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Comparative Study
. 2012 Jun;37(3):475-81.
doi: 10.1007/s00261-011-9770-5.

T-staging of rectal cancer: accuracy of 3.0 Tesla MRI compared with 1.5 Tesla

Monique Maas  1 , Doenja M J Lambregts, Max J Lahaye, Geerard L Beets, Walter Backes, Roy F A Vliegen, Margreet Osinga-de Jong, Joachim E Wildberger, Regina G H Beets-Tan
Affiliations
Comparative Study

T-staging of rectal cancer: accuracy of 3.0 Tesla MRI compared with 1.5 Tesla

Monique Maas et al. Abdom Imaging. 2012 Jun.

Abstract

Objectives: Magnetic resonance imaging (MRI) is not accurate in discriminating T1-2 from borderline T3 rectal tumors. Higher resolution on 3 Tesla-(3T)-MRI could improve diagnostic performance for T-staging. The aim of this study was 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.

Methods: 13 patients with non-locally advanced rectal cancer underwent imaging with both 1.5T and 3T-MRI. Three readers with different expertise evaluated the images and predicted T-stage with a confidence level score. Receiver operator characteristics curves with areas under the curve (AUC) and diagnostic parameters were calculated. Inter- and intra-observer agreements were calculated with quadratic kappa-weighting. Histology was the reference standard.

Results: 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 κ 0.50-0.71 at 1.5T vs. 0.15-0.68 at 3T. Intra-observer agreement was κ 0.71 at 1.5T and 0.76 at 3T.

Conclusions: This is the first study to compare 3T with 1.5T MRI for T-staging of rectal cancer within the same patients. Our results showed no difference between 3T and 1.5T-MRI for the distinction between T1-2 and borderline T3 tumors, regardless of expertise. The higher resolution at 3T-MRI did not aid in the distinction between desmoplasia in T1-2-tumors and tumor stranding in T3-tumors. Larger studies are needed to acknowledge these findings.

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Figures

Fig. 1
Fig. 1
ROC curves for T-stage prediction for all readers at 3 and 1.5T.
Fig. 2
Fig. 2
Mean over- and understaging rates for 1.5 and 3T MRI.
Fig. 3
Fig. 3
Stranding (arrows) around a pT2 tumor which cannot be distinguished from tumor extension in a T3 tumor (left 1.5T and right 3T).
Fig. 4
Fig. 4
A, B A small vessel penetrating the bowel wall is depicted in more detail on the 3T image (A) than on the 1.5T image (B). This could lead to more interpretation difficulties and thus overstaging of T2 tumors.
Fig. 5
Fig. 5
An intact hypo-intense line (arrows) is seen surrounding the tumor, which indicates that the muscularis propria is intact (1.5T image). Therefore, the tumor is confined to the bowel wall (pT1-2).
See this image and copyright information in PMC

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