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Magnetic resonance imaging evaluation in neoadjuvant therapy of locally advanced rectal cancer: a systematic review

Roberta Fusco
Roberta Fusco
, 
Mario Petrillo
Mario Petrillo
, 
Vincenza Granata
Vincenza Granata
, 
Salvatore Filice
Salvatore Filice
, 
Mario Sansone
Mario Sansone
, 
Orlando Catalano
Orlando Catalano
 and 
Antonella Petrillo
Antonella Petrillo
   | Aug 16, 2017
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Article Category: Review
Published Online: Aug 16, 2017
Page range: 252 - 262
Received: Dec 29, 2016
Accepted: Jun 21, 2017
DOI: https://doi.org/10.1515/raon-2017-0032
© 2017 Roberta Fusco, Mario Petrillo, Vincenza Granata, Salvatore Filice, Mario Sansone, Orlando Catalano, Antonella Petrillo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

T1 weighted post contrast scan obtained before (A)-(B) and after (C)-(D) chemo-radiotherapy (CRT). The analysis of time intensity curve (TIC) show areas with rapid contrast uptake and fast discharge (B). After CRT, on the same areas no pathological contrast uptake is present confirming that hypo-intense tissue are tumour nests but only residual inflammation due to CRT.
T1 weighted post contrast scan obtained before (A)-(B) and after (C)-(D) chemo-radiotherapy (CRT). The analysis of time intensity curve (TIC) show areas with rapid contrast uptake and fast discharge (B). After CRT, on the same areas no pathological contrast uptake is present confirming that hypo-intense tissue are tumour nests but only residual inflammation due to CRT.

Figure 2

Included and excluded studies in systematic review.DCE-MRI = dynamic contrast enhanced MRI; DWI = diffusion weighted imaging
Included and excluded studies in systematic review.DCE-MRI = dynamic contrast enhanced MRI; DWI = diffusion weighted imaging

Figure 3

Forest plot subdivide for imaging modality including sensitivity and specificity estimates and their confidence intervals (95%).CI = confidence interval; FN = false negative; FP = false positive; SIS = standardized index of shape; TN = true negative; TP = true positive
Forest plot subdivide for imaging modality including sensitivity and specificity estimates and their confidence intervals (95%).CI = confidence interval; FN = false negative; FP = false positive; SIS = standardized index of shape; TN = true negative; TP = true positive

Figure 4

Estimated summary ROC curves and original data points for imaging techniques.DCE-MRI = dynamic contrast enhanced MRI; DWI = diffusion weighted imaging
Estimated summary ROC curves and original data points for imaging techniques.DCE-MRI = dynamic contrast enhanced MRI; DWI = diffusion weighted imaging

Figure 5

Assessment of bias risk and applicability analysis.
Assessment of bias risk and applicability analysis.

Performance pooled analysis for MRI, diffusion weighted imaging (DWI), dynamic contrast enhanced MRI (DCE-MRI), PET/CT and multimodal imaging

PerformancePooled Analysis Sensitivity Specificity Positivepredictive value Negativepredictive value Accuracy
MRI 75,84 78,21 74,34 79,55 77,13
DCE-MRI 87,18 84,15 82,42 88,51 85,55
DWI 75,95 79,25 84,51 68,85 77,27
PET/CT 80,25 83,08 79,27 83,92 81,82
MULTIMODAL IMAGING 85,00 96,08 89,47 94,23 92,96

Number of studies and participants for each diagnostic modality

Diagnostic modality Studies Participants
MRI 6 329
DCE-MRI 6 340
DWI 4 133
PET/CT 7 366
MULTIMODAL IMAGING 2 70

Main characteristics summary of included studies in the systematic review: for each study the table reports imaging modality used; number of patients examined; parameters examined

Imaging modality Authors Approach N. patients Gold standard
Barbaro et al.69 Score system 53 TNM
Denecke et al.46 Morphologic criteria 23 TNM
MRI Dresen et al.45 Morphologic + volumetric criteria 67 TNM
Intven et al.56 Relative volume 51 TRG
Petrillo et al.52 Score system 106 TRG
Petrillo et al.64 Relative volume 29 TRG
Intven et al.56 Relative Ktrans 51 TRG
Kim et al.55 Relative Ktrans 50 TNM
DCE-MRI Martens et al.67 TIC slope 30 TRG
Petrillo et al.52 TIC visual inspection 106 TRG
Petrillo et al.64 Relative volume 29 TRG
Petrillo et al.53 Standardized index of shape 74 TRG
Birlik et al.65 ADC 43 TRG
DWI Ippolito et al.40 ADC 30 TRG
Monguzzi et al.68 ADC 31 TRG
Petrillo et al.64 Relative volume 29 TRG
MULTIMODAL IMAGING Intven et al.56 Relative volume + relative Ktrans 51 TRG
Marouf et al.63 MRI + DWI Score system 19 TNM
Altini et al.36 SUV 68 TRG
Capirci et al.42 SUV 81 TRG
Ippolito et al.40 SUV 30 TRG
PET/CT Murcia et al.43 SUV 41 TRG
Sun et al.41 Total lesion glycolysis 35 TRG
Yoon et al.66 Dual-point index 61 TRG
Palma et al.73 SUV 50 TRG
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Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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