title: Staging of rectal cancer by double-contrast MR imaging using the rectally administered superparamagnetic iron oxide contrast agent ferristene and IV gadodiamide injection: results of a multicenter phase II trial.
abstract: The aim of this study was to assess the accuracy of double-contrast magnetic resonance imaging (MRI) with rectal application of the superparamagnetic iron oxide contrast agent (SPIO) ferristene and IV gadodiamide for preoperative staging of rectal cancer. In a randomized phase II dose-ranging trial, 113 patients were studied preoperatively with one of four different formulations of ferristene (Abdoscan) as an enema before MRI. T1-weighted spin-echo (T1w SE) and T2w turbo spin-echo (TSE) single-contrast images were obtained as well as T1w SE and gradient-echo (GRE) double-contrast images after IV gadodiamide injection (Omniscan). Images were assessed qualitatively, and TNM tumor stage was compared with histopathology. High-viscosity ferristene formulations were superior to low-viscosity formulations in tumor staging (accuracy 90% vs 74%, P < 0.01). There was no significant difference between high and low iron content ferristene. MRI had a sensitivity of 97%, specificity of 50%, and accuracy of 82% for staging of rectal carcinoma higher than T2 stage. At receiver operator characteristic (ROC) analysis, MR differentiation between T1/T2 and T3/T4 tumor stages yielded a ROC index of 0.848. Double-contrast MRI is an accurate method for preoperative staging of rectal cancer.
authors.affiliation: Department of Radiology, University of Vienna, 1090 Vienna, Austria. andrea.maier@univie.ac.at
authors.forename: A G
authors.initials: AG
authors.lastname: Maier
authors.forename: B
authors.initials: B
authors.lastname: Kersting-Sommerhoff
authors.forename: J W
authors.initials: JW
authors.lastname: Reeders
authors.forename: W
authors.initials: W
authors.lastname: Judmaier
authors.forename: W
authors.initials: W
authors.lastname: Schima
authors.forename: A A
authors.initials: AA
authors.lastname: Annweiler
authors.forename: M
authors.initials: M
authors.lastname: Meusel
authors.forename: N O
authors.initials: NO
authors.lastname: Wallengren
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000285:Administration, Rectal; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D003287:Contrast Media; D004305:Dose-Response Relationship, Drug; D005260:Female; D005290:Ferric Compounds; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011300:Preoperative Care; D011336:Probability; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; C101499:ferristene; C064925:gadodiamide; D019786:Gadolinium DTPA