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April 2002

Preoperative Staging of Rectal Cancer Using Magnetic Resonance Imaging With External Phase-Arrayed Coils

Author Affiliations

From the Departments of Surgical Oncology (Drs Gagliardi, Bayar, and Salem) and Diagnostic Radiology (Dr Smith), Yale University School of Medicine, New Haven, Conn. Dr Smith is now with the Department of Radiology, Cornell University Medical College, New York, NY.

Arch Surg. 2002;137(4):447-451. doi:10.1001/archsurg.137.4.447

Hypothesis  Rectal cancer can be accurately staged preoperatively by magnetic resonance imaging (MRI) with external phase-arrayed coils.

Design  Comparison of MRIs with pathologic staging.

Setting  University hospital.

Patients  Twenty-eight consecutive patients with biopsy-proven rectal cancer who did not undergo irradiation.

Intervention  Patients underwent imaging using a 1.5-T MRI scanner with external phase-arrayed surface coils. Streaking of the perirectal fat and disruption of the bowel wall margin were interpreted as transmural invasion. Lymph nodes were defined as metastatic when they had a diameter of at least 0.5 cm. Tumors were staged according to the TNM staging system (American Joint Committee on Cancer guidelines) as confined to the bowel wall (T1-T2) and invading through the bowel wall (T3-T4). Patients underwent anterior resection (n = 15), abdominoperineal resection (n = 11), or local excision (n = 2).

Main Outcome Measures  Calculation of sensitivity, specificity, and accuracy for invasion through the bowel wall and lymph node status.

Results  Sensitivity of MRI in detecting invasion through the bowel wall was 89% (16/18), specificity was 80% (8/10), and accuracy was 86% (24/28). Sensitivity for malignant lymphadenopathy was 67% (8/12), specificity was 71% (10/14), and accuracy 69% (18/26).

Conclusion  Although more costly and not as accurate as endoscopic ultrasound, MRI with phase-arrayed coils had excellent sensitivity at detecting transmural penetration of rectal cancer.