Synthetic phase-sensitive inversion-recovery vessel for assessing extramural venous invasion in patients with rectal cancer: imaging quality and added value to T2-wighted imaging

Objectives To evaluate the imaging quality of a synthetic phase-sensitive inversion recovery (SyPSIR) vessel and to add value to T2-weighted imaging (T2WI) for extramural venous invasion (EMVI) detection in patients with rectal cancer.Methods Participants in this retrospective study underwent preoperative synthetic MRI between October 2020 and April 2022. SyPSIR image reconstruction was performed with a single inversion time of 10 ms. A junior and a senior radiologist evaluated the imaging quality, including overall imaging quality scores, motion artifact scores, and relative image signal intensity contrast between the tumor and peritumoral vessels (SItumor-vessel), of both T2WI and SyPSIR vessels. Differences in imaging quality between the two methods were assessed using the Wilcoxon signed-rank test and two-sample t-test. EMVI scores were recorded for T2WI and T2WI+SyPSIR vessel. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the diagnostic performance.Results A total of 106 patients (35 EMVI+ and 71 EMVI-) were evaluated. There were no statistically significant differences in the overall image quality scores, motion artifacts, or SItumor-vessel (p = 0.08-0.93) between the T2WI and SyPSIR vessels. On combining T2WI and SyPSIR vessels, the AUC for pathological EMVI+ diagnoses increased from 0.65 to 0.88 for the junior radiologist and from 0.86 to 0.96 for the senior radiologist. Furthermore, the sensitivity of the analyses by junior and senior radiologists increased from 0.40 to 0.77 and 0.49 to 0.86, respectively.Conclusion A SyPSIR vessel can provide additional information to improve the diagnostic efficiency of pathological EMVI in rectal cancer, which may be beneficial for individualized clinical treatment.

Automated summary

This study evaluated the imaging quality of a synthetic phase-sensitive inversion recovery (SyPSIR) vessel and its value in detecting extramural venous invasion (EMVI) in patients with rectal cancer using T2-weighted imaging (T2WI). The results showed that combining T2WI and SyPSIR vessels improved the diagnostic performance for EMVI, with increased sensitivity and area under the curve.