The clinical application value of multi-slice spiral CT enhanced scans combined with multiplanar reformations images in preoperative T staging of rectal cancer

Abstract

This study aims 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.One hundred sixty-eight consecutive patients with rectal cancer were admitted in our hospital between January 2013 and October 2018. Conventional MSCT plain scans, multi-phase dynamic contrast-enhanced scans, and MPRs were performed in all patients before surgical operation. The preoperative T staging of the rectal cancer lesions was evaluated using MSCT enhanced scans combined with MPRs, which was verified by postoperative pathological results. The diagnostic accuracy of MSCT enhanced scans combined with MPRs in evaluating T staging of the rectal cancer lesions were analyzed by χ test and Kappa test.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, χ = 4.200, P = .122).Conventional MSCT enhanced scans combined with MPRs are simple and feasible. It is consistent with the pathological diagnosis of evaluating T staging in the rectal cancer lesions. It can provide reliable imaging evidence for the preoperative evaluation of primary rectal cancer, especially in patients with magnetic resonance imaging (MRI) contraindications, or in grass-roots hospitals due to lack of MRI equipment.

Figure 1

A 63-year-old male patient with histological stage T2 tumor. Axial MSCT (plain and enhancement scan), sagittal and oblique coronal reformatted MSCT images (A–D) showed a rectal tumor surrounding the entire intestinal lumen with smooth outer border of thickened rectal wall and a clear surrounding fat plane (long arrow) indicative of T2 stage disease. Final postoperative paraffin section (E and F) revealed ulcerative and protuberant type moderately differentiated rectal adenocarcinoma infiltrating into the deep muscular layer (Hematoxylin-eosin stain; original magnification ×80 and ×200).

Figure 2

A 65-year-old male patient with histological stage T3 tumor. Axial MSCT (plain and enhancement scan), sagittal and oblique coronal reformatted MSCT images (A–D) showed a rectal tumor with a rough edge and spiculations extending into the peri-rectal fat (long arrow) indicative of stage T3 disease. Final postoperative paraffin section (E and F) revealed ulcerative type of a poorly differentiated rectal adenocarcinoma infiltrating into the entire intestinal wall and extramural fibrous adipose tissue. (Hematoxylin-eosin stain; original magnification ×80 and ×200).

Figure 3

A 78-year-old female patient with histological stage T4 tumor. Axial MSCT (plain and enhancement scan) and sagittal reformatted MSCT images (A– C) showed a rectal tumor surrounding the entire intestinal lumen with infiltration into peri-rectal fat and the obliteration of the fat plane between the rectal tumor and the posterior uterine wall indicative of T4 stage disease (long arrow). The intrauterine device was clearly visible (short arrow). Oblique coronal reformatted image (D) also showed the tumor as an irregular mural thickening of the rectal wall with spiculations extending into the peri-rectal fat (arrow). Final postoperative paraffin section (E and F) revealed ulcerative type moderately differentiated rectal adenocarcinoma infiltrating into the extramural layer and myometrium of the uterus (Hematoxylin-eosin stain; original magnification ×80 and ×200).