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This cross-sectional study evaluated the diagnostic accuracy of 1.5T MRI for detecting mesorectal fascia (MRF) invasion in 154 patients with anorectal carcinoma, using histopathology as the gold standard. The study found that MRI had an overall diagnostic accuracy of 44.2%, with a sensitivity of 26.3% and specificity of 72.9% for MRF involvement. The authors conclude that 1.5T MRI has suboptimal accuracy for preoperative assessment of MRF involvement.
Preoperative 1.5T MRI has limited diagnostic accuracy for assessing mesorectal fascia involvement in anorectal carcinoma and cannot reliably replace histopathological evaluation for definitive staging.
Objective: To evaluate the diagnostic accuracy of 1.5 Tesla Magnetic Resonance Imaging (MRI) in assessing meso-rectal fascia (MRF) invasion in patients with anorectal carcinoma as compared to histopathology, serving as the gold slandered.Methods: This was a cross-sectional study at the Department of Radiology, Ziauddin University Hospital, Karachi, conducted between July 2019 and January 2020. One hundred and fifty-four (154) patients underwent preoperative MRI patients with suspected anorectal carcinoma. MRI was done in a 1.5T Siemens Magnetom Harmony with a dedicated pelvic coil and normal T1W, T2W and contrastenhanced sequences. The involvement of MRF was evaluated using the blinded senior radiologist, who was not aware of the histopathology outcomes, with histopathology being used as a reference standard. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined.Results : The mean age of the study subjects was 47.4 + 7.05 years with 55.8% and 44.2% male and females respectively. In 95 (61.7%) cases, MRF was confirmed by histopathology. The MRI had an overall diagnostic accuracy of 44.2% (95% CI: 36.3โ52.0%). The sensitivity was 26.3% (95% CI:17.5โ35.2%), specificity was 72.9% (95% CI: 61.5โ84.2%), PPV was 61.0% (95% CI: 46.0โ75.9%), and NPV was 38.1% (95% CI: 29.1โ47.0%).Conclusion: In this study, 1.5T MRI demonstrated suboptimal sensitivity and specificity for the preoperative assessment of MRF involvement in patients with anorectal carcinoma, resulting in limited overall diagnostic accuracy. This emphasizes that, while MRI provides valuable anatomical information and aids surgical planning, it cannot reliably replace histopathological evaluation for definitive staging. Factors such as MRI field strength, imaging protocol limitations, and the absence of adjunct sequences may have contributed to these findings. Consequently, careful interpretation of MRI results is essential, and correlation with histopathology remains crucial to ensure accurate staging, optimal surgical decision-making, and appropriate oncological management
