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Rectal Cancer: MR Imaging in Local Staging—Is Gadolinium-based Contrast Material Helpful?¹

¹ From the Departments of Radiology (R.F.A.V., E.E.M.T.L., J.M.A.v.E., R.G.H.B.T.), Surgery (G.L.B., M.F.v.M.), and Statistics (A.G.H.K.), University Hospital of Maastricht, P. Debyelaan 25, 6202 AZ, Maastricht, the Netherlands. From the 2002 RSNA Annual Meeting. Received August 31, 2003; revision requested November 11; final revision received April 10, 2004; accepted May 12. Address correspondence to R.F.A.V. (e-mail: rvli@rdia.azm.nl).

PURPOSE: To determine retrospectively whether addition of gadolinium-enhanced T1-weighted magnetic resonance (MR) sequence to T2-weighted turbo spin-echo (SE) MR imaging is valuable for preoperative assessment of T stage and circumferential resection margin in patients with primary rectal cancer.

MATERIALS AND METHODS: Local institutional review board approved study and waived informed patient consent. Eighty-three patients with operable primary rectal cancer underwent preoperative MR imaging. Retrospectively, two observers independently scored T2-weighted turbo SE MR images and, in a second reading, T2-weighted images combined with gadolinium-enhanced T1-weighted turbo SE MR images for tumor penetration through rectal wall and tumor extension into mesorectal fascia. A confidence level scoring system was used, and receiver operating characteristic (ROC) curves were generated. Histologic findings were standard of reference. Difference in performance of T2-weighted and combined T2-weighted plus gadolinium-enhanced T1-weighted sequences was analyzed by comparing corresponding areas under ROC curves (A_z) for each observer. Interobserver agreement was calculated by using linear weighted statistics.

RESULTS: Addition of contrast-enhanced T1-weighted to T2-weighted MR imaging did not significantly improve diagnostic accuracy for prediction of tumor penetration through rectal wall (A_z of T2-weighted vs T2-weighted plus T1-weighted images for observer 1, 0.740 vs 0.764; observer 2, 0.856 vs 0.768) and tumor extension into mesorectal fascia (A_z for observer 1, 0.962 vs 0.902; observer 2, 0.902 vs 0.911). Diagnostic performance (A_z) of MR and interobserver agreement were high for prediction of tumor extension into mesorectal fascia ( = 0.61, 0.74) but only moderate for penetration through rectal wall ( = 0.47, 0.45).

CONCLUSION: Gadolinium-enhanced MR sequences did not improve diagnostic accuracy for assessment of tumor penetration through rectal wall and tumor extension into mesorectal fascia.

© RSNA, 2004

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