El Homsi Maria, Fuqua Louis, Kim Tae-Hyung, Fernandes Maria Clara, Shia Jinru, Widmar Maria, White Charlie, Capanu Marinela, Rodriguez Lee, Petkovska Iva
Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
Radiol Imaging Cancer. 2025 May;7(3):e240208. doi: 10.1148/rycan.240208.
Purpose To assess the accuracy of post-neoadjuvant therapy (NAT) MRI, as compared with that of pathologic evaluation, to determine anal sphincter involvement in patients with rectal cancer. Materials and Methods This retrospective study included patients diagnosed with rectal cancer between January 2015 and December 2017 whose baseline MRI showed anal sphincter involvement and who then underwent NAT, post-NAT MRI, and abdominoperineal resection. Four radiologists (with 20 years, 5 years, 2 years, and 1 year of experience) independently reviewed MRI findings. Resected specimens were reviewed by a gastrointestinal pathologist. Interreader agreement between the radiologists and pathologist was assessed using the Cohen κ statistic. Conditional sensitivity, specificity, and positive predictive value (PPV) of the radiologists were calculated among patients for whom the radiologists and the pathologist agreed that the anal canal was involved. Results Thirty-two patients were included (mean age ± SD, 60 years ± 15; 19 male, 13 female). For the post-NAT assessment of anal sphincter involvement, agreement between readers 1, 2, and 4 and the pathologist was moderate (κ = 0.55 [95% CI: 0.18, 0.91], 0.45 [95% CI: -0.06, 0.82], and 0.53 [95% CI: 0, 0.89], respectively). There was fair agreement between reader 3 and the pathologist (κ = 0.30 [95% CI: -0.09, 0.67]). Radiologists had high sensitivity for the detection of anal sphincter involvement (88%-100%), high PPV (88%-96%), and moderate to high specificity (50%-80%); the senior radiologist had the highest sensitivity, PPV, and specificity. Conclusion Radiologists had fair to moderate interreader agreement with the pathologist for post-NAT assessment of anal sphincter involvement in patients with rectal cancer and showed high conditional sensitivity regardless of their level of experience. Abdomen/GI, Rectum, Oncology, Post-Neoadjuvant Therapy MRI © RSNA, 2025.
目的 评估新辅助治疗（NAT）后MRI与病理评估相比，在确定直肠癌患者肛门括约肌受累情况方面的准确性。材料与方法 这项回顾性研究纳入了2015年1月至2017年12月期间诊断为直肠癌的患者，这些患者的基线MRI显示肛门括约肌受累，随后接受了NAT、NAT后MRI检查及腹会阴联合切除术。四位放射科医生（分别有20年、5年、2年和1年经验）独立评估MRI结果。切除标本由胃肠病理学家进行检查。使用Cohen κ统计量评估放射科医生与病理学家之间的阅片者间一致性。在放射科医生和病理学家均认为肛管受累的患者中，计算放射科医生的条件敏感性、特异性和阳性预测值（PPV）。结果 共纳入32例患者（平均年龄±标准差，60岁±15岁；男性19例，女性13例）。对于NAT后肛门括约肌受累情况的评估，阅片者1、2和4与病理学家之间的一致性为中等（κ分别为0.55[95%CI：0.18,0.91]、0.45[95%CI：-0.06,0.82]和0.53[95%CI：0,0.89]）。阅片者3与病理学家之间的一致性为一般（κ = 0.30[95%CI：-0.09,0.67]）。放射科医生对肛门括约肌受累情况的检测具有高敏感性（88%-100%）、高PPV（88%-96%）和中到高特异性（50%-80%）；资深放射科医生的敏感性、PPV和特异性最高。结论 在直肠癌患者NAT后肛门括约肌受累情况的评估中，放射科医生与病理学家之间的阅片者间一致性为一般到中等，且无论经验水平如何，均显示出高条件敏感性。腹部/胃肠、直肠、肿瘤学、新辅助治疗后MRI ©RSNA，2025年
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