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Comparative study on the application of CT grayscale inversion and MRI in the MRF of rectal cancer
LI Xueping  SUN Nan  LU Qiaoyuan  WU Jiaqi  LI Xiaoting  ZHANG Xiaoyan 

Cite this article as: LI X P, SUN N, LU Q Y, et al. Comparative study on the application of CT grayscale inversion and MRI in the MRF of rectal cancer[J]. Chin J Magn Reson Imaging, 2025, 16(1): 29-35. DOI:10.12015/issn.1674-8034.2025.01.005.


[Abstract] Objective The main objective of this study is to use the grayscale inversion technology in the post-processing workstation to reverse the density in conventional CT scanned images, to obtain images similar to MRI-T2WI, and to evaluate the application value of multidetector-row computed tomography (MDCT) in mesorectal fascia (MRF) display.Materials and Methods The images of 87 patients with rectal adenocarcinoma who only had preoperative CT examination because of contraindications in MRI scanning were retrospectively analyzed. The differences of peritoneal reflection and MRF display and display range between conventional CT images and "conventional CT+inversion images" were subjectively evaluated and compared. According to the postoperative pathological results, the diagnostic accuracy of conventional CT images and "conventional CT+inversion images" for MRF invasion was compared. The images of 123 patients with rectal adenocarcinoma who underwent radical surgery in the same period and had complete preoperative MRI data were collected retrospectively. The peritoneal reflection, MRF display and display range in MRI-T2WI were subjectively evaluated. The accuracy of MRI in the diagnosis of MRF invasion was evaluated according to the postoperative pathological results. The differences of peritoneal reflection, MRF display, display range and diagnostic accuracy of MRF invasion between "conventional CT+inversion images" and MRI-T2WI were compared.Results The display rate of peritoneal reflection was 24.1% in conventional CT images and 52.9% in "conventional CT+inversion images", and the display rate of peritoneal reflection was significantly higher in "conventional CT+inversion images" than in conventional CT images (P < 0.001). In the display range of MRF, the display range of "conventional CT+inversion images" was significantly larger than that of conventional CT images, and there were significant differences in anterior, posterior, left and right positions (P < 0.001). Taking the circumferential resection margin (CRM) status evaluated by pathology as the gold standard. The sensitivity, specificity and accuracy of conventional CT images for the diagnosis of MRF invasion were 73.3%, 93.1% and 81.6%, respectively; the sensitivity, specificity and accuracy of "conventional CT+inversion images" for the diagnosis of MRF invasion were 100.0%, 95.8% and 96.6%, respectively. The accuracy of "conventional CT+inversion images" was significantly higher than that of conventional CT images (P = 0.035). The sagittal MRI-T2WI showed 80.5% of peritoneal reflection, and MRI-T2WI was superior to inversion CT in showing peritoneal reflection (P < 0.001). In terms of MRF display range, there is a difference in the posterior MRF display range between "conventional CT+inversion images" and axial MRI-T2WI, with MRI-T2WI being able to display a larger range. The sensitivity, specificity, and accuracy of MRI images in diagnosing MRF invasion were 100.0%, 93.1%, and 93.5%, respectively, using the CRM status of pathological evaluation as the gold standard. There was no statistical difference in the accuracy of MRI images and "conventional CT+inversion images" in diagnosing MRF invasion (P = 0.528).Conclusions Conventional CT images after inversion can better display and evaluate MRF status, and for patients with contraindications of MRI scanning, "conventional CT+inversion images" can be used as a better alternative to imaging evaluation, and provide an important reference for the formulation of individual diagnosis.
[Keywords] rectal cancer；mesorectal fascia；computed tomography；grayscale inversion；magnetic resonance imaging

LI Xueping   SUN Nan   LU Qiaoyuan   WU Jiaqi   LI Xiaoting   ZHANG Xiaoyan*  

Department of Medical Imaging, Peking University Cancer Hospital, Beijing 100142, China

Corresponding author: ZHANG X Y, E-mail: 370493077@qq.com

Conflicts of interest   None.

Received  2024-08-27
Accepted  2025-01-10
DOI: 10.12015/issn.1674-8034.2025.01.005
Cite this article as: LI X P, SUN N, LU Q Y, et al. Comparative study on the application of CT grayscale inversion and MRI in the MRF of rectal cancer[J]. Chin J Magn Reson Imaging, 2025, 16(1): 29-35. DOI:10.12015/issn.1674-8034.2025.01.005.

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