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Radiologists show good agreement on rectal cancer MRI measurements, but subjective features like irregular borders are less reproducible. This impacts lymph node staging accuracy.

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Area of Science:

  • Oncology
  • Radiology
  • Medical Imaging

Background:

  • Colorectal cancer is a leading cause of cancer in Europe.
  • Accurate lymph node staging is critical for rectal cancer treatment selection.
  • MRI lymph node staging for rectal cancer lacks extensive reproducibility data.

Purpose of the Study:

  • To evaluate inter- and intraobserver variability in MRI-based lymph node staging for rectal cancer.
  • To assess variability in lymph node size, apparent diffusion coefficient (ADC), and morphology.
  • To compare reproducibility between radiologists with varying experience levels.

Main Methods:

  • Four radiologists analyzed 36 rectal adenocarcinoma MRI scans.
  • Inter- and intraobserver variability assessed using ICC and Cohens-kappa.
  • Evaluated lymph node size, ADC values, and morphological features (border, signal, shape, location).

Main Results:

  • Good to excellent agreement on lymph node length and width measurements.
  • Fair to good agreement on apparent diffusion coefficient (ADC) measurements.
  • Moderate to almost perfect agreement on extramesorectal lymph node location, but fair to moderate agreement on morphological features like irregular borders and signal heterogeneity.

Conclusions:

  • Numerical variables (size, ADC) show better reproducibility than subjective morphological characteristics in rectal cancer MRI staging.
  • Observer experience has a limited impact on the reproducibility of subjective morphological assessments.
  • Standardization of morphological assessment criteria may improve lymph node staging reliability.