Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Diagnostic Performance of Rectal CT for Staging Rectal Cancer: Comparison with Rectal MRI and Histopathology

직장암 병기결정에서 직장 CT의 진단능: 직장 MRI 및 병리결과와의 비교분석

  • Seok Yoon Son (Seoul National University College of Medicine) ;
  • Yun Seok Seo (Department of Radiology, Seoul National University Hospital) ;
  • Jeong Hee Yoon (Department of Radiology, Seoul National University Hospital) ;
  • Bo Yun Hur (Department of Radiology, Healthcare System Gangnam Center, Seoul National University Hospital) ;
  • Jae Seok Bae (Department of Radiology, Seoul National University Hospital) ;
  • Se Hyung Kim (Department of Radiology, Seoul National University Hospital)
  • 손석윤 (서울대학교 의과대학) ;
  • 서윤석 (서울대학교병원 영상의학과) ;
  • 윤정희 (서울대학교병원 영상의학과) ;
  • 허보윤 (서울대학교병원 강남센터 영상의학과) ;
  • 배재석 (서울대학교병원 영상의학과) ;
  • 김세형 (서울대학교병원 영상의학과)
  • Received : 2022.10.17
  • Accepted : 2023.03.10
  • Published : 2023.11.01
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Abstract

Purpose To compare the diagnostic performance of rectal CT with that of high-resolution rectal MRI and histopathology in assessing rectal cancer. Materials and Methods Sixty-seven patients with rectal cancer who underwent rectal CT with rectal distension using sonographic gel and high-resolution MRI were enrolled in this study. The distance from the anal verge/anorectal junction, distance to the mesorectal fascia (MRF), extramural depth (EMD), extramesorectal lymph node (LN) involvement, extramural venous invasion (EMVI), and T/N stages in rectal CT/MRI were analyzed by two gastrointestinal radiologists. The CT findings of 20 patients who underwent radical surgery without concurrent chemoradiotherapy were compared using histopathology. Interclass correlations and kappa statistics were used. Results The distance from the anal verge/anorectal junction showed an excellent intraclass correlation between CT and MRI for both reviewers. For EMD, the distance to the MRF, presence of LNs, extramesorectal LN metastasis, EMVI, T stage, and intermodality kappa or weighted kappa values between CT and MRI showed excellent agreement. Among the 20 patients who underwent radical surgery, T staging, circumferential resection margin involvement, EMVI, and LN metastasis on rectal CT showed acceptable concordance rates with histopathology. Conclusion Dedicated rectal CT may be on par with rectal MRI in providing critical information to patients with rectal cancer.

목적 직장암 병기결정에서 직장 CT의 진단능을 고해상도 직장 MRI 및 병리결과와 비교분석 하였다. 대상과 방법 초음파 젤을 이용하여 직장을 팽창시킨 후 얻은 직장 CT와 고해상도 직장 MRI를 촬영한 66명의 직장암 환자가 포함되었다. 두 명의 위장관 영상의학과 의사가 직장 CT와 MRI에서 항문피부선/항문직장경계까지의 거리, 직장간막근막까지의 거리, 벽외침범 깊이, 직장간막외 림프절 침범, 벽외정맥침범, 및 T/N 병기를 평가하였다. 동시화학방사선요법을 시행 받지 않고 근치적 수술을 시행한 20명의 환자의 CT 소견을 병리결과와 비교하였다. 급내상관분석 및 카파 분석을 이용하여 통계 분석하였다. 결과 항문피부선/항문직장경계까지의 거리 측정에서 두 명의 영상의학과 의사 모두 CT와 MRI 간에 높은 상관관계를 보였다. 벽외침범 깊이, 직장간막근막까지의 거리, 림프절의 유무, 직장간막외 림프절 침범, 벽외정맥침범, T 병기 결정에서 CT와 MRI 간의 높은 일치도를 보였다. 수술을 시행받은 20명의 환자에서 T 병기, 측방절제연 침범, 벽외정맥침범, 림프절 전이 결정에서 CT는 병리결과와 만족할만한 일치율을 보였다. 결론 직장암 전용 CT는 직장암 환자의 병기 결정에 중요한 정보를 제공하며, 진단능은 고해상도 직장 MRI와 유사하다.

Keywords

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2021R1F1A1046393) and from the Seoul National University Hospital Research Fund No. 04-2020-2010.

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