MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience
Abstract Background Anastomotic leakage (AL) is one of the most serious postoperative complications after colorectal anastomosis. This study aims to evaluate the feasibility and diagnostic accuracy of magnetic resonance imaging (MRI) in the early detection of AL in patients with clinically suspected...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-022-01872-w |
| _version_ | 1811291981725302784 |
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| author | Liang Yu Guangliang Chen Hua Wang Xiaojie Wang Zhifen Chen Ying Huang Pan Chi |
| author_facet | Liang Yu Guangliang Chen Hua Wang Xiaojie Wang Zhifen Chen Ying Huang Pan Chi |
| author_sort | Liang Yu |
| collection | DOAJ |
| description | Abstract Background Anastomotic leakage (AL) is one of the most serious postoperative complications after colorectal anastomosis. This study aims to evaluate the feasibility and diagnostic accuracy of magnetic resonance imaging (MRI) in the early detection of AL in patients with clinically suspected AL after rectal anterior resection. Methods This was a prospective study including patients who underwent anterior resection and postoperative MRI examination. AL was diagnosed by comprehensive indictors, which were mainly confirmed by clinical signs, symptoms, and retrograde contrast enema (RCE) radiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosing AL with MRI were calculated. Results In total, 347 patients received anterior resection for rectal cancer, and 28 patients were suspected to have AL. Finally, 23 patients were included and received MRI examination. The median time interval from surgery to MRI was 10 days (3–21 days). The median distance from anastomosis to anal verge was 4.0 cm (2.0–10 cm), and 11 patients underwent diverted ileostomy. Eighteen patients had an anastomotic leak, including one patient who had a pelvic abscess and five patients who had no evidence of AL in the MRI examination. The overall sensitivity and specificity were 94.4% (95% CI 70.6% to 99.7%) and 80% (95% CI 29.8% to 98.9%), respectively. The PPV was 0.94 (95% CI 0.71 to 0.99) and the NPV was 0.80 (95% CI 0.29 to 0.99). For patients who had anastomosis less than 5 cm, the diagnostic accuracy of MRI was 93.7% (15/16). T2-weighted imaging with fat suppression can effectively reveal the leak track. Conclusions The accuracy of plain MRI examination in diagnosing AL was favorable for patients with a suspected AL. T2-weighted imaging with fat suppression was the best imaging modality to diagnose AL. A multicenter prospective study with more samples is needed to further determine the safety and feasibility of MRI in the diagnosis of AL. |
| first_indexed | 2024-04-13T04:38:35Z |
| format | Article |
| id | doaj.art-2a812e0ec2be40cd9954ccbef3070742 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-04-13T04:38:35Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-2a812e0ec2be40cd9954ccbef30707422022-12-22T03:02:06ZengBMCBMC Surgery1471-24822022-12-012211710.1186/s12893-022-01872-wMRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experienceLiang Yu0Guangliang Chen1Hua Wang2Xiaojie Wang3Zhifen Chen4Ying Huang5Pan Chi6Department of Colorectal Surgery, Fujian Medical University Union HospitalDepartment of Radiology, Fujian Medical University Union HospitalDepartment of Radiology, Fujian Medical University Union HospitalDepartment of Colorectal Surgery, Fujian Medical University Union HospitalDepartment of Colorectal Surgery, Fujian Medical University Union HospitalDepartment of Colorectal Surgery, Fujian Medical University Union HospitalDepartment of Colorectal Surgery, Fujian Medical University Union HospitalAbstract Background Anastomotic leakage (AL) is one of the most serious postoperative complications after colorectal anastomosis. This study aims to evaluate the feasibility and diagnostic accuracy of magnetic resonance imaging (MRI) in the early detection of AL in patients with clinically suspected AL after rectal anterior resection. Methods This was a prospective study including patients who underwent anterior resection and postoperative MRI examination. AL was diagnosed by comprehensive indictors, which were mainly confirmed by clinical signs, symptoms, and retrograde contrast enema (RCE) radiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosing AL with MRI were calculated. Results In total, 347 patients received anterior resection for rectal cancer, and 28 patients were suspected to have AL. Finally, 23 patients were included and received MRI examination. The median time interval from surgery to MRI was 10 days (3–21 days). The median distance from anastomosis to anal verge was 4.0 cm (2.0–10 cm), and 11 patients underwent diverted ileostomy. Eighteen patients had an anastomotic leak, including one patient who had a pelvic abscess and five patients who had no evidence of AL in the MRI examination. The overall sensitivity and specificity were 94.4% (95% CI 70.6% to 99.7%) and 80% (95% CI 29.8% to 98.9%), respectively. The PPV was 0.94 (95% CI 0.71 to 0.99) and the NPV was 0.80 (95% CI 0.29 to 0.99). For patients who had anastomosis less than 5 cm, the diagnostic accuracy of MRI was 93.7% (15/16). T2-weighted imaging with fat suppression can effectively reveal the leak track. Conclusions The accuracy of plain MRI examination in diagnosing AL was favorable for patients with a suspected AL. T2-weighted imaging with fat suppression was the best imaging modality to diagnose AL. A multicenter prospective study with more samples is needed to further determine the safety and feasibility of MRI in the diagnosis of AL.https://doi.org/10.1186/s12893-022-01872-wMagnetic resonance imagingRectal resectionDiagnosisAnastomotic leakage |
| spellingShingle | Liang Yu Guangliang Chen Hua Wang Xiaojie Wang Zhifen Chen Ying Huang Pan Chi MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience BMC Surgery Magnetic resonance imaging Rectal resection Diagnosis Anastomotic leakage |
| title | MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience |
| title_full | MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience |
| title_fullStr | MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience |
| title_full_unstemmed | MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience |
| title_short | MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience |
| title_sort | mri diagnose post operative anastomotic leak in patients with rectal cancer preliminary experience |
| topic | Magnetic resonance imaging Rectal resection Diagnosis Anastomotic leakage |
| url | https://doi.org/10.1186/s12893-022-01872-w |
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