Boraschi Piero, Donati Francescamaria, Cervelli Rosa, Bani Kathrine, Morganti Riccardo, Furbetta Niccolò, Morelli Luca, Neri Emanuele
2nd Unit of Radiology, Department of Radiological Nuclear and Laboratory Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy.
2nd Unit of Radiology, Department of Radiological Nuclear and Laboratory Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy.
Eur J Radiol. 2024 Dec;181:111804. doi: 10.1016/j.ejrad.2024.111804. Epub 2024 Oct 24.
To compare the adherence of the interpretation and reporting staging system, respectively proposed in the 2012 and 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guidelines for Magnetic Resonance Imaging (MRI) staging of rectal cancer, focusing on the improvement offered by the criteria introduced by 2016 ESGAR guidelines.
Fifty-six patients affected by rectal cancer were included; 25/56 patients underwent upfront surgery; 31 underwent to neo-adjuvant chemo-radiotherapy before surgery. All patients underwent 3 T MRI examination for local staging. All MR exams were evaluated by two radiologists with 20- and 4-years' experience, who were blinded to each other; the T and N stages, the Mesorectal Fascia (MRF) status and the Extramural Vascular Invasion (EMVI) were assessed according to both 2012 and 2016 ESGAR guidelines. The correlation between radiological and pathological findings, as well as the MRI staging were evaluated.
As to the expert reviewer, no significant differences were found by comparing the MR T and N stages, T and N restaging, MRF status and EMVI according to 2012 and 2016 ESGAR guidelines. As to the 4-years' experience radiologist the MR staging agreement between 2012 and 2016 guidelines was "moderate" in N-stage evaluation and "fair" in T-restaging evaluation. No significant discrepancies were found for other parameters.
MRI is a reliable method in rectal cancer staging/restaging. The assessment of T-restaging is improved by adopting the 2016 ESGAR guidelines, especially for non-expert readers; this result could be justified by the introduction of diffusion-weighted imaging. On the contrary, the newest guidelines do not improve the diagnostic performance in assessing nodal staging and restaging.
比较分别在2012年和2016年欧洲胃肠道和腹部放射学会（ESGAR）直肠癌磁共振成像（MRI）分期指南中提出的解释和报告分期系统的依从性，重点关注2016年ESGAR指南引入的标准所带来的改进。
纳入56例直肠癌患者；56例患者中有25例接受了 upfront 手术；31例在手术前接受了新辅助放化疗。所有患者均接受3T MRI检查以进行局部分期。所有MR检查均由两位分别具有20年和4年经验的放射科医生进行评估，他们相互不知情；根据2012年和2016年ESGAR指南评估T和N分期、直肠系膜筋膜（MRF）状态和壁外血管侵犯（EMVI）。评估放射学和病理学结果之间的相关性以及MRI分期。
对于专家评审员，根据2012年和2016年ESGAR指南比较MR T和N分期、T和N重新分期、MRF状态和EMVI时，未发现显著差异。对于有4年经验的放射科医生，2012年和2016年指南之间的MR分期一致性在N分期评估中为“中等”，在T重新分期评估中为“一般”。其他参数未发现显著差异。
MRI是直肠癌分期/重新分期的可靠方法。采用2016年ESGAR指南可改善T重新分期的评估，尤其是对于非专家读者；这一结果可能是由于引入了扩散加权成像。相反，最新指南在评估淋巴结分期和重新分期方面并未提高诊断性能。
