Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 27;19(1):498.
doi: 10.1186/s12885-019-5732-z.

Association between high-resolution MRI-detected extramural vascular invasion and tumour microcirculation estimated by dynamic contrast-enhanced MRI in rectal cancer: preliminary results

Yan Chen  1 , Xinyue Yang  2 , Ziqiang Wen  1 , Yiyan Liu  1 , Baolan Lu  1 , Shenping Yu  3 , Xiaojuan Xiao  4
Affiliations

Association between high-resolution MRI-detected extramural vascular invasion and tumour microcirculation estimated by dynamic contrast-enhanced MRI in rectal cancer: preliminary results

Yan Chen et al. BMC Cancer. .

Abstract

Background: To determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) status is associated with quantitative perfusion parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) in rectal cancer.

Methods: Seventy-two patients with rectal adenocarcinoma who underwent curative surgery alone within 2 weeks following rectal MRI were enrolled in this retrospective study. mrEMVI status was determined based on high-resolution MRI. The quantitative perfusion parameters (Ktrans, kep and ve) derived from DCE-MRI were calculated from all sections containing tumours. DCE-MRI parameters and clinicopathological variables in patients with different mrEMVI statuses were compared.

Results: For patients who were mrEMVI positive, the tumours demonstrated significantly lower kep values (P = 0.012) and higher ve values (P = 0.021) than tumours of patients who were mrEMVI negative, while the Ktrans value displayed no significant difference (P = 0.390). The patients who were mrEMVI positive had larger tumour size, higher pathological tumour stage and increased regional nodal metastases compared to those who were mrEMVI negative (2.9 cm vs. 3.5 cm, P = 0.011; 63.8% vs. 92.0%, P = 0.010; 36.2% vs. 76.0%, P = 0.001; respectively).

Conclusions: This study demonstrated for the first time that tumour microcirculation is altered in mrEMVI-positive patients with rectal adenocarcinoma, as evidenced by significantly lower kep and higher ve values. In addition, these patients were more likely to have a larger tumour size, a higher pathological tumour stage and regional nodal metastases than mrEMVI-negative patients.

Keywords: Dynamic contrast-enhanced MRI; Extramural vascular invasion; Rectal cancer; Tumour microcirculation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study patients
Fig. 2
Fig. 2
A patient with rectal adenocarcinoma (pT3N1, moderately differentiated). a Oblique axial high-resolution T2WI depicted the extramural vessels were in the vicinity of stranding rectal tumour, but these vessels had normal calibre, and there is no definite tumour signal within the vessels (arrow), indicating mrEMVI-negative status. b A VOI (pink dashed line) was selected on DCE-MRI, and (c) the AIF with the smallest chi-square value was than selected. b The ROI (red continuous line) was drawn along the edge of the tumour guided by corresponding (a) oblique axial high-resolution T2WI. d The ROI was copied to Ktrans map, and the mean Ktrans (0.234 min− 1), kep (1.473 min− 1) and ve (0.232) values were obtained
Fig. 3
Fig. 3
A patient with rectal adenocarcinoma (pT4N1, moderately differentiated). a Sagittal high-resolution T2WI depicted definitive tumour signal within a marked expanded and irregular extramural vessel (arrow), confirming mrEMVI-positive status. c A VOI (pink dashed line) was selected on DCE-MRI, and (d) the AIF with the smallest chi-square value was the selected. c An ROI (red continuous line) was drawn along the edge of the tumour guided by corresponding (b) oblique axial high-resolution T2WI. e The ROI was copied to Ktrans map, and the mean Ktrans (0.121 min− 1), kep (0.514 min− 1) and ve (0.258) values were obtained
Fig. 4
Fig. 4
Boxplots showed the relationships between mrEMVI status and kep (a) and ve (b) values. Lower kep values were noted among mrEMVI-positive patients than in mrEMVI-negative patients, while ve values in the mrEMVI-positive group were significantly higher than those in the mrEMVI-negative group
Fig. 5
Fig. 5
Bland-Altman plots for interobserver reproducibility for whole tumour volume DCE-MRI quantitative perfusion parameters measurements. Bland-Altman plots of the mean Ktrans (a), kep (b) and ve (c) values of the two radiologists (x-axis) against the difference between the two radiologists (y-axis). The red continuous line represents the equality (difference = 0); the black continuous line represents the average difference (bias) between the two radiologists; the green continuous lines represent the 95% CI of the average difference; the black dashed lines represent the limits of agreement; the blue continuous lines represent the 95% CI of limits of agreement
See this image and copyright information in PMC

References

    1. Betge J, Pollheimer MJ, Lindtner RA, Kornprat P, Schlemmer A, Rehak P, Vieth M, Hoefler G, Langner C. Intramural and extramural vascular invasion in colorectal cancer: prognostic significance and quality of pathology reporting. Cancer-Am Cancer Soc. 2012;118(3):628–638. - PubMed
    1. Talbot IC, Ritchie S, Leighton MH, Hughes AO, Bussey HJR, Morson BC. The clinical significance of invasion of veins by rectal cancer. BRIT J SURG. 1980;67(6):439–442. doi: 10.1002/bjs.1800670619. - DOI - PubMed
    1. Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg. 2008;95(2):229–236. doi: 10.1002/bjs.5917. - DOI - PubMed
    1. Kirsch R, Messenger DE, Riddell RH, Pollett A, Cook M, Al-Haddad S, Streutker CJ, Divaris DX, Pandit R, Newell KJ, et al. Venous invasion in colorectal Cancer. Am J Surg Pathol. 2013;37(2):200–210. doi: 10.1097/PAS.0b013e31826a92cd. - DOI - PubMed
    1. Chand M, Palmer T, Blomqvist L, Nagtegaal I, West N, Brown G. Evidence for radiological and histopathological prognostic importance of detecting extramural venous invasion in rectal cancer: recommendations for radiology and histopathology reporting. Color Dis. 2015;17(6):468–473. doi: 10.1111/codi.12920. - DOI - PubMed

MeSH terms

LinkOut - more resources