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. 2025 Mar 7:90:e114-e123.
doi: 10.5114/pjr/200612. eCollection 2025.

A nomogram model for predicting lymph node metastasis of rectal cancer by combining preoperative magnetic resonance imaging signs and tumour markers

Meihai Xu  1 , Zheng Wang  1 , Xiu-Feng Qiao  2 , Hai Liao  1 , Dan-Ke Su  1
Affiliations

A nomogram model for predicting lymph node metastasis of rectal cancer by combining preoperative magnetic resonance imaging signs and tumour markers

Meihai Xu et al. Pol J Radiol. .

Abstract

Purpose: This study aimed to explore the diagnostic value of high-resolution magnetic resonance images and tumour markers in predicting lymph node metastasis of rectal cancer.

Material and methods: The clinical, imaging, and pathological data of patients with suspected rectal cancer were collected. The baseline data, and surgical and pathological characteristics were compared between the lymph node metastasis group and no metastasis group. Univariate and multivariate logistic regression were used to analyse the clinical and pathological factors, and preoperative magnetic resonance imaging (MRI) signs of extramural vascular invasion and rectal cancer lymph node metastasis. A nomogram model was established with statistically significant factors.

Results: 150 patients were included. Among them, 50 (33.3%) presented with vascular tumour thrombus, and 72 (48.0%) had lymph node metastasis. The detection of regional lymph nodes (DWI-LN) was an independent risk factor for lymph node metastasis. The area under curve of the nomogram model was 0.804.

Conclusion: Preoperative serum CA19.9, and the relationship between tumour and peritoneal reflection in preoperative MRI and DWI-LN have clinical value in predicting lymph node metastasis in patients with rectal cancer.

Keywords: MRI; lymph node metastasis; nomogram; rectal cancer.

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Figures

Figure 1
Figure 1
MRI image with rectal adenocarcinoma showed negative vascular tumour thrombus and no lymph node metastasis. A) Axial HRT2WI showed moderate signal tumour invading outside the rectal wall, more cord shadow in the mesorectum area, the preoperative mr-EMVI score was 2 points. B) b = 800 mm2/s, showing slightly high signal of lymph nodes, preoperative MRI considered no lymph node metastasis
Figure 2
Figure 2
MRI image with rectal adenocarcinoma showed positive vascular tumour thrombus and lymph node metastasis. A) Axial HRT2WI showed moderate signal tumour invading outside the rectal wall, more cord shadow in the mesorectum area, preoperative mr-EMVI score was 2 points. B) Axial b = 800 mm2/s, showing slightly high signal of lymph nodes, preoperative MRI considered lymph node metastasis
Figure 3
Figure 3
Multivariate logistic regression model that included smoking history, CA199, relationship between tumour and peritoneal reflux, DWI-LN to construct nomogram model
Figure 4
Figure 4
ROC curve of the prediction model
Figure 5
Figure 5
Correction of nomogram model for lymph node metastasis
See this image and copyright information in PMC

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