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MRI-detected extramural vascular invasion is a strong risk factor in predicting synchronous distant metastasis in rectal cancer1Department of Radiology, Tongji Medical College, HUST, Wuhan, China, 2Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
Synopsis
MRI detected extramural vascular invasion (mrEMVI) is potential imaging predictive biomarker for selecting optimum treatment method and is closely correlated with poor prognosis. Several studies have been done to understand the correlation between EMVI and metastasis, but not synchronous metastasis to be specific. We aimed to analyze the correlation between clinical factors including mrEMVI with synchronous metastasis. Moreover, we analyzed the correlation between grades of mrEMVI and synchronous metastasis.
Purpose
Extramural vascular invasion (EMVI) is an independent prognostic factor for poor overall survival rate in rectal cancer. We aim to evaluate the MRI-detected extramural vascular invasion (mrEMVI) in predicting synchronous distant metastasis in T3 rectal cancer.Methods and Materials
Post-operative histopathologically confirmed T3 rectal cancer patients who underwent preoperative MRI without previous treatment were enrolled for this study. Two blinded radiologists evaluated location of the tumor, the degree of mesorectal extension and mrEMVI. mrEMVI was further categorized into EMVI positive and EMVI negative using mrEMVI scoring system in T2 weighted image. The results along with other clinical characteristics (age, sex, tumor location, MRI detected distance of mesorectal extension, lymphatic invasion, perineural invasion, mrEMVI score and CEA) were then correlated with synchronous metastases to determine the risk factors using univariate and multivariate analysis.Results
Among 180 patients, 38 patients were confirmed to be mrEMVI-positive, 34 patients with synchronous metastasis in which 25 were mrEMVI-positive and 9 were mrEMVI-negative. Three factors were significantly associated with synchronous metastasis: mrEMVI (p=0.001), histopathological lymphatic invasion (p=0.001) and preoperative CEA (p=0.026). mrEMVI score 4 was more liable for synchronous metastasis (p=0.044) than mrEMVI score 3 in rectal cancer.Conclusion
There is an intimate relationship between mrEMVI and synchronous metastasis in rectal cancer. mrEMVI positive is an independent risk factor for synchronous distant metastasis in rectal cancer. mrEMVI score 4 is a strong risk factor for synchronous metastasis than mrEMVI score 3 in rectal cancer.Acknowledgements
The manuscript is original work of author. All data, tables, figures, etc. used in the manuscript are prepared originally by authors, otherwise the sources are cited and reprint permission is attached. Authors mention that there is no conflict of interest in this study.
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Figures
a. Pattern of tumor extension through the rectal wall is not nodular; no obvious adjacent vessels are seen in T2WI (mrEMVI-negative; mrEMVI score 0)
b. Minimal extramural stranding; no adjacent vessels are seen in T2WI, normal caliber vessel is only seen (white arrow) mrEMVI-negative; MRI mrEMVI 1
c. Stranding in proximity of vessels but no tumor signal in normal caliber lumen seen in T2WI (white arrow) mrEMVI-negative; mrEMVI score 2
d. Intermediate signal in lumen of vessels; slight vessel expansion seen in T2WI (white arrow) mrEMVI-positive; mrEMVI score 3
e. Irregular vessel contour; definite tumor signal seen in T2WI (white arrow) mrEMVI-positive; mrEMVI score 4
a. CEA level vs. synchronous metastasis; the pre-operative high CEA can be seen with obvious high hepatic metastasis compared with normal CEA level.
b. Lymphatic invasion status vs. synchronous metastasis; positive histopathological lymph node invasion population showed more metastasis compared to negative lymph node invasion.
c. mrEMVI score vs. synchronous metastasis; increase in metastasis with respect to the mrEMVI score can be seen in the figure above, hepatic metastasis can be seen comparatively more in mrEMVI positive (score 3 and 4)