|Table of Contents|

The predictive value of enhanced magnetic resonance imaging and diffusion weighted imaging for extramural venous invasion in rectal cancer and development of a nomogram model

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 10
Page:
1854-1860
Research Field:
Publishing date:

Info

Title:
The predictive value of enhanced magnetic resonance imaging and diffusion weighted imaging for extramural venous invasion in rectal cancer and development of a nomogram model
Author(s):
MA Qiang1; ZHENG Lu2; CHENG Hao1; YANG Zhen1
1.Department of Oncology;2.Department of General Surgery,the Second Affiliated Hospital of Anhui Medical University,Anhui Hefei 230000,China.
Keywords:
enhanced magnetic resonance imaging; diffusion weighted imaging; rectal cancer; extramural venous invasion; nomogram; volume transfer constant; apparent diffusion coefficient
PACS:
R735.3+7
DOI:
10.3969/j.issn.1672-4992.2024.10.016
Abstract:
Objective：To explore the predictive value of enhanced magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) for extramural venous invasion (EMVI) in rectal cancer,and establish a nomogram model to guide clinical practice.Methods:A retrospective summary was conducted on 98 patients with rectal adenocarcinoma confirmed by pathology in our hospital from December 2019 to December 2022.They were divided into EMVI positive group (n=47) and EMVI negative group (n=51).Before operation,plain and enhanced 3.0T MRI were used to obtain volume transfer constant (Ktrans),reverse reflux rate constant (Kep),extracellular extravascular volume fraction (Ve),and DWI parameter apparent diffusion coefficient (ADC).The general clinical data and MRI parameters between the two groups were compared,then LASSO regression model and multivariate Logistic regression were used to screen risk factors.R software was used to establish a nomogram model,Bootstrap method was used for intra-model validation,and the consistency index (C-index) was calculated to evaluate model differentiation.The area under curve (AUC) was calculated by receiver operating characteristic (ROC) curve to evaluate predictive performance of the model.The fit and net benefit ratio of the model were evaluated by calibration curve and decision analysis curve.Results:Compared with EMVI negative group,the EMVI positive group increased serum carcinoembryonic antigen (CEA) level,tumor invasion depth and circum-involvement ratio (CIR),poorly differentiated,T stage (3-4),N stage (2-3) and Ki67 positive expression rate (P＜0.05).The Ktrans and Kep values in EMVI positive group were significantly higher than EMVI negative group,while ADC value was significantly less (P＜0.05).Spearman test showed that ADC value was significantly negatively correlated with Ktrans and Kep (P＜0.05),while no correlation with Ve (P＞0.05).Logistic regression showed that CIR,N stage,ADC value,and Ktrans were predictive factors to EMVI in rectal cancer patients (P＜0.05).R software was used to establish the nomogram model,with a total score of 220 points.Internal validation C-index was 0.924.ROC showed AUC of Ktrans,Kep and ADC values for diagnosing EMVI positivity was 0.765,0.723 and 0.708,respectively (P＜0.05).The AUC of nomogram model was 0.867,significantly higher than single indicator (P＜0.05).The calibration curve showed that the predicted probability of the model was consistent with the actual occurrence rate.The decision analysis curve showed that the clinical net benefit predicted by the model was relatively good.Conclusion:Enhanced MRI and DWI are important non-invasive examination methods for preoperative evaluation of EMVI positivity in rectal cancer patients.The nomogram model of combination of CIR,N stages,ADC value and Ktrans has good diagnostic performance for EMVI positivity.

References:

[1] VAN DEN BROEK JJ,VAN DER WOLF FSW,HEIJNEN LA,et al.The prognostic importance of MRI detected extramural vascular invasion (mrEMVI) in locally advanced rectal cancer［J］.Int J Colorectal Dis,2020,35(10):1849-1854.
[2] TRIPATHI P,GUO W,RAO S,et al.Additional value of MRI-detected EMVI scoring system in rectal cancer:applicability in predicting synchronous metastasis［J］.Tumori,2020,106(4):286-294.
[3] DELLI PIZZI A,CHIARELLI AM,CHIACCHIARETTA P,et al.MRI-based clinical-radiomics model predicts tumor response before treatment in locally advanced rectal cancer［J］.Sci Rep,2021,11(1):5379.
[4] LORD AC,D' SOUZA N,SHAW A,et al.MRI-diagnosed tumour deposits and EMVI status have superior prognostic accuracy to current clinical TNM staging in rectal cancer［J］.Ann Surg,2022,276(2):334-344.
[5] 谢玉莹,彭琨.定量MRI术前评估直肠癌壁外血管侵犯的研究进展［J］.国际医学放射学杂志,2023,46(03):308-312. XIE YY,PENG K.Research progress in quantitative MRI preoperative evaluation of extramural vascular invasion in rectal cancer［J］.International J Medical Radiol,2023,46(03):308-312.
[6] 王可欣,余静,徐青.基于RESOLVE ADC的影像组学列线图在预测直肠癌壁外血管侵犯中的应用价值［J］.肿瘤影像学,2023,32(02):138-147. WANG KX,YU J,XU Q.The application value of radiomics nomograms based on RESOLVE ADC in predicting extramural vascular invasion in rectal cancer［J］.Cancer Imag,2023,32(02):138-147.
[7] BATES DDB,HOMSI ME,CHANG KJ,et al.MRI for rectal cancer:staging,mrCRM,EMVI,lymph node staging and post-treatment response［J］.Clin Colorectal Cancer,2022,21(1):10-18.
[8] SCHAAP DP,VOOGT ELK,BURGER JWA,et al.Prognostic implications of MRI-detected EMVI and tumor deposits and their response to neoadjuvant therapy in cT3 and cT4 rectal cancer［J］.Int J Radiat Oncol Biol Phys,2021,111(3):816-825.
[9] 洪宇,吴瑞,贾玉萍,等.直肠癌壁外血管浸润和肿瘤沉积的影像研究进展［J］.临床放射学杂志,2022,41(06):1170-1172. HONG Y,WU R,JIA YP,et al.Progress in imaging research on extramural vascular infiltration and tumor deposition in rectal cancer［J］.J Clinical Radiol,2022,41(06):1170-1172.
[10] SOFIC A,HUSIC-SELIMOVIC A,EFENDIC A,et al.MRI evaluation of extramural venous invasion (EMVI) with rectal carcinoma using high resolution T2 and combination of high resolution T2 and contrast enhanced T1 weighted imaging［J］.Acta Inform Med,2021,29(2):113-117.
[11]CHEN SL,LI N,TANG Y,et al.The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy:a meta-analysis［J］.Eur Radiol,2021,31(12):8827-8837.
[12] LI J,XUE F,XU X,et al.Dynamic contrast-enhanced MRI differentiates hepatocellular carcinoma from hepatic metastasis of rectal cancer by extracting pharmacokinetic parameters and radiomic features［J］.Exp Ther Med,2020,20(4):3643-3652.
[13] ZHU Y,ZHOU Y,ZHANG W,et al.Value of quantitative dynamic contrast-enhanced and di usion-weighted magnetic resonance imaging in predicting extramural venous invasion in locally advanced gastric cancer and prognostic significance［J］.Quant Imaging Med Surg,2021,11(1):328-340.
[14] CHEN Y,YANG X,WEN Z,et al.Association between high-resolution MRI-detected extramural vascular invasion and tumour microcirculation estimated by dynamic contrast-enhanced MRI in rectal cancer:preliminary results［J］.BMC Cancer,2019,19(1):498.
[15] PRAMPOLINI F,TASCHINI S,PECCHI A,et al.Magnetic resonance imaging performed before and after preoperative chemoradiotherapy in rectal cancer:predictive factors of recurrence and prognostic significance of MR-detected extramural venous invasion［J］.Abdom Radiol,2020,45(10):2941-2949.
[16] AO W,BAO X,MAO G,et al.Value of apparent diffusion coefficient for assessing preoperative T staging of low rectal cancer and whether this is correlated with Ki-67 expression［J］.Can Assoc Radiol J,2020,71(1):5-11.
[17] CHEN Z,HU D,YE G,et al.Quantitative evaluation of extramural vascular invasion of rectal cancer by dynamic contrast-enhanced magnetic resonance imaging［J］.Contrast Media Mol Imaging,2022,5(1):1023-1025.
[18] 刘颖平,易文中,丁如.多模态影像学在直肠癌壁外血管侵犯中的研究进展［J］.医学影像学杂志,2023,33(01):131-134. LIU YP,YI WZ,DING R.Research progress of multimodal imaging in extramural vascular invasion of rectal cancer［J］.J Medical Imag,2023,33(01):131-134.
[19] 张景,靳恒军,张芳,等.DWI和T2WI直肠癌体积测量与壁外血管侵犯、淋巴结转移的相关性［J］.放射学实践,2020,35(09):1151-1156. ZHANG J,JIN HJ,ZHANG F,et al.The correlation between DWI and T2WI rectal cancer volume measurement and extramural vascular invasion and lymph node metastasis［J］.Radiological Pract,2020,35(09):1151-1156.

Memo

Memo:
吴阶平医学基金会临床科研专项资助基金(编号：3206750)
Last Update: 1900-01-01