Study of Correlation between MRI Morphology of Primary Tumor and Extramural Vascular Invasion in Rectal Cancer

Abstract

Introduction. In clinical settings, nodular projection (NP) and cord sign (CS) at the tumor edge and irregular nodules (IN) in the mesorectum often appeared together with extramural vascular invasion (EMVI). We aim to evaluate the diagnostic efficiency of the MRI morphology of primary tumor in predicting EMVI in patients with rectal cancer (RC). Methods. This retrospective study included 156 patients with RC. Clinical and imaging factors including NP at the primary tumor’s edge, CS at the primary tumor’s edge, maximal extramural depth (EMD), IN in the mesorectum, growth pattern, tumor length, range of rectal wall invaded (RRWI) by tumor, peritoneal reflex invasion by surgery, and pathology-proven local node involvement (PLN) were evaluated. Then, ROC curve was drawn to depict the meaningful indicators in multivariate analyses. Results. There were 53 (34%) patients with pathological extramural venous invasion (pEMVI). Among the clinical and imaging factors evaluated, NP, CS, IN, EMD, PLN, differentiation, and peritoneal reflex invasion were significantly associated with pEMVI. NP and PLN were independent predictors of EMVI. Areas under the ROC curve (AUC) of NP for prediction of EMVI was 0.82 (95% CI, 0.74–0.90), with a sensitivity of 73.58%, a specificity of 90.29%, a positive predictive value (PPV) of 75.59%, a negative predictive value (NPV) of 86.92%, and an accuracy of 84.62%, respectively. Conclusions. Patients with primary tumor with EMVI usually showed NP and CS. NP was an independent predictor of EMVI and helpful for the diagnosis of EMVI in RC patients.