American Journal of Roentgenology, Vol 168, 1427-1434, Copyright © 1997 by American Roentgen Ray Society

ARTICLES

Accuracy of staging rectal tumors with contrast-enhanced transrectal MR imaging

TJ Vogl, W Pegios, MG Mack, M Hunerbein, R Hintze, A Adler, H Lobbeck, R Hammerstingl, P Wust, P Schlag and R Felix
Department of Radiology, Virchow Hospital, Humboldt University of Berlin, Germany.

OBJECTIVE: Our objective was to evaluate the accuracy of contrast- enhanced transrectal MR imaging in staging rectal adenoma and carcinoma by correlating with histopathologic findings. SUBJECTS AND METHODS: Thirty-five patients underwent transrectal MR imaging on a 1.5-T superconducting unit using unenhanced T1-weighted and T2-weighted spin- echo and turbo spin-echo sequences, a dynamic gadopentetate dimeglumine- enhanced turbo fast low-angle shot sequence, and enhanced T1-weighted spin-echo sequences. For all patients, histopathologic correlation was available from biopsy (n = 15) or surgical resection (n = 20). Two radiologists unaware of each other's interpretations of the scans interpreted each case from which we evaluated qualitative and quantitative data. RESULTS: Rectal adenomas (n = 15) were identified when imaging revealed an intact muscularis mucosae, a homogeneous internal structure, and high contrast enhancement of the lesion. Carcinomas staged as T1 by TNM criteria (n = 6) were best revealed by dynamic turbo fast low-angle shot sequences, in which an intact muscularis propria could be seen. Visualization of enhancing tumor tissue in the muscularis propria indicated T2 carcinoma (n = 5). All T3 (n = 5) and T4 (n = 4) carcinomas were correctly staged with dynamic and static MR imaging. The stage revealed by MR imaging correlated well with histologic staging results in 89% (observer 1) and 86% (observer 2) of interpretations. However, when interpreting MR imaging, observers tended to overstage and never understaged. CONCLUSION: Transrectal surface-coil MR imaging provided reliable information in staging patients before surgery and in evaluating rectal adenoma and carcinoma.
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