Evaluation of Mesorectal Microcirculation With Quantitative Dynamic Contrast-Enhanced MRI.

Abstract

<b>OBJECTIVE.</b> The purpose of this study was to use quantitative dynamic contrast-enhanced MRI (DCE-MRI) to evaluate mesorectal microcirculation in patients with rectal cancer. <b>MATERIALS AND METHODS.</b> A total of 53 patients with semicircular rectal tumors underwent DCE-MRI with a 3-T MRI system before surgery. ROIs were manually delineated in the mesorectum that surrounded the tumor and the mesorectum that surrounded the normal rectal wall. DCE-MRI parameters including forward volume transfer constant (K^trans), reverse volume transfer constant (k_ep), and fractional extravascular extracellular space volume (V_e) were estimated using computer software. Histopathologic analysis served as the standard reference. <b>RESULTS.</b> Mesorectum that surrounded the tumor showed significantly higher K^trans val ues than mesorectum that surrounded normal rectal wall (mean, 0.069 ± 0.035 [SD] vs 0.039 ± 0.020 min^-1; <i>p</i> < 0.001). The tumor-surrounding mesorectum also showed higher V_e values than normal mesorectum (<i>p</i> < 0.001). An opposite trend was observed for k_ep, but this was not significant (<i>p</i> = 0.077). A lower K^trans of the tumor-surrounding mesorectum was observed in patients with malignant lymph nodes compared with those with benign lymph nodes (mean, 0.054 ± 0.027 vs 0.076 ± 0.036 min^-1; <i>p</i> = 0.034). Although k_ep values for the tumor-surrounding mesorectum were higher in patients with tumors categorized as pathologic Tis (pTis) to pT2 than in those with pT3 tumors, the <i>p</i> value was close to 0.05 (<i>p</i> = 0.047). The tumor-surrounding mesorectum showed no significant differences in the aforementioned parameters between patients with positive MRI-detected extramural vascular invasion (mrEMVI) and those with negative mrEMVI. <b>CONCLUSION.</b> Mesorectum that surrounded rectal tumor had a higher blood flow than that close to the normal rectal wall. The blood flow decreased in the tumor-surrounding mesorectum when there was nodal involvement.