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MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer

 Beomseok Sohn  ;  Joon-seok Lim  ;  Honsoul Kim  ;  Sungmin Myoung  ;  Junjeong Choi  ;  Nam Kyu Kim  ;  Myeong-Jin Kim 
 European Radiology, Vol.25(5) : 1347-1355, 2015 
Journal Title
 European Radiology 
Issue Date
OBJECTIVES: To determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion (EMVI) could predict synchronous distant metastases in rectal cancer. METHODS: Patients who underwent rectal MRI between July 2011 and December 2012 were screened. This study included 447 patients with pathologically confirmed rectal adenocarcinoma who had undergone MRI without previous treatment. Distant metastases were recorded at the initial work-up and over a 6-month follow-up. Univariate/multivariate logistic regression models were used to determine the risk of metastasis. The diagnostic performance was calculated using pathologic lymphovascular invasion (LVI) as a gold standard. RESULTS: Among 447 patients, 79 patients (17.7 %) were confirmed to have distant metastases. Three MRI features are significantly associated with a high risk of distant metastasis: positive EMVI (odds ratio 3.02), high T stage (odds ratio 2.10) and positive regional lymph node metastasis (odds ratio 6.01). EMVI in a large vessel (≥3 mm) had a higher risk for metastasis than EMVI in a small vessel (<3 mm). Sensitivity, specificity and accuracy of MRI-detected EMVI were 28.2 %, 94.0 % and 80.3 %, respectively. CONCLUSIONS: MRI-detected EMVI is an independent risk factor for synchronous metastasis in rectal cancer. EMVI in large vessels is a stronger risk factor for distant metastasis than EMVI in small vessels. KEY POINTS: • EMVI, LN metastasis and T staging on MRI are risk factors for metastasis. • EMVI in large vessels has greater risk for metastasis than in small vessels. • Regional LN metastasis on MRI has highest risk for predicting metastasis. • MR findings could be helpful for selecting patients at high risk for metastasis.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
김남규(Kim, Nam Kyu) ORCID logo https://orcid.org/0000-0003-0639-5632
김명진(Kim, Myeong Jin) ORCID logo https://orcid.org/0000-0001-7949-5402
김한솔(Kim, Hon Soul)
손범석(Sohn, Beomseok) ORCID logo https://orcid.org/0000-0002-6765-8056
임준석(Lim, Joon Seok) ORCID logo https://orcid.org/0000-0002-0334-5042
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