MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy

Akitoshi Inoue, Shannon Sheedy, Jay P. Heiken, Payam Mohammadinejad, Rondell P. Graham, Hee Eun Lee, Scott R. Kelley, Stephanie L. Hansel, David H. Bruining, Jeff Lynn Fidler, Joel G. Fletcher

Research output: Contribution to journalReview articlepeer-review

Abstract

MRI is routinely used for rectal cancer staging to evaluate tumor extent and to inform decision-making regarding surgical planning and the need for neoadjuvant and adjuvant therapy. Extramural venous invasion (EMVI), which is intravenous tumor extension beyond the rectal wall on histopathology, is a predictor for worse prognosis. T2-weighted images (T2WI) demonstrate EMVI as a nodular-, bead-, or worm-shaped structure of intermediate T2 signal with irregular margins that arises from the primary tumor. Correlative diffusion-weighted images demonstrate intermediate to high signal corresponding to EMVI, and contrast enhanced T1-weighted images demonstrate tumor signal intensity in or around vessels. Diffusion-weighted and post contrast images may increase diagnostic performance but decrease inter-observer agreement. CT may also demonstrate obvious EMVI and is potentially useful in patients with a contraindication for MRI. This article aims to review the spectrum of imaging findings of EMVI of rectal cancer on MRI and CT, to summarize the diagnostic accuracy and inter-observer agreement of imaging modalities for its presence, to review other rectal neoplasms that may cause EMVI, and to discuss the clinical significance and role of MRI-detected EMVI in staging and restaging clinical scenarios.

Original languageEnglish (US)
Article number110
JournalInsights into Imaging
Volume12
Issue number1
DOIs
StatePublished - Dec 2021

Keywords

  • Disease-free survival
  • Extramural venous invasion
  • Magnetic resonance imaging
  • Prognosis
  • Rectal Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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