# Value of MSCT plus MRI in the Detection of Colon Cancer

Authors: Jingni Zhang; Yu Bao
Journal: Evidence-Based Complementary and Alternative Medicine
 (2022)

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## Abstract

Colon cancer is a common digestive system malignancy with nonspecific early symptoms, which necessitates better early detection methods. The present study was conducted to assess the accuracy and clinical value of multislice spiral CT (MSCT) plus magnetic resonance imaging (MRI) for colon cancer. Between January 2019 and July 2020, 100 patients with pathologically confirmed colon cancer treated in Wuxi People’s Hospital were assessed for eligibility and recruited. All eligible patients received MRI and MSCT without any treatment prior to scanning. The accuracy of preoperative diagnosis and staging of colon cancer by MRI, MSCT, and MRI plus MSCT were analyzed using postoperative pathological results as the gold standard, and consistency analysis was performed. The receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was obtained to analyze the preoperative diagnostic value. The accuracy of MRI, MSCT, and MRI plus MSCT was 98.00%, 96.00%, and 100% with good consistency (Kappa = 0.732, 0.703, and 0.756). The AUC of MRI, MSCT, and MRI plus MSCT was 0.889, 0.861, and 0.903, respectively. The preoperative diagnostic accuracy of MRI for colon cancer at T1, T2, T3, and T4 stages was 76.92%, 82.61%, 73.47%, and 86.67%, respectively, those of MSCT was 53.85%, 69.57%, 63.27%, and 40.00%, respectively, and those of MRI plus MSCT was 100.00%, 95.65%, 95.92%, and 86.67%, respectively. Consistency analysis yielded good consistency for the diagnosis of the T-staging of colon cancer (Kappa = 0.754, 0.731, 0.776). MSCT plus MRI yielded higher accuracy, specificity, and sensitivity in the detection of colon cancer versus the standalone MRI or MSCT, which demonstrated great potential in the early detection of colon cancer with a high clinical value.


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## Body

## 1. Introduction

Colon cancer is a common digestive system malignancy that occurs in the colon. It manifests as abdominal distention, pain, constipation, and other dyspeptics at the early stage and exhibits stabbing pain in the stomach as the disease aggravates [1–3]. Due to the insidiousness of early symptoms, the disease has mostly progressed to an advanced stage at the time of diagnosis, which results in poor treatment effectiveness and compromises patients’ life quality [4, 5]. Tradition Chinese medicine (TCM) plays an important role in improving nutrition, immunity, and postoperative quality of life in colon cancer patients. The treatment of colon cancer has developed into a comprehensive treatment with surgery as the main and radiotherapy, chemotherapy, and TCM treatment as the auxiliary [6]. Early detection and treatment may contribute to a robust treatment outcome for colon cancer. Accordingly, effective early diagnosis and timely treatment are essential for clinical treatment efficacy.Currently, the common diagnostic methods for colon cancer patients include ultrasound diagnosis, CT, and MRI. MSCT has been widely applied due to its strengths in observing the location of the lesion [7–9]. MRI diagnosis emerges with the development of medical technology and also receives widespread attention. However, MSCT or MRI alone is limited in diagnosing colon cancer. Therefore, 100 patients with colon cancer treated in our hospital between January 2019 and July 2020 were assessed for eligibility and recruited to assess the accuracy and clinical value of MSCT plus MRI for colon cancer.


## 2. Materials and Methods

### 2.1. Study Design

It was a diagnostic study that enrolled 100 patients with pathologically confirmed colon cancer treated in Wuxi People’s Hospital from January 2019 and July 2020. All eligible patients received MRI and MSCT without any treatment prior to scanning. The accuracy of preoperative diagnosis and staging of colon cancer by MRI, MSCT, and MRI plus MSCT was analyzed using postoperative pathological results as the gold standard, and consistency analysis was performed. The ROC were plotted, and the AUC was obtained to analyze the preoperative diagnostic value.


### 2.2. Inclusion and Exclusion Criteria

#### 2.2.1. Inclusion Criteria

The inclusion criteria were as follows: patients were aged 18 years or older; with a postoperative diagnosis of colon cancer confirmed by pathology; without any treatment prior to scanning and underwent MRI and MSCT before treatment; with no history of drug allergy, drug abuse, or adverse hobbies; without complications of organic diseases; and without intestinal obstruction. The study was approved by Wuxi People’s Hospital Ethics Committee (no. wxh29703). All patients voluntarily participated in this study and provided written informed consent.


#### 2.2.2. Exclusion Criteria

The exclusion criteria were as follows: patients with consciousness disorder and other digestive system diseases.


### 2.3. Methods

#### 2.3.1. MRI Scanning

Oral bowel cleansers were administered 6–8 hours before examination. The instrument was a 1.5 T magnetic resonance scanner (lot no. 3280043, 2003) manufactured by AirHealth General Electric Medical Systems Co. The patients were instructed to breathe calmly during the scanning, and T2WI (TR = 3000 ms, TE = 100 ms, NAS = 3 times, layer thickness = 3 mm, and layer spacing = 0.3 mm) sequences in the sagittal plane were scanned to determine the location of the tumor, followed by scanning of the T1WI (TR = 573 ms, TE = 8 ms, NAS = 3 times, layer thickness = 3.5 mm, and layer spacing = 0.2 mm) and T2WI (TR = 3824 ms, TE = 110 ms, NAS = 3 times, layer thickness = 3.5 mm, and layer spacing = 0.2 mm) sequences in the transverse plane perpendicular to the tumor intestine and then T2WI (TR = 3824 ms, TE = 110 ms, NAS = 2 times, layer thickness = 3.5 mm, and layer spacing = 0.3 mm) sequences in the coronal plane parallel to the tumor intestine.


#### 2.3.2. MSCT Scanning

The patients fasted for 12 h before the examination, and oral bowel cleansing drugs were administered on the night of the previous day. Scopolamine was injected intramuscularly 30 minutes before examination to reduce intestinal tone, intestinal peristalsis, and spasm. With the patients in the left lateral position, 1000–1500 mL of air was slowly injected into the intestinal tube, followed by a supine position on the examination bed. A 16-layer spiral CT (lot number: 20183060562) from the top of the diaphragm to the inferior border of the pubic symphysis was used for volumetric scanning, with a collimator width of 20 mm, a pitch of 1 mm, a tube voltage of 120 V, and a tube current of 300–00 mA. Iohexol, 350 mg/mL, 3.5–4.0 mL/s, was injected into the elbow vein using a high-pressure syringe and scanned at 30 s (arterial phase) and 60 s (parenchymal phase) after injection, respectively.


#### 2.3.3. T-Staging for Colon Cancer

Stage I: lesions invade the submucosa. Stage T2: the lesion invades the muscular layer, but the muscular layer is continuous, the outer edge of the intestinal wall is still smooth, and the surrounding fat space is clear. Stage T3: if the lesion penetrates the muscle layer, the continuity of the muscle layer signal is interrupted, the outer edge of the intestinal wall is rough, the gap between the surrounding fat is fuzzy, and the signs of cords and burr can be seen. Stage T4: tumor infiltrates into the abdominal wall or adheres to surrounding organs or structures.


## 2.1. Study Design

It was a diagnostic study that enrolled 100 patients with pathologically confirmed colon cancer treated in Wuxi People’s Hospital from January 2019 and July 2020. All eligible patients received MRI and MSCT without any treatment prior to scanning. The accuracy of preoperative diagnosis and staging of colon cancer by MRI, MSCT, and MRI plus MSCT was analyzed using postoperative pathological results as the gold standard, and consistency analysis was performed. The ROC were plotted, and the AUC was obtained to analyze the preoperative diagnostic value.


## 2.2. Inclusion and Exclusion Criteria

### 2.2.1. Inclusion Criteria

The inclusion criteria were as follows: patients were aged 18 years or older; with a postoperative diagnosis of colon cancer confirmed by pathology; without any treatment prior to scanning and underwent MRI and MSCT before treatment; with no history of drug allergy, drug abuse, or adverse hobbies; without complications of organic diseases; and without intestinal obstruction. The study was approved by Wuxi People’s Hospital Ethics Committee (no. wxh29703). All patients voluntarily participated in this study and provided written informed consent.


### 2.2.2. Exclusion Criteria

The exclusion criteria were as follows: patients with consciousness disorder and other digestive system diseases.


## 2.2.1. Inclusion Criteria

The inclusion criteria were as follows: patients were aged 18 years or older; with a postoperative diagnosis of colon cancer confirmed by pathology; without any treatment prior to scanning and underwent MRI and MSCT before treatment; with no history of drug allergy, drug abuse, or adverse hobbies; without complications of organic diseases; and without intestinal obstruction. The study was approved by Wuxi People’s Hospital Ethics Committee (no. wxh29703). All patients voluntarily participated in this study and provided written informed consent.


## 2.2.2. Exclusion Criteria

The exclusion criteria were as follows: patients with consciousness disorder and other digestive system diseases.


## 2.3. Methods

### 2.3.1. MRI Scanning

Oral bowel cleansers were administered 6–8 hours before examination. The instrument was a 1.5 T magnetic resonance scanner (lot no. 3280043, 2003) manufactured by AirHealth General Electric Medical Systems Co. The patients were instructed to breathe calmly during the scanning, and T2WI (TR = 3000 ms, TE = 100 ms, NAS = 3 times, layer thickness = 3 mm, and layer spacing = 0.3 mm) sequences in the sagittal plane were scanned to determine the location of the tumor, followed by scanning of the T1WI (TR = 573 ms, TE = 8 ms, NAS = 3 times, layer thickness = 3.5 mm, and layer spacing = 0.2 mm) and T2WI (TR = 3824 ms, TE = 110 ms, NAS = 3 times, layer thickness = 3.5 mm, and layer spacing = 0.2 mm) sequences in the transverse plane perpendicular to the tumor intestine and then T2WI (TR = 3824 ms, TE = 110 ms, NAS = 2 times, layer thickness = 3.5 mm, and layer spacing = 0.3 mm) sequences in the coronal plane parallel to the tumor intestine.


### 2.3.2. MSCT Scanning

The patients fasted for 12 h before the examination, and oral bowel cleansing drugs were administered on the night of the previous day. Scopolamine was injected intramuscularly 30 minutes before examination to reduce intestinal tone, intestinal peristalsis, and spasm. With the patients in the left lateral position, 1000–1500 mL of air was slowly injected into the intestinal tube, followed by a supine position on the examination bed. A 16-layer spiral CT (lot number: 20183060562) from the top of the diaphragm to the inferior border of the pubic symphysis was used for volumetric scanning, with a collimator width of 20 mm, a pitch of 1 mm, a tube voltage of 120 V, and a tube current of 300–00 mA. Iohexol, 350 mg/mL, 3.5–4.0 mL/s, was injected into the elbow vein using a high-pressure syringe and scanned at 30 s (arterial phase) and 60 s (parenchymal phase) after injection, respectively.


### 2.3.3. T-Staging for Colon Cancer

Stage I: lesions invade the submucosa. Stage T2: the lesion invades the muscular layer, but the muscular layer is continuous, the outer edge of the intestinal wall is still smooth, and the surrounding fat space is clear. Stage T3: if the lesion penetrates the muscle layer, the continuity of the muscle layer signal is interrupted, the outer edge of the intestinal wall is rough, the gap between the surrounding fat is fuzzy, and the signs of cords and burr can be seen. Stage T4: tumor infiltrates into the abdominal wall or adheres to surrounding organs or structures.


## 2.3.1. MRI Scanning

Oral bowel cleansers were administered 6–8 hours before examination. The instrument was a 1.5 T magnetic resonance scanner (lot no. 3280043, 2003) manufactured by AirHealth General Electric Medical Systems Co. The patients were instructed to breathe calmly during the scanning, and T2WI (TR = 3000 ms, TE = 100 ms, NAS = 3 times, layer thickness = 3 mm, and layer spacing = 0.3 mm) sequences in the sagittal plane were scanned to determine the location of the tumor, followed by scanning of the T1WI (TR = 573 ms, TE = 8 ms, NAS = 3 times, layer thickness = 3.5 mm, and layer spacing = 0.2 mm) and T2WI (TR = 3824 ms, TE = 110 ms, NAS = 3 times, layer thickness = 3.5 mm, and layer spacing = 0.2 mm) sequences in the transverse plane perpendicular to the tumor intestine and then T2WI (TR = 3824 ms, TE = 110 ms, NAS = 2 times, layer thickness = 3.5 mm, and layer spacing = 0.3 mm) sequences in the coronal plane parallel to the tumor intestine.


## 2.3.2. MSCT Scanning

The patients fasted for 12 h before the examination, and oral bowel cleansing drugs were administered on the night of the previous day. Scopolamine was injected intramuscularly 30 minutes before examination to reduce intestinal tone, intestinal peristalsis, and spasm. With the patients in the left lateral position, 1000–1500 mL of air was slowly injected into the intestinal tube, followed by a supine position on the examination bed. A 16-layer spiral CT (lot number: 20183060562) from the top of the diaphragm to the inferior border of the pubic symphysis was used for volumetric scanning, with a collimator width of 20 mm, a pitch of 1 mm, a tube voltage of 120 V, and a tube current of 300–00 mA. Iohexol, 350 mg/mL, 3.5–4.0 mL/s, was injected into the elbow vein using a high-pressure syringe and scanned at 30 s (arterial phase) and 60 s (parenchymal phase) after injection, respectively.


## 2.3.3. T-Staging for Colon Cancer

Stage I: lesions invade the submucosa. Stage T2: the lesion invades the muscular layer, but the muscular layer is continuous, the outer edge of the intestinal wall is still smooth, and the surrounding fat space is clear. Stage T3: if the lesion penetrates the muscle layer, the continuity of the muscle layer signal is interrupted, the outer edge of the intestinal wall is rough, the gap between the surrounding fat is fuzzy, and the signs of cords and burr can be seen. Stage T4: tumor infiltrates into the abdominal wall or adheres to surrounding organs or structures.


## 3. Outcome Measures

With the postoperative pathological outcome as the gold standard, the positive detection, negative detection, test accuracy, sensitivity, specificity, and AUC score of MRI, MSCT, and MRI plus MSCT were compared. Test accuracy = the number of detected cases/the number of confirmed cases × 100%.


## 4. Statistical Analysis

All statistical analyses were done by the SPSS 20.0 software, and GraphPad Prism 7 (GraphPad Software, San Diego, USA) was used to plot graphs in this study. Measurement data were expressed as (x¯ ±s) and processed by the t-test. Counting data were expressed as (n (%)) and analyzed by the chi-square test. The Kappa test was used for consistency determination, with Kappa < 0.4 indicating poor consistency, Kappa in the range of 0.4–0.7 indicating moderate consistency, and Kappa > 0.7 indicating good consistency. The receiver operating characteristic curves were plotted, and the area under the curve (AUC) was obtained to analyze the preoperative diagnostic value of MRI plus MSCT for colon cancer. Differences were considered statistically significant at a P value less than 0.05.


## 5. Results

### 5.1. General Data

There were 51 male and 49 female patients, aged 30–78 years, with an average age of (58.31 ± 4.50) years, an average height of (166.80 ± 10.26) cm, an average weight of (75.00 ± 5.96) kg, and average disease duration of (3.72 ± 0.73) months. There were 44 cases of stage I, 26 cases of stage II, 18 cases of stage III, and 12 cases of stage IV for TNM stage, and 18 cases of ascending colon, 6 cases of hepatic flexure of the colon, 4 cases of transverse colon, 3 cases of splenic flexure of the colon, 15 cases of descending colon, 49 cases of sigmoid colon, and 5 cases of ileocecal in terms of location of the lesion. Of the 100 cases included, 43 cases had a history of smoking, 38 cases had a history of drinking, 44 cases had diabetes mellitus, and 33 cases had hypertension.


### 5.2. Preoperative Diagnosis of Colon Cancer by MRI and MSCT

The accuracy of MRI, MSCT, and MRI plus MSCT was 98.00%, 96.00%, and 100%, and the consistency analysis concluded good consistency of MRI, MSCT, and MRI plus MSCT with pathological examination for colon cancer (Kappa = 0.732, 0.703, and 0.756) (Figure1).Figure 1
Typical pictures of MSCT and MRI. (a) The enhanced venous phase of MSCT, and the arrow in the figure shows sigmoid wall thickening with delayed enhancement. (b) The T1WI sequence in the arterial coronal phase of MRI, and the arrow shows the thickening of the sigmoid colon wall with obvious enhancement.
(a)(b)


### 5.3. ROC Analysis of MRI and MSCT for Preoperative Diagnosis of Colon Cancer

The AUCs of MRI, MSCT, and MRI plus MSCT for the diagnosis of colon cancer were 0.889, 0.861, and 0.903, respectively (Figure2).Figure 2
ROC analysis of MRI and MSCT.


### 5.4. Preoperative Diagnostic Value of MRI and MSCT for T-Staging of Colon Cancer

The results of the surgical pathological staging of 100 colon cancer patients showed that there were 13 cases of stage T1, 23 cases of stage T2, 49 cases of stage T3, and 15 cases of stage T4. The preoperative diagnostic accuracy of MRI for colon cancer at T1, T2, T3, and T4 stages was 76.92% (10/13), 82.61% (19/23), 73.47% (36/49), and 86.67% (13/15) (Table1), respectively, that of MSCT was 53.85% (7/13), 69.57% (16/23), 63.27% (31/49), and 40.00% (6/15) (Table 2), respectively, and that of MRI plus MSCT was 100.00% (13/13), 95.65% (22/23), 95.92% (47/49), and 86.67% (13/15), respectively (Table 3). Consistency analysis yielded good consistency of MRI, MSCT, and MRI plus MSCT with pathological examination for the diagnosis of the T-staging of colon cancer (Kappa = 0.754, 0.731, and 0.776).Table 1
Preoperative diagnostic value of MRI for T-staging of colon cancer.
MRIPathological resultsTotalT1T2T3T4T11010011T23198030T30236240T40151319Total13234915100Table 2
Preoperative diagnostic value of MSCT for T-staging of colon cancer.
MSCTPathological resultsTotalT1T2T3T4T1740011T241612335T32331642T4006612Total13234915100Table 3
Preoperative diagnostic value of MRI plus MSCT for T-staging of colon cancer.
MSCTPathological resultsTotalT1T2T3T4T11300013T20221023T30147250T40011314Total13234915100


## 5.1. General Data

There were 51 male and 49 female patients, aged 30–78 years, with an average age of (58.31 ± 4.50) years, an average height of (166.80 ± 10.26) cm, an average weight of (75.00 ± 5.96) kg, and average disease duration of (3.72 ± 0.73) months. There were 44 cases of stage I, 26 cases of stage II, 18 cases of stage III, and 12 cases of stage IV for TNM stage, and 18 cases of ascending colon, 6 cases of hepatic flexure of the colon, 4 cases of transverse colon, 3 cases of splenic flexure of the colon, 15 cases of descending colon, 49 cases of sigmoid colon, and 5 cases of ileocecal in terms of location of the lesion. Of the 100 cases included, 43 cases had a history of smoking, 38 cases had a history of drinking, 44 cases had diabetes mellitus, and 33 cases had hypertension.


## 5.2. Preoperative Diagnosis of Colon Cancer by MRI and MSCT

The accuracy of MRI, MSCT, and MRI plus MSCT was 98.00%, 96.00%, and 100%, and the consistency analysis concluded good consistency of MRI, MSCT, and MRI plus MSCT with pathological examination for colon cancer (Kappa = 0.732, 0.703, and 0.756) (Figure1).Figure 1
Typical pictures of MSCT and MRI. (a) The enhanced venous phase of MSCT, and the arrow in the figure shows sigmoid wall thickening with delayed enhancement. (b) The T1WI sequence in the arterial coronal phase of MRI, and the arrow shows the thickening of the sigmoid colon wall with obvious enhancement.
(a)(b)


## 5.3. ROC Analysis of MRI and MSCT for Preoperative Diagnosis of Colon Cancer

The AUCs of MRI, MSCT, and MRI plus MSCT for the diagnosis of colon cancer were 0.889, 0.861, and 0.903, respectively (Figure2).Figure 2
ROC analysis of MRI and MSCT.


## 5.4. Preoperative Diagnostic Value of MRI and MSCT for T-Staging of Colon Cancer

The results of the surgical pathological staging of 100 colon cancer patients showed that there were 13 cases of stage T1, 23 cases of stage T2, 49 cases of stage T3, and 15 cases of stage T4. The preoperative diagnostic accuracy of MRI for colon cancer at T1, T2, T3, and T4 stages was 76.92% (10/13), 82.61% (19/23), 73.47% (36/49), and 86.67% (13/15) (Table1), respectively, that of MSCT was 53.85% (7/13), 69.57% (16/23), 63.27% (31/49), and 40.00% (6/15) (Table 2), respectively, and that of MRI plus MSCT was 100.00% (13/13), 95.65% (22/23), 95.92% (47/49), and 86.67% (13/15), respectively (Table 3). Consistency analysis yielded good consistency of MRI, MSCT, and MRI plus MSCT with pathological examination for the diagnosis of the T-staging of colon cancer (Kappa = 0.754, 0.731, and 0.776).Table 1
Preoperative diagnostic value of MRI for T-staging of colon cancer.
MRIPathological resultsTotalT1T2T3T4T11010011T23198030T30236240T40151319Total13234915100Table 2
Preoperative diagnostic value of MSCT for T-staging of colon cancer.
MSCTPathological resultsTotalT1T2T3T4T1740011T241612335T32331642T4006612Total13234915100Table 3
Preoperative diagnostic value of MRI plus MSCT for T-staging of colon cancer.
MSCTPathological resultsTotalT1T2T3T4T11300013T20221023T30147250T40011314Total13234915100


## 6. Discussion

The insidiousness of the early symptoms of colon cancer such as indigestion and abdominal distension may prone to misdiagnosis and missed diagnosis [10–13]. Early diagnosis and correct staging are essential for the treatment and prognosis of patients with colon cancer [14, 15].CT examination is not limited by overlapping structures with high compliance of patients and easy operation, while MRI examination is free of ionizing radiation and can obtain axial, sagittal, and coronal images to provide a more comprehensive evaluation of the tumor location and depth of infiltration. For colon cancer patients, CT and MRI can observe the location of the tumor clearly, which facilitates the determination of the incision position of tumor resection [16–18]. Research has reported that both MRI and CT have high accuracy in the preoperative diagnosis and staging of colon cancer. Nevertheless, the rapid scanning of the whole abdomen and chest directly by CT prevents accurate determination of the extent of tumor development, which may lead to overestimated T-staging results; though MRI provides a higher staging accuracy than CT for the fine structure of rectal wall tissue, specific causes of intestinal wall changes are poorly distinguished [19, 20]. With the continuous progress of CT technology, MSCT is gradually applied in clinical diagnosis. It was found that MSCT scan is efficient and provides less respiratory and intestinal peristaltic artifacts, and the basic condition of the lesion and distant metastases are clearly shown after reconstruction after volume scan [21]. To further assess the value of MSCT combined with MRI diagnosis in colon cancer, the diagnostic value of MSCT and MSCT plus MRI diagnosis was investigated in the present study.The results of the present study showed that the accuracy of MRI, MSCT, and MRI plus MSCT was 98.00%, 96.00%, and 100%, and the consistency analysis concluded good consistency of MRI, MSCT, and MRI plus MSCT with pathological examination for colon cancer, indicating that MSCT and MRI are available for the preoperative diagnosis of colon cancer with higher diagnostic accuracy in the MRI plus MSCT, which is consistent with previous studies [22, 23]. The AUC of MRI, MSCT, and MRI plus MSCT for the diagnosis of colon cancer was 0.889, 0.861, and 0.903, respectively, which further confirms the value of MRI and MSCT in the preoperative diagnosis of colon cancer. Moreover, the preoperative diagnostic accuracy of MRI for colon cancer at T1, T2, T3, and T4 stages was 76.92%, 82.61%, 73.47%, and 86.67%, respectively, that of MSCT was 53.85%, 69.57%, 63.27%, and 40.00%, respectively, and that of MRI plus MSCT was 100.00%, 95.65%, 95.92%, and 86.67%, respectively. Consistency analysis yielded good consistency of MRI, MSCT, and MRI plus MSCT with pathological examination for the diagnosis of the T-staging of colon cancer, suggesting that the combined application of MSCT and MRI can significantly improve the diagnostic accuracy of T1-T3 staging and provide a reliable basis for subsequent treatment.


## 7. Conclusion

MSCT combined with MRI diagnosis yields a promising diagnostic value for patients with colon cancer regarding the test accuracy, specificity, and sensitivity. Therefore, MSCT plus MRI demonstrated great potential in the early detection of colon cancer with a high clinical value.



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