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14.07.2023 | Hollow Organ GI

MRI in rectal cancer patients on ‘watch and wait’: patterns of response and their evolution

verfasst von: Aashna Karbhari, Akshay D Baheti, Suman K Ankathi, Purvi D Haria, Amit Choudhari, Aparna Katdare, Amrita Guha, Suyash Kulkarni, Avnish Saklani, Reena Engineer, Mufaddal Kazi, Vikas Ostwal

Erschienen in: Abdominal Radiology | Ausgabe 11/2023

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Abstract

Purpose

Evaluate MR patterns of response and their evolution in rectal cancer patients on watch and wait (WW).

Methods

We retrospectively reviewed 337 MRIs of 60 patients (median follow-up: 12 months; range: 6–49 months). Baseline MRIs (available in 34/60 patients) were evaluated for tumor morphology, location, thickness, circumferential involvement, nodal status and EMVI. First post-treatment MRIs (in all patients) were additionally evaluated for pattern of response on T2 and DWI. Change in post-treatment scar thickness and scar depth angle between the first and second post-treatment scans was also evaluated. Evolution of the response pattern/recurrence were evaluated till the last available scan.

Results

On the baseline scans, 20/34 (59%) patients had polypoidal tumor with 12/20 having ≤ 25% circumferential wall involvement. We saw five patterns of response-normalized rectal wall (2/60–3%), minimal fibrosis (23/60–38%), full thickness fibrosis (16/60–27%), irregular fibrosis (11/60–18%) and split scar (6/60–10%), with 2/60 (3%) showing possible residual disease. On the first post-treatment scans, 12/60 (20%) had restricted diffusion, with 3/12 having persistent restriction till last follow-up. Post-treatment fibrosis/split scar remained stable in 44/60 (73%) cases and improved further in the rest. 9/60 (15%) patients developed regrowth/recurrence. Patients with recurrence had < 10 mm scar thickness and < 21° change in scar angle between the first and second post-treatment MRIs.

Conclusion

Most patients on WW protocol developed minimal or full thickness fibrosis, majority of which remained stable on follow-up.

Graphical abstract

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Titel: MRI in rectal cancer patients on ‘watch and wait’: patterns of response and their evolution
verfasst von: Aashna Karbhari
Akshay D Baheti
Suman K Ankathi
Purvi D Haria
Amit Choudhari
Aparna Katdare
Amrita Guha
Suyash Kulkarni
Avnish Saklani
Reena Engineer
Mufaddal Kazi
Vikas Ostwal
Publikationsdatum: 14.07.2023
Verlag: Springer US
Erschienen in: Abdominal Radiology / Ausgabe 11/2023
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-023-04003-y

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MRI in rectal cancer patients on ‘watch and wait’: patterns of response and their evolution