Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Eur Radiol. 2017 Dec;27(12):4960-4969. doi: 10.1007/s00330-017-4853-5. Epub 2017 Jun 30.
To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM).
Between January 2006 and February 2014, 81 patients who underwent TEM were included. Two expert readers (R1 and R2), independently evaluated T2-weighted (T2W) MRI and diffusion-weighted (DWI) MRI for the detection of local recurrence, retrospectively, and recorded confidence on a five-point scale. Diagnostic performance of follow-up MRI was assessed using ROC-curve analysis and kappa statistics for the reproducibility between readers.
293 MRIs were performed, 203 included DWI. 18 (22%) patients developed a local recurrence: luminal 11, nodal two and both five. Areas under the curve (AUCs) for local recurrence detection were 0.72 (R1) and 0.80 (R2) for T2W-MRI. For DWI, AUCs were 0.70 (R1) and 0.89 (R2). For nodal recurrence AUCs were 0.72 (R1) and 0.80 (R2) for T2W-MRI. Reproducibility was good for T2W-MRI (κ0.68 for luminal and κ0.71 for nodal recurrence) and moderate for DWI (κ0.57). AUCs and reproducibility for recurrence detection increased during follow-up.
Follow-up with MRI after TEM for rectal cancer is feasible. Postoperative changes can be confusing at the first postoperative MRI, but during follow-up diagnostic performance and reproducibility increase.
• Follow-up with MRI is feasible for follow-up after TEM for rectal cancer. • DWI-MRI is a useful addition to detect recurrences after TEM. • Postoperative changes can be confusing and can lead to underestimation of recurrence. • Appearance of intermediate signal at T2W-MRI is suspicious for recurrence. • Nodal staging remains challenging.
评估经肛门内镜微创手术（TEM）后直肠局部复发的随访 MRI 的诊断性能。
2006 年 1 月至 2014 年 2 月，纳入 81 例行 TEM 的患者。两名专家读者（R1 和 R2）独立回顾性评估 T2 加权（T2W）MRI 和弥散加权（DWI）MRI 对局部复发的检测，并在五分制上记录信心程度。通过 ROC 曲线分析和读者间的κ 统计评估随访 MRI 的诊断性能。
共进行了 293 次 MRI 检查，其中 203 次包含 DWI。18 例（22%）患者出现局部复发：腔内 11 例，淋巴结 2 例，两者均有 5 例。T2W-MRI 检测局部复发的曲线下面积（AUC）为 0.72（R1）和 0.80（R2）。对于 DWI，AUC 分别为 0.70（R1）和 0.89（R2）。对于淋巴结复发，T2W-MRI 的 AUC 分别为 0.72（R1）和 0.80（R2）。T2W-MRI 检测复发的重复性良好（腔内复发的κ 值为 0.68，淋巴结复发的κ 值为 0.71），而 DWI 的重复性为中度（κ 值为 0.57）。随着随访，复发检测的 AUC 和重复性增加。
TEM 后行 MRI 随访直肠癌是可行的。术后首次 MRI 时，术后改变可能会造成混淆，但随着随访的进行，诊断性能和重复性会增加。
TEM 后行 MRI 随访是可行的，可用于直肠癌的随访。
DWI-MRI 是检测 TEM 后复发的有用补充。
术后改变可能会造成混淆，导致复发的低估。
T2W-MRI 上出现中等信号提示复发。
淋巴结分期仍然具有挑战性。
