title: MRI for Local Staging of Colon Cancer: Can MRI Become the Optimal Staging Modality for Patients With Colon Cancer?
abstract: BACKGROUND
  Colon cancer is currently staged with CT. However, MRI is superior in the detection of colorectal liver metastasis, and MRI is standard in local staging of rectal cancer. Optimal (local) staging of colon cancer could become crucial in selecting patients for neoadjuvant treatment in the near future (Fluoropyrimidine Oxaliplatin and Targeted Receptor Preoperative Therapy trial).
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the diagnostic performance of MRI for local staging of colon cancer.
  
  
  METHODS
  This was a retrospective study.
  
  
  METHODS
  The study was conducted at the Maastricht University Medical Centre.
  
  
  METHODS
  In total, 55 patients with biopsy-proven colon carcinoma were included.
  
  
  METHODS
  All of the patients underwent an MRI (1.5-tesla; T2 and diffusion-weighted imaging) of the abdomen and were retrospectively analyzed by 2 blinded, independent readers. Histopathology after resection was the reference standard. Both readers evaluated tumor characteristics, including invasion through bowel wall (T3/T4 tumors), invasion beyond bowel wall of ≥5 mm and/or invasion of surrounding organs (T3cd/T4), serosal involvement, extramural vascular invasion, and malignant lymph nodes (N+). Interobserver agreement was compared using κ statistics.
  
  
  RESULTS
  MRI had a high sensitivity (72%-91%) and specificity (84%-89%) in detecting T3/T4 tumors (35/55) and a low sensitivity (43%-67%) and high specificity (75%-88%) in detecting T3cd/T4 tumors (15/55). For detecting serosal involvement and extramural vascular invasion, MRI had a high sensitivity and moderate specificity, as well as a moderate sensitivity and specificity in the detection of nodal involvement. Interobserver agreements were predominantly good; the more experienced reader achieved better results in the majority of these categories.
  
  
  CONCLUSIONS
  The study was limited by its retrospective nature and moderate number of inclusions.
  
  
  CONCLUSIONS
  MRI has a good sensitivity for tumor invasion through the bowel wall, extramural vascular invasion, and serosal involvement. In addition, together with its superior liver imaging, MRI might become the optimal staging modality for colon cancer. However, more research is needed to confirm this. See Video Abstract at http://links.lww.com/DCR/A309.
authors.affiliation: 1 Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands 2 GROW School of Oncology and Developmental Biology, University of Maastricht Medical Centre, Maastricht, the Netherlands 3 Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands 4 Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands 5 Department of Pathology, Maastricht University Medical Centre, Maastricht, the Netherlands 6 Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom.
authors.forename: Elias
authors.initials: E
authors.lastname: Nerad
authors.forename: Doenja M J
authors.initials: DM
authors.lastname: Lambregts
authors.forename: Erik L J
authors.initials: EL
authors.lastname: Kersten
authors.forename: Monique
authors.initials: M
authors.lastname: Maas
authors.forename: Frans C H
authors.initials: FC
authors.lastname: Bakers
authors.forename: Harrie C M
authors.initials: HC
authors.lastname: van den Bosch
authors.forename: Heike I
authors.initials: HI
authors.lastname: Grabsch
authors.forename: Regina G H
authors.initials: RG
authors.lastname: Beets-Tan
authors.forename: Max J
authors.initials: MJ
authors.lastname: Lahaye
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies