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Value of orthogonal axial MR images in preoperative T staging of gastric cancer

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Abstract

Purpose

To assess the value of orthogonal axial images (OAI) of MRI in gastric cancer T staging.

Methods

This retrospective study enrolled 133 patients (median age, 63 [range, 24–85] years) with gastric adenocarcinoma who underwent both CT and MRI followed by surgery. MRI lacking or incorporating OAI and CT images were evaluated, respectively. Diagnostic performance (accuracy, sensitivity, and specificity) for each T stage, overall diagnostic accuracy and rates of over- and understaging were quantified employing pathological T stage as a reference standard. The McNemar’s test was performed to compare the overall accuracy.

Results

Among patients with pT1–pT4 disease, MRI with OAI (accuracy: 88.7–94.7%, sensitivity: 66.7–93.0%, specificity: 91.5–100.0%) exhibited superior diagnostic performance compared to MRI without OAI (accuracy: 81.2–88.7%, sensitivity: 46.2–83.1%, specificity: 85.5–99.1%) and CT (accuracy: 88.0–92.5%, sensitivity: 53.3–90.1%, specificity: 88.7–98.1%). The overall accuracy of MRI with OAI was significantly higher (83.5%) than that of MRI without OAI (67.7%) (p < .001). However, there was no significant difference in the overall accuracy of MRI with OAI and CT (78.9%) (p = .35). The over- and understaging rates of MRI with OAI (12.0, 4.5%) were lower than those of MRI without OAI (21.8, 10.5%) and CT (12.8, 8.3%).

Conclusion

OAI play a pivotal role in the T staging of gastric cancer. MRI incorporating OAI demonstrated commendable performance for gastric cancer T-staging, with a slight tendency toward its superiority over CT.

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Data availability

All data are available upon request.

References

  1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians 2021; 71:209-249

    PubMed  Google Scholar 

  2. Amin MB ES, Greene FL et al. AJCC Cancer Staging Manual, 8th ed. Springer, New York 2017;

    Google Scholar 

  3. Ajani JA, D'Amico TA, Bentrem DJ, et al. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network : JNCCN 2022; 20:167-192

    Article  CAS  PubMed  Google Scholar 

  4. Chen CY, Hsu JS, Wu DC, et al. Gastric cancer: preoperative local staging with 3D multi-detector row CT--correlation with surgical and histopathologic results. Radiology 2007; 242:472-482

    Article  PubMed  Google Scholar 

  5. Joo I, Lee JM, Kim JH, Shin CI, Han JK, Choi BI. Prospective comparison of 3T MRI with diffusion-weighted imaging and MDCT for the preoperative TNM staging of gastric cancer. Journal of magnetic resonance imaging : JMRI 2015; 41:814-821

    Article  PubMed  Google Scholar 

  6. Joshi SS, Badgwell BD. Current treatment and recent progress in gastric cancer. CA: a cancer journal for clinicians 2021; 71:264-279

    PubMed  Google Scholar 

  7. Lee IJ, Lee JM, Kim SH, et al. Diagnostic performance of 64-channel multidetector CT in the evaluation of gastric cancer: differentiation of mucosal cancer (T1a) from submucosal involvement (T1b and T2). Radiology 2010; 255:805-814

    Article  PubMed  Google Scholar 

  8. Lordick F, Carneiro F, Cascinu S, et al. Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:1005-1020

    Article  CAS  PubMed  Google Scholar 

  9. Zhang Y, Yu J. The role of MRI in the diagnosis and treatment of gastric cancer. Diagnostic and interventional radiology (Ankara, Turkey) 2020; 26:176-182

    Article  PubMed  Google Scholar 

  10. Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet (London, England) 2020; 396:635-648

    Article  CAS  PubMed  Google Scholar 

  11. Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer. The Cochrane database of systematic reviews 2015; 2015:Cd009944

    Article  PubMed  PubMed Central  Google Scholar 

  12. Spolverato G, Ejaz A, Kim Y, et al. Use of endoscopic ultrasound in the preoperative staging of gastric cancer: a multi-institutional study of the US gastric cancer collaborative. Journal of the American College of Surgeons 2015; 220:48-56

    Article  PubMed  Google Scholar 

  13. Giganti F, Orsenigo E, Arcidiacono PG, et al. Preoperative locoregional staging of gastric cancer: is there a place for magnetic resonance imaging? Prospective comparison with EUS and multidetector computed tomography. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2016; 19:216-225

    Article  CAS  PubMed  Google Scholar 

  14. Huang Z, **e DH, Guo L, et al. The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis. The British journal of radiology 2015; 88:20140552

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Caraiani C, Petresc B, Dong Y, Dietrich CF. Contraindications and adverse effects in abdominal imaging. Medical ultrasonography 2019; 21:456-463

    Article  PubMed  Google Scholar 

  16. Cha MJ, Kang DY, Lee W, et al. Hypersensitivity Reactions to Iodinated Contrast Media: A Multicenter Study of 196 081 Patients. Radiology 2019; 293:117-124

    Article  PubMed  Google Scholar 

  17. Caschera L, Lazzara A, Piergallini L, Ricci D, Tuscano B, Vanzulli A. Contrast agents in diagnostic imaging: Present and future. Pharmacological research 2016; 110:65-75

    Article  CAS  PubMed  Google Scholar 

  18. Thomsen HS. Imaging patients with chronic kidney disease: CIN or NSF? La Radiologia medica 2007; 112:621-625

    Article  CAS  PubMed  Google Scholar 

  19. Erturk SM, Alberich-Bayarri A, Herrmann KA, Marti-Bonmati L, Ros PR. Use of 3.0-T MR imaging for evaluation of the abdomen. Radiographics : a review publication of the Radiological Society of North America, Inc 2009; 29:1547-1563

    Article  PubMed  Google Scholar 

  20. Liu S, He J, Guan W, et al. Added value of diffusion-weighted MR imaging to T2-weighted and dynamic contrast-enhanced MR imaging in T staging of gastric cancer. Clinical imaging 2014; 38:122-128

    Article  CAS  PubMed  Google Scholar 

  21. Sohn KM, Lee JM, Lee SY, Ahn BY, Park SM, Kim KM. Comparing MR imaging and CT in the staging of gastric carcinoma. AJR American journal of roentgenology 2000; 174:1551-1557

    Article  CAS  PubMed  Google Scholar 

  22. Zheng D, Liu Y, Liu J, et al. Improving MR sequence of 18F-FDG PET/MR for diagnosing and staging gastric Cancer: a comparison study to (18)F-FDG PET/CT. Cancer imaging : the official publication of the International Cancer Imaging Society 2020; 20:39

    Article  PubMed  Google Scholar 

  23. Anzidei M, Napoli A, Zaccagna F, et al. Diagnostic performance of 64-MDCT and 1.5-T MRI with high-resolution sequences in the T staging of gastric cancer: a comparative analysis with histopathology. La Radiologia medica 2009; 114:1065-1079

    Article  CAS  PubMed  Google Scholar 

  24. Borggreve AS, Goense L, Brenkman HJF, et al. Imaging strategies in the management of gastric cancer: current role and future potential of MRI. The British journal of radiology 2019; 92:20181044

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kaur H, Choi H, You YN, et al. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. Radiographics : a review publication of the Radiological Society of North America, Inc 2012; 32:389-409

    Article  PubMed  Google Scholar 

  26. Nougaret S, Reinhold C, Mikhael HW, Rouanet P, Bibeau F, Brown G. The Use of MR Imaging in Treatment Planning for Patients with Rectal Carcinoma: Have You Checked the "DISTANCE"? Radiology 2013; 268:329-343

    Article  Google Scholar 

  27. Kang BC, Kim JH, Kim KW, et al. Value of the dynamic and delayed MR sequence with Gd-DTPA in the T-staging of stomach cancer: correlation with the histopathology. Abdominal imaging 2000; 25:14-24

    Article  CAS  PubMed  Google Scholar 

  28. D'Elia F, Zingarelli A, Palli D, Grani M. Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases. European radiology 2000; 10:1877-1885

    Article  CAS  PubMed  Google Scholar 

  29. Kim JW, Shin SS, Heo SH, et al. Diagnostic performance of 64-section CT using CT gastrography in preoperative T staging of gastric cancer according to 7th edition of AJCC cancer staging manual. European radiology 2012; 22:654-662

    Article  PubMed  Google Scholar 

  30. Minami M, Kawauchi N, Itai Y, Niki T, Sasaki Y. Gastric tumors: radiologic-pathologic correlation and accuracy of T staging with dynamic CT. Radiology 1992; 185:173-178

    Article  CAS  PubMed  Google Scholar 

  31. Yu JS, Choi SH, Choi WH, Chung JJ, Kim JH, Kim KW. Value of nonvisualized primary lesions of gastric cancer on preoperative MDCT. AJR American journal of roentgenology 2007; 189:W315-319

    Article  PubMed  Google Scholar 

  32. Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 1999; 211:215-222

    Article  CAS  PubMed  Google Scholar 

  33. Fowler JM, Beagley CE, Blomqvist L, et al. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: Results of the MERCURY Study. Radiology 2007; 243:132-139

    Article  Google Scholar 

  34. Seevaratnam R, Cardoso R, McGregor C, et al. How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2012; 15 Suppl 1:S3-18

    Article  PubMed  Google Scholar 

  35. Shimizu K, Ito K, Matsunaga N, Shimizu A, Kawakami Y. Diagnosis of gastric cancer with MDCT using the water-filling method and multiplanar reconstruction: CT-histologic correlation. AJR American journal of roentgenology 2005; 185:1152-1158

    Article  PubMed  Google Scholar 

  36. Mudie DM, Murray K, Hoad CL, et al. Quantification of Gastrointestinal Liquid Volumes and Distribution Following a 240 mL Dose of Water in the Fasted State. Molecular Pharmaceutics 2014; 11:3039-3047

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We great thank Miao LIN for her time and valuable contributions to the study.

Funding

This study was funded by Guangdong Province Basic and Applied Basic Research Foundation (2020A1515010796), Shen-** YU.

Author information

Author notes

  1. Quan-meng Liu and Yan Chen have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China

    Quan-meng Liu, Yan Chen, Wen-jie Fan, Xue-han Wu, Zhi-wen Zhang, Bao-lan Lu, Yu-ru Ma, Yi-yan Liu, Shen-** Yu & Zi-qiang Wen

  2. Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518017, China

    Wen-jie Fan & Xue-han Wu

  3. MR Scientific Marketing, SIEMENS Healthineers Ltd., Shanghai, 210031, China

    Yun-zhu Wu

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Contributions

QML drafted and revised the manuscript; analyzed data; collected imaging data. YC analyzed data and interpreted imaging data; revised the manuscript and enhanced the intellectual content of the manuscript. WJF, XHW, ZWZ, BLL, YRM and YYL collected clinical and pathological data. YZW revised the manuscript. SPY obtained funding to support the study; revised the manuscript; made contributions to the design of the work. WZQ responsible for the designing of the study; analyzed and interpreted imaging data; acquired imaging data. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Shen-** Yu or Zi-qiang Wen.

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Competing interests

Yun-zhu WU is a staff member of Siemens Healthineers. The other authors have no competing interests to declare that they are relevant to the content of this article.

Ethical approval

Approval was obtained from the Institutional Review Board of our hospital.

Informed consent

Informed consent from patients was waived due to the retrospective nature of the study by the Institutional Review Board.

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Cite this article

Liu, Qm., Chen, Y., Fan, Wj. et al. Value of orthogonal axial MR images in preoperative T staging of gastric cancer. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04322-8

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