MRI Diagnostic Accuracy In The Detection Of Emvi, In Carcinoma Rectum Using Histopathology As The Gold Standard

Original Article

Abstract

Background: Extramural Venous Invasion [EMVI] is the intravenous tumour extension beyond the rectal wall in patients with rectal cancer. Being a predictor of a worse prognosis, detection of EMVI is important to decide on treatment options.  

Objective: To determine the diagnostic accuracy of preoperative MRI in detecting extramural vascular invasion in patients with rectal cancer, taking histopathology as the gold standard.

Study design: A Retrospective observational diagnostic accuracy study.

Place and duration of study: department of radiology in Kuwait Teaching Hospital Peshawar for from 05-Feb-2020 to  05-March 2021

 Materials & Methods: The study included 118 patients who did an MRI in Kuwait Teaching Hospital Peshawar for Rectal carcinoma from Feb 2020 to March 2021. Patients were examined with a 0.3 Tesla MRI machine using MRI sequences T2WI, T1WI, FLAIR and DWI. Post-op specimens were sent in formalin for histopathological assessment. Data, including MRI features and Histopathological findings, were assessed with SPSS version 24.

 Results: Our study included 118 rectal cancer patients, 55.1% (85) male and 44.9% (70) female. 31- 100 in 10-year increases. 31-50 and 41-50 had four instances (3.4%). Twenty (16.9%) patients were between 51 and 60, 22 (18.6%) were between 61 and 70, 35 (29.7%) were between 71 and 80, 11

(9.3%) Between 81 and 90, and 22 (18.6%) were between 91 and 100. MRI results found 57

EMVI-positive and 61 negative individuals. 45 (38.1%) patients had EMVI, whereas 73 (61.9%) did not. Cross-tabulation was utilized to analyze MRI's sensitivity, specificity, PPV, and NPV in diagnosing EMVI. MRI was 83.3% sensitive, 69% specific, 60% positive predictive, and 88.3% negative predictive. EMVI correlates with neoplastic mass.

Conclusion: Diagnostic accuracy, including sensitivity, specificity, positive predictive value, and negative predictive value, is high using MRI to identify EMVI in rectal cancer.

Keywords: Carcinoma Rectum, Extramural Venous Invasion, MRI, Mesorectal Fascia.