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Preoperative Staging of Rectal Cancer: Comparison of 3-T High-Field MRI and Endorectal Sonography

Ho-Kyung Chun1, Dongil Choi2, Min Ju Kim2, Jongmee Lee2, Seong Hyeon Yun1, Seung Hoon Kim2, Soon Jin Lee2 and Chan Kyo Kim2

1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
2 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, South Korea.


Figure 1
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  		Fig. 1A —52-year-old man with T1 rectal cancer (pT1) who underwent anterior resection with total mesorectal excision. Axial MR image from T2-weighted turbo spin-echo acquisition shows tumor (arrows) extending into muscular layer with loss of interface between submucosa and muscle layer. All three observers interpreted lesion as mT2, overstaging it.

 

Figure 2
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  		Fig. 1B —52-year-old man with T1 rectal cancer (pT1) who underwent anterior resection with total mesorectal excision. Transverse endorectal sonographic image shows small hypoechoic mass (arrows) confined to mucosal and submucosal layers. All three observers correctly interpreted lesion as sT1.

 

Figure 3
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  		Fig. 2A —70-year-old man with T2 rectal cancer (pT2) who underwent anterior resection with total mesorectal excision. Axial MR image from T2-weighted turbo spin-echo acquisition shows tumor (arrows) extending through muscle layer into perirectal tissue (arrowheads). All three observers interpreted lesion as mT3, overstaging it.

 

Figure 4
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  		Fig. 2B —70-year-old man with T2 rectal cancer (pT2) who underwent anterior resection with total mesorectal excision. Transverse endorectal sonographic image shows hypoechoic mass (arrows) invading muscularis propria (arrowheads). Perirectal tissue is clear. All three observers correctly interpreted lesion as sT2.

 

Figure 5
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  		Fig. 3A —51-year-old woman with T3 rectal cancer (pT3) who underwent anterior resection with total mesorectal excision. Axial MR image from T2-weighted turbo spin-echo acquisition shows tumor (arrows) extending into muscle layer, but perirectal tissue is clear. All three observers interpreted lesion as mT2, understaging it.

 

Figure 6
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  		Fig. 3B —51-year-old woman with T3 rectal cancer (pT3) who underwent anterior resection with total mesorectal excision. Transverse endorectal sonographic image shows hypoechoic mass (arrows) penetrating into perirectal tissue (arrowheads). All three observers correctly interpreted lesion as sT3.

 

Figure 7
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  		Fig. 4 —Graph shows composite receiver operating characteristic (ROC) curves for 3-T MRI (Figure 7) and endorectal sonography ({diamondsuit}) calculated with pooled data reviewed by three observers. Mean area under ROC curve (Az) indicates diagnostic accuracy for perirectal tissue invasion at endorectal sonography (Az = 0.982 ± 0.006) and at 3-T MRI (Az = 0.952 ± 0.010). Difference in mean Az was statistically significant (p = 0.028).

 

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