The Role of Predictive and Prognostic MRI-Based Biomarkers in the Era of Total Neoadjuvant Treatment in Rectal Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Conventional MRI
2.1. Tumour Extent beyond Muscularis Propria
2.2. Circumferential Resection Margin (CRM)
2.3. Extramural Venous Invasion (EMVI)
2.4. Tumour Deposits (N1c)
2.5. Lymph Nodes
2.6. Mucinous Tumours
2.7. MRI Tumour Regression Grade (mrTRG)
3. Functional MRI
3.1. Diffusion Weighted Imaging (DWI)
3.2. Dynamic Contrast Enhancement (DCE-MRI)
4. Radiomics and Artificial Intelligence (AI)
5. The Emerging Role of MRI in ‘Watch-And-Wait’ Strategies
6. Future Directions
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Reference | Year | Assessed Feature | Main Outcome |
---|---|---|---|
Hamabe et al. [173] | 2024 | Tumour segmentation | Optimal MRI imaging conditions can improve the accuracy of mrAI tumour delineation, enabling it to provide feedback to radiologists without overestimating tumour stage. |
Wei et al. [176] | 2024 | T-staging MRF status | The multiparametric deep-learning model has the potential to aid clinicians by offering more accurate and reliable preoperative T staging diagnoses. |
Liang et al. [151] | 2024 | EMVI detection | MRI-based radiomic models have strong diagnostic value in detecting EMVI in rectal cancer patients. Further prospective, high-quality studies with larger sample sizes are needed to validate these findings. |
Sun et al. [174] | 2024 | Tumour deposits | Combining rad-score (T2WI + ADC) with clinical factors may serve as a tool to predict the presence of tumour deposits (TDs) in rectal cancer patients. |
Abbaspour et al. [175] | 2024 | Positive lymph nodes | Artificial intelligence-based radiomics demonstrates promising results in preoperative lymph node staging for colorectal cancer, with significant predictive performance. |
Miranda et al. [172] | 2023 | mrTRG | MRI-based rad-score has comparable diagnostic performance to ymrTRG |
Li et al. [177] | 2024 | pCR | The review highlights that MRI-based radiomics holds great potential for predicting pathological complete responses to NAT in patients with locally advanced rectal cancer. |
MRI Feature | Main Point |
---|---|
T-staging | The maximum tumour extension beyond the muscularis propria should be staged as <1 mm (T3a), 1–5 mm (T3b), 5–15 mm (T3c) and >15 mm (T3d). |
mrCRM | Positive circumferential margin is defined as a distance of 1 mm or less between the tumour and the mesorectal fascia; the same criteria is applied for irregular lymph nodes. |
EMVI | Intermediate signal within the mesorectal vessels, with a loss of normal hypointense flow void; additional features include irregular contours and increased calibre of the mesorectal vessels; should be documented both pre- and post-treatment; |
Lymph nodes | Malignant lymph nodes criteria: short axis diameter ≥9 mm, 5–8 mm and ≥2 suspicious features, <5 mm and 3 suspicious features, all mucinous lymph nodes; morphologically suspicious features: round shape, irregular border, internal heterogenous signal; |
Tumour deposits (N1c) | Tumour deposits follow the course of a venous channel compared to lymph nodes which are usually isolated within the mesorectal fat |
Mucinous tumours | Mucin component is readily identified as high signal intensity on T2WI |
Tumour response assessment (mrTRG) | mrTRG1: complete response or no signs of residual tumour; mrTRG2: good response: >75% dense fibrosis, minimal, if any intermediate signal; mrTRG3: moderate response: >50% fibrosis and visible intermediate signal; mrTRG4: poor response: minimal fibrosis within intermediate signal; mrTRG5: no response: no fibrosis, unchanged original tumour; |
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Curcean, S.; Curcean, A.; Martin, D.; Fekete, Z.; Irimie, A.; Muntean, A.-S.; Caraiani, C. The Role of Predictive and Prognostic MRI-Based Biomarkers in the Era of Total Neoadjuvant Treatment in Rectal Cancer. Cancers 2024, 16, 3111. https://doi.org/10.3390/cancers16173111
Curcean S, Curcean A, Martin D, Fekete Z, Irimie A, Muntean A-S, Caraiani C. The Role of Predictive and Prognostic MRI-Based Biomarkers in the Era of Total Neoadjuvant Treatment in Rectal Cancer. Cancers. 2024; 16(17):3111. https://doi.org/10.3390/cancers16173111
Chicago/Turabian StyleCurcean, Sebastian, Andra Curcean, Daniela Martin, Zsolt Fekete, Alexandru Irimie, Alina-Simona Muntean, and Cosmin Caraiani. 2024. "The Role of Predictive and Prognostic MRI-Based Biomarkers in the Era of Total Neoadjuvant Treatment in Rectal Cancer" Cancers 16, no. 17: 3111. https://doi.org/10.3390/cancers16173111