Diagnostic accuracy of rectal tumor staging MRI in evaluating extramural vascular invasion

Khalid Khan, Noor Shamlooh, Shaima Shousha, Nawal Al Hamar, Tejal Shamik Shah



To determine the diagnostic accuracy of baseline pre-operative MRI in detecting extramural vascular invasion in rectal tumors compared with histopathological reference standard.


Materials and Methods:

Patients presenting with rectal carcinoma at Salmaniya Medical Complex, Bahrain between 1st January 2017 and 31st December 2019 were retrospectively reviewed for the presence of extramural vascular invasion (EMVI) detected on pre-operative staging MRI and a 5-point EMVI score (0-4) was assigned. These findings were then correlated with histopathology reports that were labelled as either positive or negative for EMVI.



A total of 82 patients were included in this study. Out of these patients, 71 patients (86.5%) received pre-operative chemotherapy and radiotherapy. 11 patients (13.4%) did not receive any pre-operative chemotherapy or radiotherapy and proceeded directly to surgery. On MRI EMVI (mr-EMVI) was reported in 31 patients (37.8%) while on pathology it was seen in 26 patients (31.7%). Sensitivity, specificity and accuracy of mr-EMVI were 81.2%, 90% and 86.6%, respectively. It was noted that upon staging the tumor, the stage most frequently associated with EMVI was Stage T3c with 18 out of the 31 cases (58%) showing EMVI on MRI. The predominant location of the tumors showing mr-EMVI was in tumors located in mid rectum (90.3%; 28/31).



Pre-operative baseline MRI for staging rectal tumors is a highly effective imaging modality to evaluate for the presence of EMVI which can have a significant effect on the management plan.


Rectal cancer; Colorectal cancer; Extramural invasion; Extramural vascular invasion; MRI

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