MRI-based Nomogram Analysis: Recognition of Anterior Peritoneal Reflection and Its Relationship to Rectal Cancers

Overview

Journal BMC Med Imaging

Publisher Biomed Central

Specialty Radiology

Date 2021 Mar 18

PMID 33731051

Citations 3

Authors

Shaoting Zhang

Fangying Chen

Xiaolu Ma

Minjie Wang

Guanyu Yu

Fu Shen

Xianhua Gao

Jianping Lu

Affiliations

Soon will be listed here.

Abstract

Background: This study is aimed to explore the factors influencing the visualization of the anterior peritoneal reflection (APR) and evaluated the feasibility of measuring the distance from the anal verge to APR (AV-APR), the tumor height on MRI and the accuracy of determining the tumor location with regard to APR.

Methods: We retrospectively analyzed 110 patients with rectal cancer. A univariate and multivariate logistic regression was performed to identify the independent factors (age, sex, T stage, the degree of bladder filling, pelvic effusion, intraoperative tumor location, BMI, uterine orientation, the distance from seminal vesicle/uterus to rectum) associated with the visualization of the APR on MRI. The nomogram diagram and receiver operating characteristic curve (ROC curve) were established. Intraclass correlation coefficient (ICC) was used to evaluate the consistency of the distance of AV-APR. The Pearson correlation coefficient was used to characterize the agreement between measurements of the tumor height by colonoscopy and MRI. The Kappa statistics was used to evaluate the value of MRI in the diagnosis of the tumor location with regard to the APR.

Results: Multivariate logistic regression showed that BMI (P = 0.031, odds ratio, OR = 1.197), pelvic effusion (P = 0.020, OR = 7.107) and the distance from seminal vesicle/uterus to the rectum (P = 0.001, OR = 3.622) were correlated with the visualization of APR. The cut-off point of BMI and the distance from seminal vesicle/uterus to the rectum is 25.845 kg/m and 1.15 cm. The area under curve (AUC) (95% Confidence Interval, 95% CI) of the combined model is 0.840 (0.750-0.930). The favorable calibration of the nomogram showed a non-significant Hosmer-Lemeshow test statistic (P = 0.195). The ICC value (95% CI) of the distance of AV-APR measured by two radiologists was 0.981 (0.969-0.989). The height measured by MRI and colonoscopy were correlated with each other (r = 0.699, P < 0.001). The Kappa value was 0.854.

Conclusions: BMI, pelvic effusion, and the distance from seminal vesicle/uterus to rectum could affect the visualization of APR on MRI. Also, it's feasible to measure the distance of AV-APR, the tumor height, and to evaluate the tumor location with regard to APR using MRI.

Citing Articles

Deep learning-based reconstruction: a reliability assessment in preoperative magnetic resonance imaging for primary rectal cancer.

Feng W, Zhu L, Xia Y, Tan J, Dai J, Dong H Quant Imaging Med Surg. 2024; 14(12):8927-8941.

PMID: 39698686 PMC: 11651964. DOI: 10.21037/qims-24-907.

Effects of magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) and tumor deposits (TDs) on distant metastasis and long-term survival after surgery for stage III rectal cancer: a retrospective study grouped based on the....

Jiang D, Fan X, Chen K, Li H, Dai Y, Sun N J Gastrointest Oncol. 2023; 14(2):963-979.

PMID: 37201089 PMC: 10186500. DOI: 10.21037/jgo-23-222.

Determination of the positional relationship of the second Houston valve and peritoneal reflection using computed tomographic colonography and magnetic resonance imaging.

Murai S, Kawai K, Nozawa H, Sasaki K, Murono K, Emoto S Surg Today. 2022; 53(5):614-620.

PMID: 36344772 DOI: 10.1007/s00595-022-02615-3.

References

Najarian M, Belzer G, Cogbill T, Mathiason M . Determination of the peritoneal reflection using intraoperative proctoscopy. Dis Colon Rectum. 2005; 47(12):2080-5. DOI: 10.1007/s10350-004-0740-7. View

Yiqun S, Tong T, Fangqi L, Sanjun C, Chao X, Yajia G . Recognition of Anterior Peritoneal Reflections and Their Relationship With Rectal Tumors Using Rectal Magnetic Resonance Imaging. Medicine (Baltimore). 2016; 95(9):e2889. PMC: 4782861. DOI: 10.1097/MD.0000000000002889. View

Bruheim K, Guren M, Skovlund E, Hjermstad M, Dahl O, Frykholm G . Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2009; 76(4):1005-11. DOI: 10.1016/j.ijrobp.2009.03.010. View

Finlay I . Preoperative staging for rectal cancer. BMJ. 2006; 333(7572):766-7. PMC: 1602008. DOI: 10.1136/bmj.38996.423102.BE. View

Gerdes B, Langer P, Kopp I, Bartsch D, Stinner B . Localization of the peritoneal reflection in the pelvis by endorectal ultrasound. Surg Endosc. 1998; 12(12):1401-4. DOI: 10.1007/s004649900868. View

Siegel R, Miller K, Jemal A . Cancer statistics, 2020. CA Cancer J Clin. 2020; 70(1):7-30. DOI: 10.3322/caac.21590. View

Yun H, Chun H, Lee W, Cho Y, Yun S, Lee W . Intra-operative measurement of surgical lengths of the rectum and the peritoneal reflection in Korean. J Korean Med Sci. 2009; 23(6):999-1004. PMC: 2610666. DOI: 10.3346/jkms.2008.23.6.999. View

Bartram C, Brown G . Endorectal ultrasound and magnetic resonance imaging in rectal cancer staging. Gastroenterol Clin North Am. 2002; 31(3):827-39. DOI: 10.1016/s0889-8553(02)00027-4. View

Birgisson H, Pahlman L, Gunnarsson U, Glimelius B . Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol. 2005; 23(34):8697-705. DOI: 10.1200/JCO.2005.02.9017. View

10.

Nijkamp J, Kusters M, Beets-Tan R, Martijn H, Beets G, van de Velde C . Three-dimensional analysis of recurrence patterns in rectal cancer: the cranial border in hypofractionated preoperative radiotherapy can be lowered. Int J Radiat Oncol Biol Phys. 2010; 80(1):103-10. DOI: 10.1016/j.ijrobp.2010.01.046. View

11.

Aschele C, Lonardi S . Multidisciplinary treatment of rectal cancer: medical oncology. Ann Oncol. 2007; 18 Suppl 9:ix114-21. DOI: 10.1093/annonc/mdm305. View

12.

Chen W, Sun K, Zheng R, Zeng H, Zhang S, Xia C . Cancer incidence and mortality in China, 2014. Chin J Cancer Res. 2018; 30(1):1-12. PMC: 5842223. DOI: 10.21147/j.issn.1000-9604.2018.01.01. View

13.

Paparo F, Puppo C, Montale A, Bacigalupo L, Pascariello A, Clavarezza M . Comparison between magnetic resonance imaging and rigid rectoscopy in the preoperative identification of intra- and extraperitoneal rectal cancer. Colorectal Dis. 2014; 16(11):O379-85. DOI: 10.1111/codi.12698. View

14.

Balyasnikova S, Brown G . Optimal Imaging Strategies for Rectal Cancer Staging and Ongoing Management. Curr Treat Options Oncol. 2016; 17(6):32. PMC: 4891388. DOI: 10.1007/s11864-016-0403-7. View

15.

Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U . Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005; 23(24):5644-50. DOI: 10.1200/JCO.2005.08.144. View

16.

Revelli M, Paparo F, Bacigalupo L, Puppo C, Furnari M, Conforti C . Comparison of computed tomography and magnetic resonance imaging in the discrimination of intraperitoneal and extraperitoneal rectal cancer: initial experience. Clin Imaging. 2015; 40(1):57-62. DOI: 10.1016/j.clinimag.2015.10.006. View

17.

Park J, Sakai Y, Simon N, Lun Law W, Kim H, Oh J . Long-Term Survival and Local Relapse Following Surgery Without Radiotherapy for Locally Advanced Upper Rectal Cancer: An International Multi-Institutional Study. Medicine (Baltimore). 2016; 95(22):e2990. PMC: 4900695. DOI: 10.1097/MD.0000000000002990. View

18.

Gollub M, Maas M, Weiser M, Beets G, Goodman K, Berkers L . Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol. 2012; 200(1):97-101. DOI: 10.2214/AJR.11.7602. View

19.

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

20.

Rosenberg R, Maak M, Schuster T, Becker K, Friess H, Gertler R . Does a rectal cancer of the upper third behave more like a colon or a rectal cancer?. Dis Colon Rectum. 2010; 53(5):761-70. DOI: 10.1007/DCR.0b013e3181cdb25a. View