Publications by authors named "Marc J Gollub"

77 Publications

Bone lesions on baseline staging rectal MRI: prevalence and significance in patients with rectal adenocarcinoma.

Abdom Radiol (NY) 2021 Feb 4. Epub 2021 Feb 4.

Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.

A T1 sequence on routine baseline staging rectal magnetic resonance imaging (MRI) is thought to help detect bone lesions. Our primary aim was to evaluate the incidence of bone lesions encountered on baseline staging rectal MRI, particularly the prevalence of bone metastases. This retrospective study included patients with rectal adenocarcinoma who underwent baseline rectal MRI at our institution between January 2010 and December 2017. The MRI report was reviewed for presence of bone lesions. When found, lesion type, presence of axial T1 non-fat-suppressed sequence, primary tumor T-stage, and presence of other organ metastases were recorded. In the absence of bone biopsy, the reference standard was follow-up imaging via computed tomography (CT), MRI, and/or positron emission tomography/CT (PET/CT) ≥ 1 year after the baseline MRI. The Wilcoxon rank-sum test and Fisher's exact test were used to compare clinicopathologic data of patients with malignant or benign bone lesions. A total of 1197 patients were included. 62/1197 patients (mean age 56.8 years (SD: 13.8), with 39 men) had bone lesions on baseline imaging, with 6 being bone metastases (0.5%, 95% CI 0.2%-1.1%). Of the 6 patients with bone metastases, 5/6 had other metastases (i.e., liver, lung) at baseline. Bone metastases on baseline rectal MRI performed for rectal adenocarcinoma are extremely rare. Furthermore, bone metastases without other organ (i.e., liver, lung) involvement is extremely rare.
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http://dx.doi.org/10.1007/s00261-020-02923-7DOI Listing
February 2021

Rectal cancer with complete endoscopic response after neoadjuvant therapy: what is the meaning of a positive MRI?

Eur Radiol 2021 Jan 15. Epub 2021 Jan 15.

Division of Colorectal, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.

Objectives: To determine the short-term outcomes of discordant tumor assessments between DWI-MRI and endoscopy in patients with treated rectal cancer when tumor-bed diffusion restriction is present ("+DWI").

Methods: In this HIPPA-compliant, IRB-approved retrospective study, rectal MRI and endoscopic reports were reviewed for patients with locally advanced primary rectal adenocarcinoma (LARC) treated with chemoradiotherapy or total neoadjuvant therapy and imaged between January 2016 and December 2019. Eligible patients had a +DWI and endoscopy within 2 weeks of each other. True positive MRI were those with tumor on endoscopy and/or biopsy (TP) or in whom endoscopy was negative for tumor, but subsequent 3-month follow-up endoscopy and DWI were both positive (TP). The positive predictive value of DWI-MRI was calculated on a per-scan and per-patient basis. DWI-negative MRI exams were not explored in this study.

Results: In total, 397 patients with nonmetastatic primary LARC were analyzed. After exclusions, 90 patients had 98 follow-up rectal MRI studies with +DWI. Seventy-six patients underwent 80 MRI scans and had concordant findings at endoscopy (TPa). Seventeen patients underwent 18 MRI scans and had discordant findings at endoscopy (FP); among these, 4 scans in 4 patients were initially false positive (FP) but follow-up MRI remained +DWI and the endoscopy turned concordantly positive (TP). PPV was 0.86 per scan and per patient. In 4/18 (22%) scans and 4/17 (24%) patients with discordances, MRI detected tumor regrowth before endoscopy.

Conclusions: Although most +DWI exams discordant with endoscopy are false positive, 22% will reveal that DWI-MRI detects tumor recurrence before endoscopy.

Key Points: • Most often, in post-treatment assessment for rectal cancer when DWI-MRI shows restriction in the tumor bed and endoscopy shows no tumor, +DWI MRI will be proven false positive. • Conversely, our study demonstrated that, allowing for sequential follow-up at a 3-month maximum interval, DWI-MRI may detect tumor presence in the treated tumor bed before endoscopy in 22% of discordant findings between DWI-MRI and endoscopy. • Our results showed that a majority of DWI-MRI-positive scans in treated rectal cancer concur with the presence of tumor on endoscopy performed within 2 weeks.
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http://dx.doi.org/10.1007/s00330-020-07657-0DOI Listing
January 2021

Measurement of rectal tumor height from the anal verge on MRI: a comparison of internal versus external anal sphincter.

Abdom Radiol (NY) 2020 Sep 17. Epub 2020 Sep 17.

Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.

Purpose: To determine the most accurate measurement technique to assess rectal tumor height on MRI using two different anatomic landmarks for the anal verge.

Introduction: Accurate measurements and standardized reporting of MRI for rectal cancer staging is essential. It is not known whether measurements starting from the internal anal sphincter (IAS) or external anal sphincter (EAS) more closely correlate with tumor height from the anal verge on endoscopy.

Methods: This retrospective study included baseline staging MRI examinations for 85 patients after exclusions. Two radiologists blinded to endoscopic results measured the distance of rectal tumors from the internal anal sphincter and external anal sphincter on sagittal T2 images. The reference standard was endoscopic measurement of tumor height; descriptive statistics were performed.

Results: For reader 1, the mean difference in measurement of tumor height between MRI and endoscopy was - 0.45 cm (SD ± 1.76 cm, range - 6.0 to 3.9 cm) for the IAS and 0.51 cm (SD ± 1.75 cm range - 4.7 to 4.8 cm) for the EAS. For reader 2, the mean difference in measurement of tumor height between MRI and endoscopy was - 0.57 (STD ± 1.81, range - 5.9 to 4.8 cm) for the IAS and 0.52 cm (STD ± 1.85, range - 4.3 to 5.6 cm) for the EAS. Interobserver ICC was excellent between reader 1 and reader 2 for measurements from both the IAS (0.955 95% CI 0.931-0.97) and EAS (0.952, 95% CI 0.928, 0.969).

Conclusion: Measurement of tumor height on MRI was highly reproducible between readers; beginning measurements from the EAS tends to slightly overestimate tumor height on average and from the IAS tends to slightly underestimate tumor height on average.
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http://dx.doi.org/10.1007/s00261-020-02757-3DOI Listing
September 2020

Does microenema administration improve the quality of DWI sequences in rectal MRI?

Abdom Radiol (NY) 2020 Sep 14. Epub 2020 Sep 14.

Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA.

Purpose: To determine whether the administration of a microenema immediately prior to rectal magnetic resonance imaging (MRI) decreases the level of gas-related artifacts on diffusion-weighted imaging (DWI) sequences.

Methods: This retrospective analysis included 492 (183 baseline and 309 post-total neoadjuvant treatment [TNT]) consecutive MRI scans for rectal cancer from January 2019 to January 2020. Scan-related factors were identified including microenema use (yes or no), field of view (FOV) in DWI (b = 800 or b = 1500), and magnet strength (1.5 T or 3 T). Two readers scored DWI studies for gas-related artifacts and T2-weighted sequences for the amount of intraluminal gas on a 5-point scale. Fisher's exact test and the Rao-Scott Chi-squared test were used to examine associations between microenema use and other factors. Generalized estimating equation and multivariable regression models were performed to examine the effect of microenema use in subgroups of scans for each reader. Cohen's κ was used to assess inter-reader agreement.

Results: Gas-related artifact levels decreased in scans with microenema overall (P < 0.001) as well as when scans were stratified by FOV (P ≤ 0.003). For both readers, post-TNT scans with microenema showed lower artifact levels overall (P < 0.014 and P < 0.001) and in post-TNT subgroups of axial DWI scans (P ≤ 0.006 and P < 0.001) and scans acquired with a 3 T magnet (P ≤ 0.001 for both FOV). No evidence of decreased artifact level was found for baseline studies. Decreased gas was seen with microenema use (P < 0.001 for both readers). Inter-reader agreement on artifact-level and gas-level assessments ranged from slight to substantial (κ = 0.273-0.685).

Conclusion: Microenema use prior to rectal MRI reduces gas-related artifacts on DWI, including both large and small FOV sequences and particularly on post-TNT scans performed at 3 T, and offers a viable solution to improve DWI quality.
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http://dx.doi.org/10.1007/s00261-020-02718-wDOI Listing
September 2020

CT colonography's role in the COVID-19 pandemic: a safe(r), socially distanced total colon examination.

Abdom Radiol (NY) 2021 02 3;46(2):486-490. Epub 2020 Aug 3.

Department of Radiology, Boston University School of Medicine, Boston, MA, USA.

Purpose: To describe the favorable procedural profile of CT colonography (CTC) during the COVID-19 pandemic.

Conclusion: Postponement of cancer screening due to COVID-19 has resulted in a backlog of individuals needing to undergo structural examination of the colon. The experience during the initial COVID-19 surge with urgent evaluation of the colon for transplant patients prior to transplant suggests that CTC can be done in a lower risk manner as compared to other structural examinations. The procedural profile of CTC is advantageous during this pandemic as maintaining social distancing and preserving healthcare supplies including PPE are of paramount importance. CTC is an important option to utilize in the screening armamentarium to allow effective screening of average risk asymptomatic individuals in the COVID-19 era.
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http://dx.doi.org/10.1007/s00261-020-02674-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398602PMC
February 2021

ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper.

Nat Rev Clin Oncol 2020 12 6;17(12):757-770. Epub 2020 Jul 6.

Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

An increasing number of studies are describing potential uses of circulating tumour DNA (ctDNA) in the care of patients with colorectal cancer. Owing to this rapidly developing area of research, the Colon and Rectal-Anal Task Forces of the United States National Cancer Institute convened a panel of multidisciplinary experts to summarize current data on the utility of ctDNA in the management of colorectal cancer and to provide guidance in promoting the efficient development and integration of this technology into clinical care. The panel focused on four key areas in which ctDNA has the potential to change clinical practice, including the detection of minimal residual disease, the management of patients with rectal cancer, monitoring responses to therapy, and tracking clonal dynamics in response to targeted therapies and other systemic treatments. The panel also provides general guidelines with relevance for ctDNA-related research efforts, irrespective of indication.
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http://dx.doi.org/10.1038/s41571-020-0392-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790747PMC
December 2020

Use of a portable computed tomography scanner for chest imaging of COVID-19 patients in the urgent care at a tertiary cancer center.

Emerg Radiol 2020 Dec 9;27(6):597-600. Epub 2020 Jun 9.

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.

To present a novel use of a portable computed tomography (CT) for evaluation of COVID-19 patients presenting to an urgent care center (UCC). Infection control is imperative for hospitals treating patients with COVID-19, even more so in cancer centers, where the majority of the patient population is susceptible to adverse outcomes from the infection. Over the past several weeks, our department has worked to repurpose a portable CT scanner from our surgical colleagues that operates with fixed-parameters to perform non-contrast, helical, thin-slice chest imaging to address the known pulmonary complications of COVID-19. Despite the technical limitations of the portable CT unit that was repurposed for the UCC, diagnostic-quality images in an acute care setting were successfully obtained. Repurposing of a portable CT scanner for use in COVID-19 patients offers a feasible option to obtain diagnostic quality images while minimizing the risk of exposing other patients and hospital staff to an infected patient.
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http://dx.doi.org/10.1007/s10140-020-01801-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280689PMC
December 2020

Clinical utility of radiomics at baseline rectal MRI to predict complete response of rectal cancer after chemoradiation therapy.

Abdom Radiol (NY) 2020 11;45(11):3608-3617

Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.

Purpose: To investigate the value of T2-radiomics combined with anatomical MRI staging criteria from pre-treatment rectal MRI in predicting complete response to neoadjuvant chemoradiation therapy (CRT).

Methods: This retrospective study included patients with locally advanced rectal cancer who underwent rectal MRI before neoadjuvant CRT from October 2011 to January 2015 and then surgery. Surgical histopathologic analysis was used as the reference standard for pathologic complete response. Anatomical MRI staging criteria were extracted from our institutional standardized radiology report. In radiomics analysis, one radiologist manually segmented the primary tumor on T2-weighted images for all 102 patients (i.e., training set); two different radiologists independently segmented 66/102 patients (i.e., validation set). 108 radiomics features were extracted. Then, scanner-independent features were identified and least absolute shrinkage operator analysis was used to extract a radiomics score. Finally, a support vector machine model combining the radiomics score and anatomical MRI staging criteria was compared against both anatomical MRI-only and radiomics-only models using the deLong test.

Results: The study included 102 patients (42 women; median age = 61 years).The radiomics score produced an area under the curve (AUC) of 0.75. Comparable results were found using the validation set (AUCs = 0.75 and 0.71 for each radiologist, respectively). The anatomical MRI-only model had an accuracy of 67% (sensitivity 42%, specificity 72%); when adding the radiomics score, the accuracy increased to 74% (sensitivity 58%, specificity 77%).

Conclusion: Combining T2-radiomics and anatomical MRI staging criteria from pre-treatment rectal MRI may help to stratify patients based on the prediction of treatment response to neoadjuvant therapy.
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http://dx.doi.org/10.1007/s00261-020-02502-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572430PMC
November 2020

Diagnostic accuracy of b800 and b1500 DWI-MRI of the pelvis to detect residual rectal adenocarcinoma: a multi-reader study.

Abdom Radiol (NY) 2020 02;45(2):293-300

Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.

Purpose: To compare the sensitivity, specificity and intra-observer and inter-observer agreement of pelvic magnetic resonance imaging (MRI) b800 and b1500 s/mm sequences in the detection of residual adenocarcinoma after neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer (LARC).

Introduction: Detection of residual adenocarcinoma after neoadjuvant CRT for LARC has become increasingly important and relies on both MRI and endoscopic surveillance. Optimal MRI diffusion b values have yet to be established for this clinical purpose.

Methods: From our MRI database between 2018 and 2019, we identified a cohort of 28 patients after exclusions who underwent MRI of the rectum before and after neoadjuvant chemoradiation with a protocol that included both b800 and b1500 s/mm diffusion sequences. Four radiologists experienced in rectal MRI interpreted the post-CRT MRI studies with either b800 DWI or b1500 DWI, and a minimum of 2 weeks later re-interpreted the same studies using the other b value sequence. Surgical pathology or endoscopic follow-up for 1 year without tumor re-growth was used as the reference standard. Descriptive statistics compared accuracy for each reader and for all readers combined between b values. Inter-observer agreement was assessed using kappa statistics. A p value of 0.05 or less was considered significant.

Results: Within the cohort, 19/28 (67.9%) had residual tumor, while 9/28 (32.1%) had a complete response. Among four readers, one reader had increased sensitivity for detection of residual tumor at b1500 s/mm (0.737 vs. 0.526, p = 0.046). There was no significant difference between detection of residual tumor at b800 and at b1500 for the rest of the readers. With all readers combined, the pooled sensitivity was 0.724 at b1500 versus 0.605 at b800, but this was not significant (p = 0.119). There was no difference in agreement between readers at the two b value settings (67.8% at b800 vs. 72.0% at b1500), or for any combination of individual readers.

Conclusion: Aside from one reader demonstrating increased sensitivity, no significant difference in accuracy parameters or inter-observer agreement was found between MR using b800 and b1500 for the detection of residual tumor after neoadjuvant CRT for LARC. However, there was a suggestion of a trend towards increased sensitivity with b1500, and further studies using larger cohorts may be needed to further investigate this topic.
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http://dx.doi.org/10.1007/s00261-019-02283-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386086PMC
February 2020

Introduction to the special section on rectal cancer.

Abdom Radiol (NY) 2019 11;44(11):3497

Massachusetts General Hospital, Harvard Medical School, Boston, USA.

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http://dx.doi.org/10.1007/s00261-019-02221-xDOI Listing
November 2019

Patient-Specific Organ and Effective Dose Estimates in Adult Oncologic CT.

AJR Am J Roentgenol 2020 04 15;214(4):738-746. Epub 2019 Aug 15.

Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1250 York Ave, New York, NY 10065.

Patient-specific organ and effective dose provides essential information for CT protocol optimization. However, such information is not readily available in the scan records. The purpose of this study was to develop a method to obtain accurate examination- and patient-specific organ and effective dose estimates by use of available scan data and patient body size information for a large cohort of patients. The data were randomly collected for 1200 patients who underwent CT in a 2-year period. Physical characteristics of the patients and CT technique were processed as inputs for the dose estimator. Organ and effective doses were estimated by use of the inputs and computational human phantoms matched to patients on the basis of sex and effective diameter. Size-based ratios were applied to correct for patient-phantom body size differences. Patients received a mean of 59.9 mGy to the lens of the eye per brain scan, 10.1 mGy to the thyroid per chest scan, 17.5 mGy to the liver per abdomen and pelvis scan, and 19.0 mGy to the liver per body scan. A factor of 2 difference in dose estimates was observed between patients of various habitus. Examination- and patient-specific organ and effective doses were estimated for 1200 adult oncology patients undergoing CT. The dose conversion factors calculated facilitate rapid organ and effective dose estimation in clinics. Compared with nonspecific dose estimation methods, patient dose estimations with data specific to the patient and examination can differ by a factor of 2.
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http://dx.doi.org/10.2214/AJR.19.21197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393764PMC
April 2020

Rectal cancer lexicon: consensus statement from the society of abdominal radiology rectal & anal cancer disease-focused panel.

Abdom Radiol (NY) 2019 11;44(11):3508-3517

Department of Radiology, Hospital Sirio-Libanes, São Paulo, São Paulo, Brazil.

Standardized terminology is critical to providing consistent reports to referring clinicians. This lexicon aims to provide a reference for terminology frequently used in rectal cancer and reflects the consensus of the Society of Abdominal Radiology Disease Focused Panel in Rectal cancer. This lexicon divided the terms into the following categories: primary tumor staging, nodal staging, treatment response, anal canal anatomy, general anatomy, and treatments.
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http://dx.doi.org/10.1007/s00261-019-02170-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824987PMC
November 2019

Radiomics-based prediction of microsatellite instability in colorectal cancer at initial computed tomography evaluation.

Abdom Radiol (NY) 2019 11;44(11):3755-3763

Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA.

Purpose: To predict microsatellite instability (MSI) status of colon cancer on preoperative CT imaging using radiomic analysis.

Methods: This retrospective study involved radiomic analysis of preoperative CT imaging of patients who underwent resection of stage II-III colon cancer from 2004 to 2012. A radiologist blinded to MSI status manually segmented the tumor region on CT images. 254 Intensity-based radiomic features were extracted from the tumor region. Three prediction models were developed with (1) only clinical features, (2) only radiomic features, and (3) "combined" clinical and radiomic features. Patients were randomly separated into training (n = 139) and test (n = 59) sets. The model was constructed from training data only; the test set was reserved for validation only. Model performance was evaluated using AUC, sensitivity, specificity, PPV, and NPV.

Results: Of the total 198 patients, 134 (68%) patients had microsatellite stable tumors and 64 (32%) patients had MSI tumors. The combined model performed slightly better than the other models, predicting MSI with an AUC of 0.80 for the training set and 0.79 for the test set (specificity = 96.8% and 92.5%, respectively), whereas the model with only clinical features achieved an AUC of 0.74 and the model with only radiomic features achieved an AUC of 0.76. The model with clinical features alone had the lowest specificity (70%) compared with the model with radiomic features alone (95%) and the combined model (92.5%).

Conclusions: Preoperative prediction of MSI status via radiomic analysis of preoperative CT adds specificity to clinical assessment and could contribute to personalized treatment selection.
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http://dx.doi.org/10.1007/s00261-019-02117-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824954PMC
November 2019

Evaluation of diffusion kurtosis and diffusivity from baseline staging MRI as predictive biomarkers for response to neoadjuvant chemoradiation in locally advanced rectal cancer.

Abdom Radiol (NY) 2019 11;44(11):3701-3708

Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.

Purpose: To evaluate the role of diffusion kurtosis and diffusivity as potential imaging biomarkers to predict response to neoadjuvant chemoradiation therapy (CRT) from baseline staging magnetic resonance imaging (MRI) in locally advanced rectal cancer (LARC).

Materials And Methods: This retrospective study included 45 consecutive patients (31 male/14 female) who underwent baseline MRI with high b-value sequences (up to 1500 mm/s) for LARC followed by neoadjuvant chemoradiation and surgical resection. The mean age was 57.4 years (range 34.2-72.9). An abdominal radiologist using open source software manually segmented T2-weighted images. Segmentations were used to derive diffusion kurtosis and diffusivity from diffusion-weighted images as well as volumetric data. These data were analyzed with regard to tumor regression grade (TRG) using the four-tier American Joint Committee on Cancer (AJCC) classification, TRG 0-3. Proportional odds regression was used to analyze the four-level ordinal outcome. A sensitivity analysis was performed using univariable logistic regression for binary TRG groups, TRG 0/1 (> 90% response), or TRG 2/3 (< 90% response). p < 0.05 was considered significant throughout.

Results: In the univariable proportional odds regression analysis, higher diffusivity summary (D) values were observed to be significantly associated with higher odds of being in one or more favorable TRG group (TRG 0 or 1). In other words, on average, patients with higher D values were more likely to be in a more favorable TRG group. These results are mostly consistent with the sensitivity analysis, in which higher values for most D values [all but region of interest (ROI)-max D median (p = 0.08)] were observed to be significantly associated with higher odds of being TRG 0 or 1. Tumor volume of interest (VOI) and ROI volume, ROI kurtosis mean and median, and VOI kurtosis mean and median were not significantly associated with TRG.

Conclusion: Diffusivity derived from the baseline staging MRI, but not diffusion kurtosis or volumetric data, is associated with TRG and therefore shows promise as a potential imaging biomarker to predict the response to neoadjuvant chemotherapy in LARC.

Clinical Relevance Statement: Diffusivity shows promise as a potential imaging biomarker to predict AJCC TRG following neoadjuvant CRT, which has implications for risk stratification. Patients with TRG 0/1 have 5-year disease-free survival (DFS) of 90-98%, as opposed to those who are TRG 2/3 with 5-year DFS of 68-73%.
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http://dx.doi.org/10.1007/s00261-019-02073-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457148PMC
November 2019

Current controversy, confusion, and imprecision in the use and interpretation of rectal MRI.

Abdom Radiol (NY) 2019 11;44(11):3549-3558

Harvard Medical School, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, 02215, MA, USA.

There has been a rapid increase in the utilization of MRI in rectal cancer staging in the USA essentially replacing endorectal ultrasound and mimicking the trend in Europe seen in the 1990s and 2000s. Accompanying this trend, there is a demand, and recognized need, for greater precision and clarification of confusing, misunderstood and poorly understood concepts, facts, statements and nomenclature regarding rectal cancer and the use of pelvic MRI for diagnosis. As such, this Review, part evidence-based and part expert opinion, will attempt to elucidate and clarify several concepts the authors have encountered in 25 years of imaging rectal cancer, focusing on MRI.
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http://dx.doi.org/10.1007/s00261-019-01996-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365137PMC
November 2019

Radiogenomics of rectal adenocarcinoma in the era of precision medicine: A pilot study of associations between qualitative and quantitative MRI imaging features and genetic mutations.

Eur J Radiol 2019 Apr 18;113:174-181. Epub 2019 Feb 18.

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address:

Objective: To investigate associations between genetic mutations and qualitative as well as quantitative features on MRI in rectal adenocarcinoma at primary staging.

Methods: In this retrospective study, patients with rectal adenocarcinoma, genome sequencing, and pretreatment rectal MRI were included. Statistical analysis was performed to evaluate associations between qualitative features obtained from subjective evaluation of rectal MRI and gene mutations as well as between quantitative textural features and gene mutations. For the qualitative evaluation, Fisher's Exact test was used to analyze categorical associations and Wilcoxon Rank Sum test was used for continuous clinical variables. For the quantitative evaluation, we performed manual segmentation of T2-weighted images for radiomics-based quantitative image analysis. Thirty-four texture features consisting of first order intensity histogram-based features (n = 4), second order Haralick textures (n = 5), and Gabor-edge based Haralick textures were computed at two different orientations. Consensus clustering was performed with 34 computed texture features using the K-means algorithm with Euclidean distance between the texture features. The clusters resulting from the algorithm were then used to enumerate the prevalence of gene mutations in those clusters.

Results: In 65 patients, 45 genes were mutated in more than 3/65 patients (5%) and were included in the statistical analysis. Regarding qualitative imaging features, on univariate analysis, tumor location was significantly associated with APC (p = 0.032) and RASA1 mutation (p = 0.032); CRM status was significantly associated with ATM mutation (p = 0.021); and lymph node metastasis was significantly associated with BRCA2 (p = 0.046) mutation. However, these associations were not significant after adjusting for multiple comparisons. Regarding quantitative imaging features, Cluster C1 had tumors with higher mean Gabor edge intensity compared with cluster C2 (θ = 0°, p = 0.018; θ = 45°, p = 0.047; θ = 90°, p = 0.037; cluster C3 (θ = 0°, p = 0.18; θ = 45°, p = 0.1; θ = 90°, p = 0.052), and cluster C4 (θ = 0°, p = 0.016; θ = 45°, p = 0.033; θ = 90°, p = 0.014) suggesting that the cluster C1 had tumors with more distinct edges or heterogeneous appearance compared with other clusters.

Conclusions: Although this preliminary study showed promising associations between quantitative features and genetic mutations, it did not show any correlation between qualitative features and genetic mutations. Further studies with larger sample size are warranted to validate our preliminary data.
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http://dx.doi.org/10.1016/j.ejrad.2019.02.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443100PMC
April 2019

MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management.

Radiographics 2019 Mar-Apr;39(2):367-387. Epub 2019 Feb 15.

From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.).

Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of rectal MRI and increased radiologist awareness of the key rectal cancer TNM staging features, the mortality rate of rectal cancer has been declining over the past few decades in adults over 50 years of age. Currently, rectal MRI plays a key role in the pre- and posttreatment evaluation of rectal cancer, assisting the multidisciplinary team in tailoring the most appropriate treatment option. The benefits achieved with rectal MRI are strictly dependent on obtaining good-quality images, which is important for the characterization of the main anatomic structures and their relationship with the tumor. In primary staging, rectal MRI helps the radiologist (a) describe the tumor location and morphology, (b) provide its T and N categories, (c) detect the presence of extramural vascular invasion, and (d) identify its relationship with surrounding structures, including the sphincter complex and involvement of the mesorectal fascia. These features help diagnose locally advanced rectal tumors (categories T3c-d, T4, N1, and N2), for which neoadjuvant chemoradiotherapy (CRT) is indicated. In restaging after neoadjuvant CRT, in addition to reassessing the features noted during primary staging, rectal MRI can help in the assessment of treatment response, especially with the emergence of nonsurgical approaches such as "watch and wait." RSNA, 2019.
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http://dx.doi.org/10.1148/rg.2019180114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438362PMC
March 2020

Assessment of a Watch-and-Wait Strategy for Rectal Cancer in Patients With a Complete Response After Neoadjuvant Therapy.

JAMA Oncol 2019 Apr 11;5(4):e185896. Epub 2019 Apr 11.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.

Importance: The watch-and-wait (WW) strategy aims to spare patients with rectal cancer unnecessary resection.

Objective: To analyze the outcomes of WW among patients with rectal cancer who had a clinical complete response to neoadjuvant therapy.

Design, Setting, And Participants: This retrospective case series analysis conducted at a comprehensive cancer center in New York included patients who received a diagnosis of rectal adenocarcinoma between January 1, 2006, and January 31, 2015. The median follow-up was 43 months. Data analyses were conducted from June 1, 2016, to October 1, 2018.

Exposures: Patients had a clinical complete response after completing neoadjuvant therapy and agreed to a WW strategy of active surveillance and possible salvage surgery (n = 113), or patients underwent total mesorectal excision and were found to have a pathologic complete response (pCR) at resection (n = 136).

Main Outcomes And Measures: Kaplan-Meier estimates were used for analyses of local regrowth and 5-year rates of overall survival, disease-free survival, and disease-specific survival.

Results: Compared with the 136 patients in the pCR group, the 113 patients in the WW group were older (median [range], 67.2 [32.1-90.9] vs 57.3 [25.0-87.9] years, P < .001) with cancers closer to the anal verge (median [range] height from anal verge, 5.5 [0.0-15.0] vs 7.0 [0.0-13.0] cm). All 22 local regrowths in the WW group were detected on routine surveillance and treated by salvage surgery (20 total mesorectal excisions plus 2 transanal excisions). Pelvic control after salvage surgery was maintained in 20 of 22 patients (91%). No pelvic recurrences occurred in the pCR group. Rectal preservation was achieved in 93 of 113 patients (82%) in the WW group (91 patients with no local regrowths plus 2 patients with local regrowths salvaged with transanal excision). At 5 years, overall survival was 73% (95% CI, 60%-89%) in the WW group and 94% (95% CI, 90%-99%) in the pCR group; disease-free survival was 75% (95% CI, 62%-90%) in the WW group and 92% (95% CI, 87%-98%) in the pCR group; and disease-specific survival was 90% (95% CI, 81%-99%) in the WW group and 98% (95% CI, 95%-100%) in the pCR group. A higher rate of distant metastasis was observed among patients in the WW group who had local regrowth vs those who did not have local regrowth (36% vs 1%, P < .001).

Conclusions And Relevance: A WW strategy for select rectal cancer patients who had a clinical complete response after neoadjuvant therapy resulted in excellent rectal preservation and pelvic tumor control; however, in the WW group, worse survival was noted along with a higher incidence of distant progression in patients with local regrowth vs those without local regrowth.
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http://dx.doi.org/10.1001/jamaoncol.2018.5896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459120PMC
April 2019

CT Colonography in Preoperative Staging of Colon Cancer: Evaluation of FOxTROT Inclusion Criteria for Neoadjuvant Therapy.

AJR Am J Roentgenol 2019 01 13;212(1):94-102. Epub 2018 Nov 13.

1 Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.

Objective: The purpose of the present study is to evaluate the diagnostic performance of and interreader agreement for CT colonography (CTC) in the local staging of colon cancer, with emphasis given to the FOxTROT (Fluoropyrimidine, Oxaliplatin, and Targeted-Receptor pre-Operative Therapy [Panitumumab]) trial inclusion criteria, which propose a new tailored treatment paradigm for colon cancer that uses neoadjuvant therapy for patients with a high-risk of locoregional disease as determined by imaging.

Materials And Methods: This biinstitutional retrospective study involved 89 patients (with 93 tumors) who had colon cancer and underwent presurgical CTC. Two radiologists reviewed the CTC studies for local staging, including measurement of the tumor beyond the muscularis propria on a true orthogonal plane. Histopathologic findings for surgical colectomy specimens served as the reference standard for local pathologic staging. The sensitivity, specificity, positive predictive value, and negative predictive value for local determination of the T category, N category, and extramural vascular invasion (EMVI) were calculated separately for each reader. High-risk T category tumors were the same as those as used in the FOxTROT trial. Interreader agreement was assessed using the kappa statistic.

Results: Thirty-five of 93 tumors (37.6%) were histologically classified as high-risk tumors (T3c, T3d, or T4 tumors). The interreader agreement was substantial (κ = 0.68) for classifying high-risk tumors with the use of CTC, moderate for differentiating N0 from N1 and N2 (κ = 0.44), and slight for detecting EMVI (κ = 0.15). The diagnostic statistics for CTC for the two readers were as follows: for detection of high-risk tumors, sensitivity was 65.7% and 82.9%, and specificity was 81.0% and 87.9%; for detection of N category-positive disease, sensitivity was 50.9% and 69.8%, and specificity was 50.0% and 72.5%; and for detection of EMVI, sensitivity was 18.2% and 66.7%, and specificity was 60.0% and 91.7%.

Conclusion: The present study shows that CTC might be a feasible imaging modality for preoperative local staging of higher-risk colon cancers for which neoadjuvant chemotherapy is more suitable on the basis of the FOxTROT trial criteria. However, further studies are required to allow a better generalization of our results.
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http://dx.doi.org/10.2214/AJR.18.19928DOI Listing
January 2019

Pelvic MRI after induction chemotherapy and before long-course chemoradiation therapy for rectal cancer: What are the imaging findings?

Eur Radiol 2019 Apr 2;29(4):1733-1742. Epub 2018 Oct 2.

Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Objectives: To determine the appearance of rectal cancer on MRI after oxaliplatin-based chemotherapy (ICT) and make a preliminary assessment of MRI's value in predicting response to total neoadjuvant treatment (TNT).

Methods: In this IRB-approved, HIPAA-compliant, retrospective study between 1 January 2010-20 October 2014, pre- and post-ICT tumour T2 volume, relative T2 signal intensity (rT2SI), node size, signal intensity and border characteristics were assessed in 63 patients (65 tumours) by three readers. The strength of association between the reference standard of histopathological percent tumour response and tumour volume change, rT2SI and lymph node characteristics was assessed with Spearman's correlation coefficient and Wilcoxon's rank sum test. Cox regression was used to assess association between DFS and radiological measures.

Results: Change in T2 volume was not associated with TNT response. Change in rT2SI showed correlation with TNT response for one reader only using selective regions of interest (ROIs) and borderline correlation with response using total volume ROI. There was a significant negative correlation between baseline and post-ICT node size and TNT response (r = -0.25, p = 0.05; r = -0.35, p = 0.005, readers 1 and 2, respectively). Both baseline and post-induction median node sizes were significantly smaller in complete responders (p = 0.03, 0.001; readers 1 and 2, respectively). Change in largest baseline node size and decrease in post-ICT node signal heterogeneity were associated with 100% tumour response (p = 0.04). Nodal sizes at baseline and post-ICT MRI correlated with DFS.

Conclusion: In patients undergoing post-ICT MRI, tumour volume did not correlate with TNT response, but decreased lymph node sizes were significantly associated with complete response to TNT as well as DFS. Relative T2SI showed borderline correlation with TNT response.

Key Points: • MRI-based tumour volume after induction chemotherapy and before chemoradiotherapy did not correlate with overall tumour response at the end of all treatment. • Lymph node size after induction chemotherapy and before chemoradiotherapy was strongly associated with complete pathological response after all treatment. • Lymph node sizes at baseline and post-induction chemotherapy MRI correlated with disease-free survival.
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http://dx.doi.org/10.1007/s00330-018-5726-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420840PMC
April 2019

Value of adding dynamic contrast-enhanced MRI visual assessment to conventional MRI and clinical assessment in the diagnosis of complete tumour response to chemoradiotherapy for rectal cancer.

Eur Radiol 2019 Mar 21;29(3):1104-1113. Epub 2018 Sep 21.

Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.

Purpose: To determine if DCE-MRI adds diagnostic value to the combined use of T2WI and DWI-MRI in the determination of clinical complete response (cCR) after neoadjuvant treatment (NAT) in patients with locally advanced rectal cancer.

Methods And Materials: In this IRB-approved, HIPAA-compliant retrospective study, response was assessed using a 5-point confidence score by T2WI and DWI-MRI only ('standard MRI'), then with addition of DCE-MRI. Review of digital rectal exams and endoscopy notes produced a clinical overall response score. The reference standard was CR by histopathology or cCR determined after a minimum of 18 months' follow-up. Diagnostic accuracy and ROC curves were calculated for standard MRI and added DCE-MRI (to detect complete or good response), for clinical evaluation (to detect CR) and for MRI and clinical methods combined.

Results: Of 65 patients undergoing NAT, 20 had cCR (31%). Sensitivity, specificity and area under the ROC (AUC) were 0.55, 0.87 and 0.69 for clinical evaluation; 0.42, 0.77 and 0.66 for standard MRI, and 0.53, 0.76 and 0.68 for added DCE-MRI, respectively. Combined clinical evaluation and standard MRI with DCE-MRI resulted in the highest specificity of 0.96 and highest AUC of 0.72.

Conclusion: For the assessment of cCR after neoadjuvant therapy using clinical and multi-sequence MRI reading strategies, the addition of DCE-MRI increased specificity and PPV, but not significantly.

Key Points: • The addition of dynamic contrast-enhanced MRI to standard MRI, including DWI-MRI, may not significantly improve accuracy of response assessment in rectal cancer treatment. • Clinical assessment consisting of digital rectal examination and endoscopy is the most accurate standalone test to assess response to chemoradiotherapy in rectal cancer. • Combining MRI using DWI and DCE with the clinical assessment may potentially improve the accuracy for response assessment in rectal cancer.
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http://dx.doi.org/10.1007/s00330-018-5719-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358522PMC
March 2019

Atypical Colonic Polyp.

Gastroenterology 2019 01 7;156(1):31-33. Epub 2018 Sep 7.

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.

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http://dx.doi.org/10.1053/j.gastro.2018.08.047DOI Listing
January 2019

MR Imaging of Rectal Cancer.

Radiol Clin North Am 2018 Sep 11;56(5):751-774. Epub 2018 Jul 11.

Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Electronic address:

This article aims to review current concepts in the management of patients with rectal cancer, including the most common surgical techniques, anatomic landmarks with MR imaging correlation, and the role of each imaging modality in local staging, focusing on MR imaging technique and its importance in primary staging, restaging, and local recurrence.
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http://dx.doi.org/10.1016/j.rcl.2018.04.004DOI Listing
September 2018

Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017.

Abdom Radiol (NY) 2018 11;43(11):2893-2902

Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.

Purpose: To propose guidelines based on an expert-panel-derived unified approach to the technical performance, interpretation, and reporting of MRI for baseline and post-treatment staging of rectal carcinoma.

Methods: A consensus-based questionnaire adopted with permission and modified from the European Society of Gastrointestinal and Abdominal Radiologists was sent to a 17-member expert panel from the Rectal Cancer Disease-Focused Panel of the Society of Abdominal Radiology containing 268 question parts. Consensus on an answer was defined as ≥ 70% agreement. Answers not reaching consensus (< 70%) were noted.

Results: Consensus was reached for 87% of items from which recommendations regarding patient preparation, technical performance, pulse sequence acquisition, and criteria for MRI assessment at initial staging and restaging exams and for MRI reporting were constructed.

Conclusion: These expert consensus recommendations can be used as guidelines for primary and post-treatment staging of rectal cancer using MRI.
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http://dx.doi.org/10.1007/s00261-018-1642-9DOI Listing
November 2018

Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer.

JAMA Oncol 2018 06 14;4(6):e180071. Epub 2018 Jun 14.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.

Importance: Treatment of locally advanced rectal (LARC) cancer involves chemoradiation, surgery, and chemotherapy. The concept of total neoadjuvant therapy (TNT), in which chemoradiation and chemotherapy are administered prior to surgery, has been developed to optimize delivery of effective systemic therapy aimed at micrometastases.

Objective: To compare the traditional approach of preoperative chemoradiation (chemoRT) followed by postoperative adjuvant chemotherapy with the more recent TNT approach for LARC.

Design, Setting, And Participants: A retrospective cohort analysis using Memorial Sloan Kettering Cancer Center (MSK) records from 2009 to 2015 was carried out. A total of 811 patients who presented with LARC (T3/4 or node-positive) were identified.

Exposures: Of the 811 patients, 320 received chemoRT with planned adjuvant chemotherapy and 308 received TNT (induction fluorouracil- and oxaliplatin-based chemotherapy followed by chemoRT).

Main Outcomes And Measures: Treatment and outcome data for the 2 cohorts were compared. Dosing and completion of prescribed chemotherapy were assessed on the subset of patients who received all therapy at MSK.

Results: Of the 628 patients overall, 373 (59%) were men and 255 (41%) were women, with a mean (SD) age of 56.7 (12.9) years. Of the 308 patients in the TNT cohort, 181 (49%) were men and 127 (49%) were women. Of the 320 patients in the chemoRT with planned adjuvant chemotherapy cohort, 192 (60%) were men and 128 (40%) were women. Patients in the TNT cohort received greater percentages of the planned oxaliplatin and fluorouracil prescribed dose than those in the chemoRT with planned adjuvant chemotherapy cohort. The complete response (CR) rate, including both pathologic CR (pCR) in those who underwent surgery and sustained clinical CR (cCR) for at least 12 months posttreatment in those who did not undergo surgery, was 36% in the TNT cohort compared with 21% in the chemoRT with planned adjuvant chemotherapy cohort.

Conclusions And Relevance: Our findings provide additional support for the National Comprehensive Cancer Network (NCCN) guidelines that categorize TNT as a viable treatment strategy for rectal cancer. Our data suggest that TNT facilitates delivery of planned systemic therapy. Long-term follow-up will determine if this finding translates into improved survival. In addition, given its high CR rate, TNT may facilitate nonoperative treatment strategies aimed at organ preservation.
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http://dx.doi.org/10.1001/jamaoncol.2018.0071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885165PMC
June 2018

MR Imaging of Rectal Cancer: Radiomics Analysis to Assess Treatment Response after Neoadjuvant Therapy.

Radiology 2018 06 7;287(3):833-843. Epub 2018 Mar 7.

From the Departments of Radiology (N.H., M.K., I.B., E.S., M.J.G., I.P.), Medical Physics (H.V.), Epidemiology and Biostatistics (J.Z., M.C.), and Surgery (J.G.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY 10065.

Purpose To investigate the value of T2-weighted-based radiomics compared with qualitative assessment at T2-weighted imaging and diffusion-weighted (DW) imaging for diagnosis of clinical complete response in patients with rectal cancer after neoadjuvant chemotherapy-radiation therapy (CRT). Materials and Methods This retrospective study included 114 patients with rectal cancer who underwent magnetic resonance (MR) imaging after CRT between March 2012 and February 2016. Median age among women (47 of 114, 41%) was 55.9 years (interquartile range, 45.4-66.7 years) and median age among men (67 of 114, 59%) was 55 years (interquartile range, 48-67 years). Surgical histopathologic analysis was the reference standard for pathologic complete response (pCR). For qualitative assessment, two radiologists reached a consensus. For radiomics, one radiologist segmented the volume of interest on high-spatial-resolution T2-weighted images. A random forest classifier was trained to separate the patients by their outcomes after balancing the number of patients in each response category by using the synthetic minority oversampling technique. Statistical analysis was performed by using the Wilcoxon rank-sum test, McNemar test, and Benjamini-Hochberg method. Results Twenty-one of 114 patients (18%) achieved pCR. The radiomic classifier demonstrated an area under the curve of 0.93 (95% confidence interval [CI]: 0.87, 0.96), sensitivity of 100% (95% CI: 0.84, 1), specificity of 91% (95% CI: 0.84, 0.96), positive predictive value of 72% (95% CI: 0.53, 0.87), and negative predictive value of 100% (95% CI: 0.96, 1). The diagnostic performance of radiomics was significantly higher than was qualitative assessment at T2-weighted imaging or DW imaging alone (P < .02). The specificity and positive predictive values were significantly higher in radiomics than were at combined T2-weighted and DW imaging (P < .0001). Conclusion T2-weighted-based radiomics showed better classification performance compared with qualitative assessment at T2-weighted and DW imaging for diagnosing pCR in patients with locally advanced rectal cancer after CRT. RSNA, 2018 Online supplemental material is available for this article.
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http://dx.doi.org/10.1148/radiol.2018172300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978457PMC
June 2018

Gadolinium-Based Contrast Agent During Pelvic MRI: Contribution to Patient Management in Rectal Cancer.

Dis Colon Rectum 2018 Feb;61(2):193-201

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.

Background: Few publications exist regarding gadolinium-enhanced sequences in rectal MRI. None have evaluated its potential impact on patient management.

Objective: This study aimed to assess whether gadolinium-enhanced sequences, including dynamic contrast enhancement, change radiologic interpretation and clinical management of rectal cancer.

Design: This is a retrospective analysis of 100 rectal MRIs (50 baseline and 50 postneoadjuvant treatment), both without and with gadolinium-enhanced sequences. Treatment plans were rendered based on each radiologic interpretation for each case by a single experienced surgeon. Differences in radiologic interpretation and management were statistically analyzed.

Settings: The study was conducted at the Memorial Sloan Kettering Cancer Center.

Patients: Patients undergoing rectal MRI between 2011 and 2015 for baseline tumor staging and/or postneoadjuvant restaging were included.

Main Outcome Measures: Primary outcome measures were changes in radiologic tumor stage, tumor margins, and surgical planning with the use of gadolinium at baseline and postneoadjuvant time points.

Results: At baseline, tumor downstaging occurred in 8 (16%) of 50 and upstaging in 4 (8%) of 50 with gadolinium. Postneoadjuvant treatment, upstaging occurred in 1 (2%) of 50 from T2 to T3a. At baseline, mean distances from tumor to anorectal ring, anal verge, and mesorectal fascia were not statistically different with gadolinium. However, in 7 patients, differences could have resulted in treatment changes, accounted for by changes in relationships to anterior peritoneal reflection (n = 4), anorectal ring (n = 2), or anal verge (n = 1). Postneoadjuvant treatment, distances to anorectal ring and anal verge (in centimeters) were statistically smaller with gadolinium (p = 0.0017 and p = 0.0151) but could not have resulted in clinically significant treatment changes.

Limitations: This study was limited by its retrospective design.

Conclusions: The use of gadolinium at baseline MRI could have altered treatment in 24% of patients because of differences in tumor stage or position. Postneoadjuvant treatment, gadolinium resulted in statistically smaller distances to sphincters, which could influence surgical decision for sphincter-preserving rectal resection. See Video Abstract at http://links.lww.com/DCR/A444.
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http://dx.doi.org/10.1097/DCR.0000000000000925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772900PMC
February 2018

Correction to: Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting.

Eur Radiol 2018 06;28(6):2711

Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.

The article Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting, written by [§§§ AuthorNames §§§].
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http://dx.doi.org/10.1007/s00330-017-5204-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6828070PMC
June 2018

Clinical Value of CT Colonography Versus Preoperative Colonoscopy in the Surgical Management of Occlusive Colorectal Cancer.

AJR Am J Roentgenol 2018 Feb 20;210(2):333-340. Epub 2017 Dec 20.

1 Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.

Objective: CT colonography (CTC) has been recognized as a complementary approach to evaluating the entire colon after incomplete colonoscopy (IC) in patients with occlusive colorectal cancer (CRC). The objective of this study is to evaluate changes in preoperative surgical planning after CTC is performed for patients with occlusive CRC and IC in an oncologic hospital.

Materials And Methods: This retrospective study included 65 consecutive patients with occlusive CRC who underwent CTC after IC at our institution from February 2000 to April 2016. CTC examinations and radiology reports were reviewed by an abdominal radiologist. Clinical information was obtained from a review of the electronic medical record.

Results: CTC contributed to a change in the initial surgical plan of the surgeon for 14 of 65 patients (21.5%). In these 14 patients, CTC detected five synchronous proximal colon polyps (35.7%), five synchronous proximal cancers (35.7%), two imprecise CRC locations (14.3%), one case of proximal colon ischemia (7.1%), and one instance of tumor infiltration of the urinary bladder (7.1%). All CTC findings were confirmed at surgery, and all proximal colon polyps were subsequently confirmed to be advanced adenomas.

Conclusion: The preoperative CTC findings optimized the surgical management plan for 21.5% of patients with occlusive CRC and IC.
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http://dx.doi.org/10.2214/AJR.17.18144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473453PMC
February 2018

Computed Tomography Colonography vs Colonoscopy for Colorectal Cancer Surveillance After Surgery.

Gastroenterology 2018 03 22;154(4):927-934.e4. Epub 2017 Nov 22.

Fox Chase Cancer Center, Philadelphia, Pennsylvania.

Background & Aims: Recommendations for surveillance after curative surgery for colorectal cancer (CRC) include a 1-year post-resection abdominal-pelvic computed tomography (CT) scan and optical colonoscopy (OC). CT colonography (CTC), when used in CRC screening, effectively identifies colorectal polyps ≥10 mm and cancers. We performed a prospective study to determine whether CTC, concurrent with CT, could substitute for OC in CRC surveillance.

Methods: Our study enrolled 231 patients with resected stage 0-III CRC, identified at 5 tertiary care academic centers. Approximately 1 year after surgery, participants underwent outpatient CTC plus CT, followed by same-day OC. CTC results were revealed after endoscopic visualization of sequential colonic segments, which were re-examined for discordant findings. The primary outcome was performance of CTC in the detection of colorectal adenomas and cancers using endoscopy as the reference standard.

Results: Of the 231 participants, 116 (50.2%) had polyps of any size or histology identified by OC, and 15.6% had conventional adenomas and/or serrated polyps ≥6 mm. No intra-luminal cancers were detected. CTC detected patients with polyps of ≥6 mm with 44.0% sensitivity (95% CI, 30.2-57.8) and 93.4% specificity (95% CI, 89.7-97.0). CTC detected polyps ≥10 mm with 76.9% sensitivity (95% CI, 54.0-99.8) and 89.0% specificity (95% CI, 84.8-93.1). Similar values were found when only adenomatous polyps were considered. The negative predictive value of CTC for adenomas ≥6 mm was 90.7% (95% CI, 86.7-94.5) and for adenomas ≥10 mm the negative predictive value was 98.6% (95% CI, 97.0-100).

Conclusions: In a CRC surveillance population 1 year following resection, CTC was inferior to OC for detecting patients with polyps ≥6 mm. Clinical Trials.gov Registration Number: NCT02143115.
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http://dx.doi.org/10.1053/j.gastro.2017.11.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847443PMC
March 2018