Application value of transrectal contrast-enhanced ultrasound combined with magnetic resonance imaging in T staging and treatment decision-making for middle and low rectal cancer

Abstract

Abstract:

ObjectiveTo explore the application value of contrast-enhanced ultrasound (CEUS) combined with magnetic resonance imaging (MRI) in T staging of middle and low rectal cancer, providing an accurate basis for multidisciplinary treatment (MDT).MethodAA retrospective analysis was conducted on the case data of 80 consecutive patients with middle and low rectal cancer admitted to the hospital from April 2023 to February 2025. All patients underwent transrectal ultrasound (TRUS), CEUS, and 3.0T MRI examinations within one week before biopsy or surgery. Using postoperative pathological results as the gold standard, the diagnostic performance of single and combined examinations in diagno-sing T staging of low rectal cancer was calculated separately.ResultThe combined examination for T₁rectal cancer showed a sensitivity of 87.5%, specificity of 99%, positive predictive value of 99.9%, and negative predictive value of 96.7%. For T₂rectal cancer, the sensitivity, specificity, positive predictive value, and negative predictive value were 91.3%, 96.3%, 91.3%, and 96.3%, respectively. For T₃rectal cancer, these values were 93.5%, 97.8%, 96.7%, and 95.7%, respectively. For T₄rectal cancer, these values were 90%, 98.5%, 90%, and 98.5%, respectively. The diagnostic accuracy of the combined examination for T₁-T₄rectal cancer was 97.5%, 97.5%, 96.25%, and 98.7%, respectively. The diagnostic accuracy of CEUS examination alone for T₁-T₄stages was 87.5%, 86.96%, 80.65%, and 80%, respectively. The diagnostic accuracy of MRI examination alone for T₁-T₄stages was 81.25%, 78.26%, 90.32%, and 90%, respectively. The accuracy of the combined examination was significantly higher than that of CEUS or MRI examination alone (P<0.05). The consistency between the combined examination and pathological staging was good (Kappa value=0.877,P<0.05). After CEUS combined with MRI examination, the area under the curve (AUC) of the receiver operating characteristic curve of the diagnostic model rose to 0.85, significantly exceeding that of single examination methods(CEUS AUC=0.75, MRI AUC=0.758). Additionally, it was found that T₁-T₂rectal cancer showed varying degrees of uniform enhancement on CEUS, and the specificity of CEUS combined with MRI in diagnosing T₁-T₂rectal cancer reached over 96.3%. The low enhancement observed on CEUS in the portal phase achieved a high specificity of 95.5% for diagnosing T₃and higher-stage tumors.ConclusionCEUS combined with MRI has significant advantages in the diagnosis of T staging of rectal cancer, especially for T₁and T₂stages, which have notable superiority over single examination. The accuracy of the combined examination can reach 97.5% and 97.5%, and the specificity can reach 99% and 96.3%, respectively, making it useful for ruling out non-neoplastic lesions.

Key words:Multimodal imaging,Transrectal contrast-enhanced ultrasound,Magnetic resonance imaging,Rectal cancer T staging,Surgical treatment

CLC Number:

ZHAO Ran, ZHAN Weiwei, LI Cheng, TANG Hailang, BO Yulian, LIU Kun. Application value of transrectal contrast-enhanced ultrasound combined with magnetic resonance imaging in T staging and treatment decision-making for middle and low rectal cancer[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(03): 293-300.

Figures/Tables7

Pathologic staging	Joint inspection accuracy	Kappavalue	Pvalue
pT₁	97.5%	0.877	<0.05
pT₂	97.5%	0.877	<0.05
pT₃	96.25%	0.877	<0.05
pT₄	98.7%	0.877	<0.05

Table 1

Pathologic staging	T₁	T₂	T₃	T₄
CEUS	87.5%	86.96%	80.65%	80%
MRI	81.25%	78.26%	90.32%	90%
Joint inspection	97.5%	97.5%	96.25%	98.7%

Table 2

Pathologic staging	Inspection method	Sensitivity	Specificity	Positive predictive value	Negative predictive value
T₁	CEUS MRI Joint inspection	0.875 0.813 0.875	0.981 0.990 0.990	0.933 0.999 0.999	0.964 0.948 0.967
T₂	CEUS MRI Joint inspection	0.870 0.783 0.913	0.959 0.926 0.963	0.909 0.818 0.913	0.940 0.909 0.963
T₃	CEUS MRI Joint inspection	0.806 0.903 0.935	0.955 0.952 0.978	0.926 0.933 0.967	0.875 0.930 0.957
T₄	CEUS MRI Joint inspection	0.800 0.900 0.900	0.983 0.983 0.985	0.889 0.900 0.900	0.967 0.983 0.985

Table 3

Figure 1

Figure 2

Figure 3

Table 4

Statistics of Missed Diagnosis and Misdiagnosis with Causes for CEUS, MRI, and Combined Examination in Mid-low Rectal Cancer

Pathological staging	Diagnostic methods	Total number of cases	Number of correct diagnoses	Number of missed diagnoses (underestimation)	Missed diagnosis rate	Number of misdiagnoses (overestimation)	Misdiagnosis rate	Diagnostic accuracy rate
pT₁	CEUS	16	14	0	0.0	2	12.5	87.5
	MRI	16	13	0	0.0	3	18.8	81.2
	Combined examination	16	14	0	0.0	2	12.5	87.5
pT₂	CEUS	23	20	0	0.0	3	13.0	87.0
	MRI	23	18	0	0.0	5	21.7	78.3
	Combined examination	23	21	0	0.0	2	8.7	91.3
pT₃	CEUS	31	25	6	19.4	0	0.0	80.6
	MRI	31	28	1	3.2	2	6.5	90.3
	Combined examination	31	29	0	0.0	2	6.5	93.5
pT₄	CEUS	10	8	2	20.0	0	0.0	80
	MRI	10	9	1	10.0	0	0.0	90
	Combined examination	10	9	1	10.0	0	0.0	90
Total	CEUS	80	67	8	10.0	5	6.3	83.8
	MRI	80	68	2	2.5	10	12.5	85
	Combined examination	80	73	1	1.2	6	7.5	91.3

Table 4

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