Preoperative 3T MR imaging of rectal cancer: local staging accuracy using a two-dimensional and three-dimensional T2-weighted turbo spin echo sequence

PURPOSE: The purpose of our study was to evaluate the image quality and diagnostic performance of two-dimensional (D) turbo spin echo (TSE) and 3D T2-weighted TSE MR imaging in local staging of rectal cancer at 3T. MATERIALS AND METHODS: 3T phased-array MR imaging was performed in 36 consecutive patients with biopsy-proven rectal cancer. High-resolution 2D TSE images in three planes and 3D TSE images of the rectum were obtained. Two independent observers performed an image quality assessment using eight image quality characteristics. All 2D and 3D datasets were evaluated separately. MR images were prospectively evaluated by two experienced radiologists in consensus with regard to local disease. Total mesorectal excision was used as the standard of reference. The sensitivity, specificity, positive and negative predictive value, and overall accuracy were calculated. Areas under the receiver operating characteristic (ROC) curve (AUC) were determined. RESULTS: Twenty-two patients who underwent a total mesorectal excision were enrolled in this study. Significantly more motion artifacts were present with 3D TSE imaging (P=0.04). The overall sensitivity, specificity, and accuracy of muscularis propria invasion in rectal cancer using 2D T2-weighted images were 100%, 66%, and 95%, respectively. There was a statistical significant greater AUC using 2D T2-weighted images compared to 3D T2-weighted MR images (P=0.04). The ROC curves describing the results of the interpretation of 2D and 3D T2-weighted datasets regarding perirectal tissue invasion showed no statistical significant difference (P=0.41). CONCLUSIONS: In this study, high local staging accuracies with 3T 2D T2-weighted MR imaging were demonstrated. 3D T2-weighted MR imaging cannot replace 2D MR imaging for local staging of rectal cancer. However, 3D MR imaging can be used for visualization of the complex pelvic anatomy for treatment planning purposes.