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Gadolinium-Based Contrast Agent During Pelvic MRI

Contribution to Patient Management in Rectal Cancer

Corines, Marina J. B.A.1; Nougaret, Stephanie M.D., Ph.D.1,2; Weiser, Martin R. M.D.3; Khan, Monika M.P.H.1; Gollub, Marc J. M.D.1,4

doi: 10.1097/DCR.0000000000000925
Original Contributions: Colorectal Cancer
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BACKGROUND: Few publications exist regarding gadolinium-enhanced sequences in rectal MRI. None have evaluated its potential impact on patient management.

OBJECTIVE: This study aimed to assess whether gadolinium-enhanced sequences, including dynamic contrast enhancement, change radiologic interpretation and clinical management of rectal cancer.

DESIGN: This is a retrospective analysis of 100 rectal MRIs (50 baseline and 50 postneoadjuvant treatment), both without and with gadolinium-enhanced sequences. Treatment plans were rendered based on each radiologic interpretation for each case by a single experienced surgeon. Differences in radiologic interpretation and management were statistically analyzed.

SETTINGS: The study was conducted at the Memorial Sloan Kettering Cancer Center.

PATIENTS: Patients undergoing rectal MRI between 2011 and 2015 for baseline tumor staging and/or postneoadjuvant restaging were included.

MAIN OUTCOME MEASURES: Primary outcome measures were changes in radiologic tumor stage, tumor margins, and surgical planning with the use of gadolinium at baseline and postneoadjuvant time points.

RESULTS: At baseline, tumor downstaging occurred in 8 (16%) of 50 and upstaging in 4 (8%) of 50 with gadolinium. Postneoadjuvant treatment, upstaging occurred in 1 (2%) of 50 from T2 to T3a. At baseline, mean distances from tumor to anorectal ring, anal verge, and mesorectal fascia were not statistically different with gadolinium. However, in 7 patients, differences could have resulted in treatment changes, accounted for by changes in relationships to anterior peritoneal reflection (n = 4), anorectal ring (n = 2), or anal verge (n = 1). Postneoadjuvant treatment, distances to anorectal ring and anal verge (in centimeters) were statistically smaller with gadolinium (p = 0.0017 and p = 0.0151) but could not have resulted in clinically significant treatment changes.

LIMITATIONS: This study was limited by its retrospective design.

CONCLUSIONS: The use of gadolinium at baseline MRI could have altered treatment in 24% of patients because of differences in tumor stage or position. Postneoadjuvant treatment, gadolinium resulted in statistically smaller distances to sphincters, which could influence surgical decision for sphincter-preserving rectal resection. See Video Abstract at http://links.lww.com/DCR/A444.

1 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York

2 Department of Radiology, Institut du Cancer de Montpellier, Montpellier, France

3 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York

4 Department of Radiology, Weill-Cornell Medical College, New York, New York

Funding/Support: This work was supported by the National Cancer Institute, National Institutes of Health, award No. R25CA020449.

Financial Disclosure: None reported.

Presented at the European Society of Gastrointestinal and Abdominal Radiology Conference, Prague, Czech Republic, June 14 to 17, 2016.

Correspondence: Marc J. Gollub, M.D., 1275 York Ave, Box 29, New York, NY 10065. E-mail: gollubm@mskcc.org

© 2018 The American Society of Colon and Rectal Surgeons