiction of hypovascular hepatic metastases by using intraoperative ultrasonographic (US) and histopathologic findings as the standard of reference. |
Among 59 hepatic metastases, unenhanced, arterial-dominant, and portal-dominant phase helical CT imaging depicted 39 (66.1%; 95% CI: 53.3%, 76.8%), 44 (74.5%; 95% CI: 62.2%, 83.9%), and 54 (91.5%; 95% CI: 81.6%, 96.3%) metastases, respectively. Portal-dominant phase imaging depicted significantly more hypovascular hepatic metastases than did unenhanced (P <.001) or arterial-dominant (P <.01) phase imaging (Wilcoxon test). |
2 |
| 117. Brouquet A, Abdalla EK, Kopetz S, et al. High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol. 2011;29(8):1083-1090. |
Observational-Tx |
127 patients |
A retrospective study to compare outcomes of patients undergoing at least the first stage of two-stage resection with those of selected nonsurgically treated patients responding to modern chemotherapy. |
65 patients underwent the first stage of two-stage resection; 62 patients fulfilled the inclusion criteria for the medical group. Two-stage resection patients had a mean of 6.7 +/- 3.4 colorectal liver metastases with mean size of 4.5 +/- 3.1 cm. Nonsurgical patients had a mean of 5.9 +/- 2.9 colorectal liver metastases with mean size of 5.4 +/- 3.4 cm (not significant). 47 two-stage resection patients (72%) completed the second stage. Progression between stages was the main cause of noncompletion of the second stage (61%). After 50 months median follow-up, the 5-year survival rate was 51% in the two-stage resection group and 15% in the medical group (P=.005). In patients who underwent two-stage resection, noncompletion of two-stage resection and major postoperative complications were independently associated with worse survival. |
2 |
| 118. Shindoh J, Loyer EM, Kopetz S, et al. Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases. J Clin Oncol 2012;30:4566-72. |
Observational-Tx |
209 patients |
To confirm the prognostic value of an optimal morphologic response to preoperative chemotherapy in patients undergoing chemotherapy with or without bevacizumab before resection of colorectal liver metastases (CLM) and to identify predictors of the optimal morphologic response. |
An optimal morphologic response was observed in 47% of patients treated with bevacizumab and 12% of patients treated without bevacizumab (P < .001). The 3- and 5-year OS rates were higher in the optimal response group (82% and 74%, respectively) compared with the suboptimal response group (60% and 45%, respectively; P < .001). On multivariate analysis, suboptimal morphologic response was an independent predictor of worse OS (hazard ratio, 2.09; P = .007). Receipt of bevacizumab (odds ratio, 6.71; P < .001) and largest metastasis before chemotherapy of </= 3 cm (odds ratio, 2.12; P = .025) were significantly associated with optimal morphologic response. The morphologic response showed no specific correlation with conventional size-based RECIST criteria, and it was superior to RECIST in predicting major pathologic response. |
2 |
| 119. O'Leary MP, Parrish AB, Tom CM, MacLaughlin BW, Petrie BA. Staging Rectal Cancer: The Utility of Chest Radiograph and Chest Computed Tomography. Am Surg. 82(10):1005-1008, 2016 Oct. |
Observational-Dx |
74 patients |
To evaluate whether patients who are newly diagnosed with rectal cancer can undergo posteroanterior and lateral chest radiography (X-ray) for adequate staging. |
Sixty-three (85%) had a normal chest X-ray and 11 (15%) had an abnormal chest X-ray. Of the 63 patients with a normal chest X-ray, 40 (63%) had a corresponding normal chest CT and 23 (37%) had a lesion only noted on chest CT. Four patients (17%) in the latter group had metastatic cancer to the lung at the time of workup and four out of five of the tumors found to metastasize were within 5 cm from the anal verge. Our data suggest that a staging chest X-ray is unlikely to diagnose metastatic lungs lesions from a primary rectal cancer. |
3 |
| 120. Kronawitter U, Kemeny NE, Heelan R, Fata F, Fong Y. Evaluation of chest computed tomography in the staging of patients with potentially resectable liver metastases from colorectal carcinoma. Cancer 1999;86:229-35. |
Observational-Dx |
202 patients |
Retrospective analysis to determine whether CT of the chest was necessary in patients with negative chest radiograph. |
For routine preoperative workup, majority of lesions appearing on chest CT scans of patients with negative chest radiographs were not malignant. The positive yield of CT-guided workup was 10/202 patients (5%). |
3 |
| 121. Grossmann I, Avenarius JK, Mastboom WJ, Klaase JM. Preoperative staging with chest CT in patients with colorectal carcinoma: not as a routine procedure. Ann Surg Oncol 2010;17:2045-50. |
Review/Other-Dx |
200 patients |
To analyze the outcome and clinical benefit of routine staging with chest CT after inclusion of a consecutive series of 200 patients with colorectal cancer. |
Synchronous metastases were present in 60 patients (30%). Staging chest CT revealed pulmonary metastases in 6 patients, with 1 false positive finding. In 50 patients indeterminate lesions were seen on chest CT (25%). These were diagnosed during follow-up as true metastases (n = 8), bronchus carcinoma (n = 2), benign lesions (n = 25), and remaining unknown (n = 15). Ultimately, synchronous pulmonary metastases were diagnosed in 13 patients (7%), in 6 patients confined to the lung (3%). In none of the patients the treatment plan for the primary tumor was changed based on the staging chest CT. |
4 |
| 122. Christoffersen MW, Bulut O, Jess P. The diagnostic value of indeterminate lung lesions on staging chest computed tomographies in patients with colorectal cancer. Dan Med Bull 2010;57:A4093. |
Observational-Dx |
131 consecutive patients |
To evaluate the significance of such indeterminate lung findings in staging CT scans. |
In eight of the 22 patients (36%) lesions progressed. In one patient, the lesion turned out to be a primary lung cancer, in another a lymphoma. In the last six patients (27%), the lesions developed into colorectal cancer lung metastases within a median period of 15 months. These results were significantly different from those obtained in patients who had a normal CT, among whom only 6% developed lung malignancies in the follow-up period (p < 0.0001). The development of lung metastases was significantly related to positive nodal status at operation and elevated carcinoembryonic antigen (CEA) level at follow-up (p < 0.05). |
4 |
| 123. Choi DJ, Kwak JM, Kim J, Woo SU, Kim SH. Preoperative chest computerized tomography in patients with locally advanced mid or lower rectal cancer: its role in staging and impact on treatment strategy. J Surg Oncol 2010;102:588-92. |
Review/Other-Dx |
103 patients |
To evaluate the role of chest CT on preoperative staging in rectal cancer patients and to assess the impact on treatment strategy. |
Nine patients (8.7%) had pulmonary metastases detected on CT. CXR did not reveal any pulmonary metastatic lesions in four of the nine patients. Of these four, treatment was changed in three patients because of these findings. Forty (38.8%) patients had indeterminate nodules on chest CT. Of these, 37 patients had follow-up CTs and four patients (10.8%) showed interval changes that were confirmed as pulmonary metastasis. |
4 |
| 124. McQueen AS, Scott J. CT staging of colorectal cancer: what do you find in the chest? Clin Radiol 2012;67:352-8. |
Review/Other-Dx |
514 patients |
To clarify the chest computed tomography (CT) findings in patients with a new diagnosis of colorectal adenocarcinoma. |
Five hundred and fourteen out of 568 (90.5%) CRC patients underwent complete CT staging. Thirty-one patients (6%) had lung metastases, of which four (0.8%) were isolated. Three hundred and fifty-three (68.7%) had no evidence of pulmonary metastases, but 130 (25.3%) had indeterminate lung nodules (ILNs). The ILNs of 12 patients were subsequently confirmed as metastases on follow-up. A major non-metastatic finding (pulmonary embolism or synchronous primary malignancy) was found in 15/514 patients (3%). |
4 |
| 125. Mainenti PP, Iodice D, Segreto S, et al. Colorectal cancer and 18FDG-PET/CT: what about adding the T to the N parameter in loco-regional staging? World J Gastroenterol. 2011;17(11):1427-1433. |
Observational-Dx |
34 patients |
To evaluate whether FDG-positron emission tomography (PET)/computed tomography (CT) may be an accurate technique in the assessment of the T stage in patients with colorectal cancer. |
Thirty five/37 (94.6%) adenocarcinomas were identified and correctly located on PET/CT images. PET/CT correctly staged the T of 33/35 lesions identified showing an accuracy of 94.3% (95% CI: 87%-100%). All T1, T3 and T4 lesions were correctly staged, while two T2 neoplasms were overstated as T3. |
3 |
| 126. Kinner S, Antoch G, Bockisch A, Veit-Haibach P. Whole-body PET/CT-colonography: a possible new concept for colorectal cancer staging. Abdom Imaging. 32(5):606-12, 2007 Sep-Oct. |
Observational-Dx |
55 patients |
To develop and evaluate a combined whole-body PET/CT-colonography protocol for dedicated CRC staging in routine clinical use. |
All examinations were fully diagnostic and well tolerated by the patients. PET/CT-colonography showed highly accurate results for overall TNM-evaluation and was significantly more accurate than CT-colonography alone. |
3 |
| 127. Veit-Haibach P, Kuehle CA, Beyer T, et al. Diagnostic accuracy of colorectal cancer staging with whole-body PET/CT colonography. JAMA. 296(21):2590-600, 2006 Dec 06. |
Observational-Dx |
47 patients |
To determine the staging accuracy of whole-body PET/CT colonography compared with the staging accuracies of CT followed by PET (CT + PET) and CT alone and to evaluate the effect of PET/CT colonography on therapy planning compared with conventional staging (CT of the abdomen and thorax and optical colonoscopy). |
Of the 47 patients with a total of 50 lesions, the overall TNM stage was correctly determined for 37 lesions with PET/CT colonography (74%; 95% confidence interval [CI], 60%-85%), 32 lesions with CT + PET (64%; 95% CI, 49%-77%), and 26 lesions with CT alone with a 0.7-cm node threshold (52%; 95% CI, 37%-66%). Compared with optimized abdominal CT staging alone, PET/CT colonography was significantly more accurate in defining TNM stage (difference, 22%; 95% CI, 9%-36%; P=.003), which was mainly based on a more accurate definition of the T-stage. Differences were not detected for defining N-stage between PET/CT colonography and CT alone with a threshold of 0.7 cm for malignant nodes but were detected with a threshold of 1 cm. Differences were not detected in defining M-stage separately or when comparing the accuracies of PET/CT colonography with CT + PET. PET/CT colonography affected consecutive therapy decisions in 4 patients (9%; 95% CI, 2.4%-20.4%) compared with conventional staging (CT alone and colonoscopy). |
2 |
| 128. Ramos E, Valls C, Martinez L, et al. Preoperative staging of patients with liver metastases of colorectal carcinoma. Does PET/CT really add something to multidetector CT? Ann Surg Oncol 2011;18:2654-61. |
Observational-Dx |
97 patients |
To determine prospectively whether the systematic use of PET/CT associated with conventional techniques could improve the accuracy of staging in patients with liver metastases of colorectal carcinoma. |
In a lesion-by-lesion analysis of the hepatic staging, the sensitivity of MDCT/RM was superior to PET/CT (89.2 vs. 55%, p < 0.001). On the extrahepatic staging, PET/CT was superior to MDCT/MR only for the detection of locoregional recurrence (p = 0.03) and recurrence in uncommon sites (p = 0.016). New findings in PET/CT resulted in a change in therapeutic strategy in 17 patients. However, additional information was correct only in eight cases and wrong in nine patients. |
2 |
| 129. Shin SS, Jeong YY, Min JJ, Kim HR, Chung TW, Kang HK. Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT. [Review] [41 refs]. Abdom Imaging. 33(3):270-7, 2008 May-Jun. |
Review/Other-Dx |
N/A |
To discuss the role, relative advantages and limitations of CT and PET/CT in the preoperative staging of colorectal cancer. |
With the advance of CT technology, CT has still relative advantages over PET/CT with respect to local extent of primary tumor and regional lymph node metastases. The most significant additional information provided by PET/CT relates to the accurate detection of distant metastases. At present, routine evaluation of patients with suspicious colorectal cancer by PET/CT seems not to be necessary. But, it should be performed on selected patients who have suggestive but inconclusive metastatic lesions with CT. In addition, PET/CT with dedicated CT protocols, such as contrastenhanced PET/CT and PET/CT colonography, mayreplace the diagnostic CT for the preoperative staging of colorectal cancer. |
4 |
| 130. Briggs RH, Chowdhury FU, Lodge JP, Scarsbrook AF. Clinical impact of FDG PET-CT in patients with potentially operable metastatic colorectal cancer. Clin Radiol. 66(12):1167-74, 2011 Dec. |
Observational-Dx |
102 patients |
To assess the clinical impact of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography-computed tomography (PET-CT) in patients with potentially resectable metastatic colorectal cancer. |
Of 102 patients (mean age 67 years, range 27-85 years), 94 had liver, five had isolated lung, and three had limited peritoneal metastases. In 31 patients (30%) PET-CT had a major impact on subsequent management, by correctly clarifying indeterminate lesions on conventional imaging as inoperable metastatic disease in 16 patients, detecting previously unsuspected metastatic disease in nine patients, identifying occult second primary tumours in three patients, and correctly down-staging three patients. PET-CT had a minor impact in 12 patients (12%), no impact in 49 cases (48%), and a potentially negative impact in 10 cases (10%). Following PET-CT, 36 (35%) patients were no longer considered for surgery. Of those remaining operative 45 of 66 (68%) underwent potentially curative metastatic surgery. In this cohort PET-CT saved 16 futile laparotomies. |
3 |
| 131. Eglinton T, Luck A, Bartholomeusz D, Varghese R, Lawrence M. Positron-emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal cancer. Colorectal Dis 2010;12:667-73. |
Observational-Dx |
20 patients |
To assess the role of (18)flourodeoxyglucose positron-emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal adenocarcinoma. |
Positron-emission tomography/computed tomography correctly identified the primary tumour in all 20 patients. Comparing PET/CT with conventional staging modalities, there were 11 discordant or incidental findings in nine patients (45%). This resulted in a potential change in stage in 30% (four patients downstaged and two upstaged). PET/CT suggested additional neoplastic pathology in three patients and excluded the same in two patients. The incidental neoplastic findings were of minor clinical significance and one was eventually deemed false positive. While PET/CT resulted in potential management changes in five patients (25%), no changes in surgical management occurred. When tumours were grouped according to conventional stage, PET/CT resulted in fewer changes in stage in stage I (0%), compared with stages II to IV (43%) (P = 0.08). |
2 |
| 132. Llamas-Elvira JM, Rodriguez-Fernandez A, Gutierrez-Sainz J, et al. Fluorine-18 fluorodeoxyglucose PET in the preoperative staging of colorectal cancer. Eur J Nucl Med Mol Imaging 2007;34:859-67. |
Observational-Dx |
104 patients |
To evaluate the utility of FDG-PET in the initial staging of patients with CC in comparison with conventional staging methods and to determine its impact on therapeutic management. |
In 14 patients, surgery was contraindicated by FDG-PET owing to the extent of disease (only 6/14 suspected by CT). FDG-PET revealed four synchronous tumours. For N staging, both procedures showed a relatively high specificity but a low diagnostic accuracy (PET 56%, CT 60%) and sensitivity (PET 21%, CT 25%). For M assessment, diagnostic accuracy was 92% for FDG-PET and 87% for CT. FDG-PET results led to modification of the therapy approach in 50% of patients with unresectable disease. FDG-PET findings were important, revealing unknown disease in 19.2%, changing the staging in 13.46% and modifying the scope of surgery in 11.54% (with a change in the therapeutic approach in 17.85% of those patients with rectal cancer). |
2 |
| 133. Spatz J, Holl G, Sciuk J, Anthuber M, Arnholdt HM, Markl B. Neoadjuvant chemotherapy affects staging of colorectal liver metastasis--a comparison of PET, CT and intraoperative ultrasound. Int J Colorectal Dis 2011;26:165-71. |
Observational-Dx |
34 patients |
To evaluate the effects of neoadjuvant chemotherapy on the efficacy of positron emission tomography (PET), PET-computed tomography (CT), CT and intraoperative ultrasound (IUS) in the detection of liver metastasis. |
A total of 109 liver segments were resected, of which 50 showed no metastatic involvement (45.9%). For patients without systemic chemotherapy, sensitivities for PET, CT/MRI and IUS were 92%, 64% and 100% respectively as compared with 63%, 65% and 94% for patients after neoadjuvant chemotherapy in a segment-based analysis. For PET, standardised uptake values were decreased by 3.9 in 10 patients after chemotherapy whereas lesion diameters were similar (3.0 vs. 3.2 cm). Additional metastases were detected by IUS in seven patients resulting in a change of operative procedure in 20.6%. |
3 |
| 134. Capirci C, Rubello D, Pasini F, et al. The role of dual-time combined 18-fluorodeoxyglucose positron emission tomography and computed tomography in the staging and restaging workup of locally advanced rectal cancer, treated with preoperative chemoradiation therapy and radical surgery. Int J Radiat Oncol Biol Phys 2009;74:1461-9. |
Observational-Dx |
87 consecutive patients enrolled, 2 reviewers |
To evaluate the possible role of dual time sequential FDG-PET scans in the staging and restaging workup of locally advanced rectal cancer. |
Six of 87 patients were excluded due to protocol deviation. Following CRT, 40/81 patients (49%) were classified as responders according to Mandard's criteria (TRG1-2). The mean pre-CRT SUV(max) was significantly higher than post-CRT (15.8, vs 5.9; p < 0.001). The mean RI was significantly higher in responders than in nonresponder patients (71.3% vs 38%; p = 0.0038). Using a RI cut-off of 65% for defining response to therapy, the following parameters have been obtained: 84.5% sensitivity, 80% specificity, 81.4% positive predictive value, 84.2% negative predictive value, and 81% overall accuracy. |
2 |
| 135. Berger-Kulemann V, Schima W, Baroud S, et al. Gadoxetic acid-enhanced 3.0 T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference. Eur J Surg Oncol 2012;38:670-6. |
Observational-Dx |
23 patients |
To compare the diagnostic value of gadoxetic acid-enhanced MRI at 3.0 T with 64-row MDCT in the detection of colorectal liver metastases in diffuse fatty infiltration of the liver after neoadjuvant chemotherapy. |
Overall, 68 metastases (range, 0.4-6 cm; 31/68 metastases [46%] </= 1 cm) were found at histology. MDCT detected 49/68 lesions (72%), and MRI 66/68 (97%, p < 0.001). For lesions </= 1 cm, MDCT detected only 13/31 (41.9%) and MRI 29/31 (93%, p < 0.001). Eight false-positive lesions were detected by MDCT, seven small lesions by MRI. There was no statistically significant difference between the two modalities in the detection of lesions > 1 cm (p = 0.250). IOUS detected all metastases and revealed two false-positive diagnoses. |
2 |
| 136. Hammerstingl R, Huppertz A, Breuer J, et al. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2008;18:457-67. |
Experimental-Dx |
169 patients |
To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). |
Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: -4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT. |
1 |
| 137. Kim YK, Park G, Kim CS, Yu HC, Han YM. Diagnostic efficacy of gadoxetic acid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol 2012;85:539-47. |
Observational-Dx |
67 patients |
To compare the diagnostic performance of gadoxetic acid-enhanced MRI and 16-slice multidetector CT (MDCT) with respect to their abilities to detect hepatic metastases and differentiate hepatic metastases from hepatic cysts and haemangiomas. |
For both observers, the Az values of gadoxetic acid-enhanced MRI (mean, 0.982 and 0.981) were significantly higher than the Az values of MDCT (mean, 0.839 and 0.892) (p<0.05) for the detection of metastases and for the differentiation of metastases from haemangiomas and cysts. Sensitivities of gadoxetic acid-enhanced MRI with regard to the detection and characterisation of liver metastases (mean, 96.9% and 96.0%) were significantly higher than those of MDCT (mean, 78.7% and 75.0%) (p<0.05). |
2 |
| 138. Knowles B, Welsh FK, Chandrakumaran K, John TG, Rees M. Detailed liver-specific imaging prior to pre-operative chemotherapy for colorectal liver metastases reduces intra-hepatic recurrence and the need for a repeat hepatectomy. HPB (Oxford) 2012;14:298-309. |
Review/Other-Dx |
242 patients |
Retrospective review of a prospective database to determine whether liver-specific magnetic resonance imaging (MRI) prior to pre-operative chemotherapy affects intra-hepatic recurrence and long-term outcome after hepatectomy. |
A liver-specific MRI pre-chemotherapy changed the staging in 56% of patients. At a median (range) follow-up of 55 (6-94) months, there was a higher incidence of intra-hepatic recurrence at a new site in the non-PCI group (65% vs. 48% in the PCI group, P= 0.041) and an increased rate of recurrence in patients with the same number of lesions pre- and post-chemotherapy [hazard ratio (HR) 2.02, 1:10-3.37, P= 0.024]. The non-PCI group underwent more repeat hepatectomies than the PCI group (24.7% vs. 13%, P= 0.034), achieving similar long-term survival. |
4 |
| 139. Koh DM, Collins DJ, Wallace T, Chau I, Riddell AM. Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases. Br J Radiol 2012;85:980-9. |
Observational-Dx |
72 patients |
To compare the diagnostic accuracy of gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, diffusion-weighted MRI (DW-MRI) and a combination of both techniques for the detection of colorectal hepatic metastases. |
417 lesions (310 metastases, 107 benign) were found in 72 patients. For both readers, diagnostic accuracy using the combined image set was higher [area under the curve (Az)=0.96, 0.97] than Gd-EOB-DTPA image set (Az=0.86, 0.89) or DW-MRI image set (Az=0.93, 0.92). Using combined image set improved identification of liver metastases compared with Gd-EOB-DTPA image set (p<0.001) or DW-MRI image set (p<0.001). There was very good interobserver agreement for lesion classification (kappa=0.81-0.88). |
2 |
| 140. Macera A, Lario C, Petracchini M, et al. Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy. Eur Radiol. 23(3):739-47, 2013 Mar. |
Observational-Dx |
32 patients |
To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy. |
Evaluation of image set 1 correctly identified 127/166 lesions (accuracy 76.5 %; 95 % CI 69.3-82.7) and 106/144 metastases (sensitivity 73.6 %, 95 % CI 65.6-80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3-72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9-68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4-93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1-95.1). Differences were statistically significant (P < 0.001). Notably, similar results were obtained analysing only small lesions (<1 cm). |
2 |
| 141. Kim SH, Lee JM, Hong SH, et al. Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology 2009;253:116-25. |
Observational-Dx |
40 patients |
To investigate the added value of diffusion-weighted (DW) magnetic resonance (MR) imaging in the evaluation of complete response (CR) to neoadjuvant combined chemotherapy and radiation therapy (CRT) in patients with locally advanced rectal cancer. |
Diagnostic accuracy (area under the ROC curve [A(z)]) in the evaluation of CR was significantly improved after additional review of DW MR images for both reviewers: For reviewer 1, A(z) improved from 0.676 to 0.876 (P = .005), whereas for reviewer 2, A(z) improved from 0.658 to 0.815 (P = .036). Mean ADC ([1.62 +/- 0.36] x 10(-3) mm(2)/sec) (standard deviation) of the CR group (n = 11) was significantly higher than that ([1.04 +/- 0.24] x 10(-3) mm(2)/sec) of the non-CR group (n = 29) (P < .0001). |
2 |
| 142. Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 2007;188:1622-35. |
Review/Other-Dx |
N/A |
Review applications and challenges of DWI in the body. |
DWI derives its image contrast from differences in the motion of water molecules between tissues. Such imaging can be performed quickly without the need for the administration of exogenous contrast medium. The technique yields qualitative and quantitative information that reflects changes at a cellular level and provides unique insights about tumor cellularity and the integrity of cell membranes. Recent advances enable the technique to be widely applied for tumor evaluation in the abdomen and pelvis and have led to the development of whole-body DWI. |
4 |
| 143. Sugita R, Ito K, Fujita N, Takahashi S. Diffusion-weighted MRI in abdominal oncology: clinical applications. World J Gastroenterol 2010;16:832-6. |
Review/Other-Dx |
N/A |
Review clinical applications of DWI MRI in abdominal oncology. |
DWI can be used for pretreatment tumor detection, characterization including predicting tumor response to therapy, monitoring tumor response during therapy and follow-up study after treatment to detect possible tumor recurrence. |
4 |
| 144. Granata V, Fusco R, de Lutio di Castelguidone E, et al. Diagnostic performance of gadoxetic acid-enhanced liver MRI versus multidetector CT in the assessment of colorectal liver metastases compared to hepatic resection. BMC Gastroenterol. 19(1):129, 2019 Jul 24. |
Observational-Dx |
128 patients |
To compare the diagnostic performance of gadoxetic acid-(Gd-EOB) enhanced liver MRI and contrast-enhanced MDCT in the detection of liver metastasis from colorectal cancer (mCRC). |
MRI detected 489 liver metastases and MDCT 384. In terms of per-lesion sensitivity in the detection of liver metastasis, all three readers had higher diagnostic sensitivity with Gd-EOB MRI than with MDCT (95.5% vs. 72% reader 1; 90% vs. 72% reader 2; 96% vs. 75% reader 3). Each reader showed a statistical significant difference (p < <.001 at Chi square test). MR imaging showed a higher performance than MDCT in per-patient detection sensitivity (100% vs. 74.2% [p < <.001] reader 1, 98% vs. 73% [p < <.001] reader 2, and 100% vs. 78% [p < <.001] reader 3). In the control group, MRI and MDCT showed similar per-patient specificity (100% vs. 98% [p = 0.31] reader 1, 100% vs. 100% [p = 0.92] reader 2, and 100% vs. 96% [p = 0.047] reader 3). Inter-reader agreement of lesion detection between the three radiologists was moderate to excellent (k range, 0.56-0.86) for Gd-EOB MRI and substantial to excellent for MDCT (k range, 0.75-0.8). |
2 |
| 145. Koh FHX, Tan KK, Teo LLS, Ang BWL, Thian YL. Prospective comparison between magnetic resonance imaging and computed tomography in colorectal cancer staging. ANZ J Surg. 88(6):E498-E502, 2018 Jun. |
Observational-Dx |
30 patients |
To compare the accuracy of DW-MRI with multidetector computed tomography (MDCT) in staging of colorectal cancer. |
The primary cancers were located in the rectum (n = 16, 53.3%), sigmoid colon (n = 9, 30%) and right colon (n = 5, 16.6%). For nodal metastases, the sensitivity and specificity of DW-MRI were 84.6% (95% confidence interval (CI): 54.6-98.1%) and 20.0% (95% CI: 2.5-55.6%) compared with 84.6% (95% CI: 54.6-98.1%) and 40.0% (95% CI: 12.2-73.8%) for MDCT. For liver metastases, the sensitivity and specificity for DW-MRI were 100.0% (95% CI: 63.1-100.0%) and 100% (95% CI: 84.6-100%) compared with 87.5% (95% CI: 47.4-99.7%) and 95.5% (95% CI: 77.2-99.9%) for MDCT. DW imaging altered the clinical management in three (10.0%) patients by detecting missed hepatic metastases in two patients and accurately diagnosing another patient with a hepatic cyst, mistaken for metastasis on MDCT. |
3 |
| 146. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
