Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Radiology, Institut du Cancer de Montpellier, Montpellier, France.
Dis Colon Rectum. 2018 Feb;61(2):193-201. doi: 10.1097/DCR.0000000000000925.
Few publications exist regarding gadolinium-enhanced sequences in rectal MRI. None have evaluated its potential impact on patient management.
This study aimed to assess whether gadolinium-enhanced sequences, including dynamic contrast enhancement, change radiologic interpretation and clinical management of rectal cancer.
This is a retrospective analysis of 100 rectal MRIs (50 baseline and 50 postneoadjuvant treatment), both without and with gadolinium-enhanced sequences. Treatment plans were rendered based on each radiologic interpretation for each case by a single experienced surgeon. Differences in radiologic interpretation and management were statistically analyzed.
The study was conducted at the Memorial Sloan Kettering Cancer Center.
Patients undergoing rectal MRI between 2011 and 2015 for baseline tumor staging and/or postneoadjuvant restaging were included.
Primary outcome measures were changes in radiologic tumor stage, tumor margins, and surgical planning with the use of gadolinium at baseline and postneoadjuvant time points.
At baseline, tumor downstaging occurred in 8 (16%) of 50 and upstaging in 4 (8%) of 50 with gadolinium. Postneoadjuvant treatment, upstaging occurred in 1 (2%) of 50 from T2 to T3a. At baseline, mean distances from tumor to anorectal ring, anal verge, and mesorectal fascia were not statistically different with gadolinium. However, in 7 patients, differences could have resulted in treatment changes, accounted for by changes in relationships to anterior peritoneal reflection (n = 4), anorectal ring (n = 2), or anal verge (n = 1). Postneoadjuvant treatment, distances to anorectal ring and anal verge (in centimeters) were statistically smaller with gadolinium (p = 0.0017 and p = 0.0151) but could not have resulted in clinically significant treatment changes.
This study was limited by its retrospective design.
The use of gadolinium at baseline MRI could have altered treatment in 24% of patients because of differences in tumor stage or position. Postneoadjuvant treatment, gadolinium resulted in statistically smaller distances to sphincters, which could influence surgical decision for sphincter-preserving rectal resection. See Video Abstract at http://links.lww.com/DCR/A444.
关于直肠 MRI 的钆增强序列的出版物很少。目前还没有研究评估其对患者管理的潜在影响。
本研究旨在评估钆增强序列（包括动态对比增强）是否会改变直肠癌的影像学诊断和临床管理。
这是一项对 100 例直肠 MRI（50 例基线和 50 例新辅助治疗后）的回顾性分析，这些 MRI 均未进行和进行了钆增强序列检查。根据每位经验丰富的外科医生对每个病例的影像学解读，制定治疗计划。对影像学解读和管理方面的差异进行了统计学分析。
这项研究在纪念斯隆-凯特琳癌症中心进行。
纳入 2011 年至 2015 年间因基线肿瘤分期和/或新辅助治疗后再分期而行直肠 MRI 检查的患者。
主要观察指标是基线和新辅助治疗后使用钆前后影像学肿瘤分期、肿瘤边缘和手术计划的变化。
基线时，50 例中有 8 例（16%）肿瘤降期，4 例（8%）肿瘤升期。新辅助治疗后，从 T2 到 T3a，有 1 例（2%）肿瘤升期。基线时，肿瘤与肛直肠环、肛门缘和直肠系膜筋膜的距离在使用钆前后无统计学差异。然而，在 7 例患者中，由于与前腹膜反射（n=4）、肛直肠环（n=2）或肛门缘（n=1）的关系发生变化，可能导致治疗方式的改变。新辅助治疗后，肛直肠环和肛门缘（厘米）的距离在使用钆前后有统计学意义的减小（p=0.0017 和 p=0.0151），但不会导致临床意义上的治疗方式改变。
本研究受限于其回顾性设计。
基线 MRI 中使用钆可能会因为肿瘤分期或位置的不同而改变 24%患者的治疗方式。新辅助治疗后，钆增强导致与括约肌的距离统计学上减小，这可能会影响保肛直肠切除术的手术决策。[视频摘要见 http://links.lww.com/DCR/A444。]
