Objective: To correlate imaging parameters from baseline MRI diffusion-weighted imaging (DWI) and fludeoxyglucose (FDG) positron emission tomography (PET)-CT with synchronous and metachronous metastases in mucinous carcinoma (MC) and non-mucinous carcinoma (NMC) rectal cancer. Methods: 111 patients with extraperitoneal locally advanced rectal cancer, who underwent pelvic MRI, DWI and FDG PET-CT, were stratified into MC (n523) and NMC (n588). We correlated adverse morphologic features on MRI [mT4, mesorectal fascia involvement, extramural venous invasion (mEMVI), mN2] and quantitative imaging parameters [minimum apparent diffusion coefficient (ADCmin), maximum standardized uptake value, total lesion glycolysis, metabolic tumour volume, T2 weighted and DWI tumour volumes] with the presence of metastatic disease. All patients underwent preoperative chemoradiation therapy (CRT); 100/111 patients underwent surgery after CRT and were classified as pathological complete response (PCR) and no PCR [tumour regression grade (TRG)1 vs TRG2-5] and as ypN0 and ypN1-2. Median follow-up time was 48 months. Metastases were confirmed on FDG PET-CT and contrastenhanced multidetector CT. Results: The percentage of mucin measured by MRI correlates with that quantified by histology. On multivariate analysis, the synchronous metastases were correlated with mEMVI [odds ratio (OR) 5 21.48, p,0.01] and low ADCmin (OR50.04, p50.038) in NMC. The difference of metachronous recurrence between the MC group (10-90% mucin) and NMC group was significant (p,0.01) (OR521.67, 95% confidence interval 3.8-120.5). Metachronous metastases were correlated with ypN2 (OR58.24, p50.01) in MC and in NMC. In NMC, mEMVI correlated with no PCR (p50.018) and ypN2 (p,0.01). Conclusion: mEMVI could identify patients with NMC, who are at high risk of synchronous metastases. The MC group is at a high risk of developing metachronous metastases. Advances in knowledge: Patients at high risk of metastases are more likely to benefit from more aggressive neoadjuvant therapy.

Barbaro, B., Leccisotti, L., Vecchio, F. M., Di Matteo, M., Serra, T., Salsano, M., Poscia, A., Coco, C., Persiani, R., Alfieri, S., Gambacorta, M. A., Valentini, V., Giordano, A., Bonomo, L., The potential predictive value of MRI and PET-CT in mucinous and nonmucinous rectal cancer to identify patients at high risk of metastatic disease, <<BRITISH JOURNAL OF RADIOLOGY>>, 2016; 90 (1069): 20150836-N/A. [doi:10.1259/bjr.20150836] [http://hdl.handle.net/10807/92428]

The potential predictive value of MRI and PET-CT in mucinous and nonmucinous rectal cancer to identify patients at high risk of metastatic disease

Barbaro, Brunella
;
Leccisotti, Lucia
Secondo
;
Vecchio, Fabio Maria;Di Matteo, Marialuisa;Salsano, Marco;Poscia, Andrea;Coco, Claudio;Persiani, Roberto;Alfieri, Sergio;Gambacorta, Maria Antonietta;Valentini, Vincenzo;Giordano, Alessandro
Penultimo
;
Bonomo, Lorenzo
Ultimo
2017

Abstract

Objective: To correlate imaging parameters from baseline MRI diffusion-weighted imaging (DWI) and fludeoxyglucose (FDG) positron emission tomography (PET)-CT with synchronous and metachronous metastases in mucinous carcinoma (MC) and non-mucinous carcinoma (NMC) rectal cancer. Methods: 111 patients with extraperitoneal locally advanced rectal cancer, who underwent pelvic MRI, DWI and FDG PET-CT, were stratified into MC (n523) and NMC (n588). We correlated adverse morphologic features on MRI [mT4, mesorectal fascia involvement, extramural venous invasion (mEMVI), mN2] and quantitative imaging parameters [minimum apparent diffusion coefficient (ADCmin), maximum standardized uptake value, total lesion glycolysis, metabolic tumour volume, T2 weighted and DWI tumour volumes] with the presence of metastatic disease. All patients underwent preoperative chemoradiation therapy (CRT); 100/111 patients underwent surgery after CRT and were classified as pathological complete response (PCR) and no PCR [tumour regression grade (TRG)1 vs TRG2-5] and as ypN0 and ypN1-2. Median follow-up time was 48 months. Metastases were confirmed on FDG PET-CT and contrastenhanced multidetector CT. Results: The percentage of mucin measured by MRI correlates with that quantified by histology. On multivariate analysis, the synchronous metastases were correlated with mEMVI [odds ratio (OR) 5 21.48, p,0.01] and low ADCmin (OR50.04, p50.038) in NMC. The difference of metachronous recurrence between the MC group (10-90% mucin) and NMC group was significant (p,0.01) (OR521.67, 95% confidence interval 3.8-120.5). Metachronous metastases were correlated with ypN2 (OR58.24, p50.01) in MC and in NMC. In NMC, mEMVI correlated with no PCR (p50.018) and ypN2 (p,0.01). Conclusion: mEMVI could identify patients with NMC, who are at high risk of synchronous metastases. The MC group is at a high risk of developing metachronous metastases. Advances in knowledge: Patients at high risk of metastases are more likely to benefit from more aggressive neoadjuvant therapy.
Inglese
http://www.birpublications.org/doi/pdf/10.1259/bjr.20150836
Barbaro, B., Leccisotti, L., Vecchio, F. M., Di Matteo, M., Serra, T., Salsano, M., Poscia, A., Coco, C., Persiani, R., Alfieri, S., Gambacorta, M. A., Valentini, V., Giordano, A., Bonomo, L., The potential predictive value of MRI and PET-CT in mucinous and nonmucinous rectal cancer to identify patients at high risk of metastatic disease, <>, 2016; 90 (1069): 20150836-N/A. [doi:10.1259/bjr.20150836] [http://hdl.handle.net/10807/92428]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/92428
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