Accuracy of magnetic resonance imaging in predicting dentate line invasion in low rectal cancer

Purpose To retrospectively assess the accuracy of magnetic resonance imaging (MRI) in predicting dentate line invasion in low rectal cancer. Materials and methods Eighty-one patients with primary rectal cancer were assessed by dynamic contrast-enhanced MRI. The location of the dentate line was assessed on MRI in 27 patients with upper-mid rectal cancer. Two observers independently evaluated the distance between the distal tumor edge and the MRI-defined dentate line in 54 patients with low rectal cancer, and the imaging and histological findings were compared. Results The MRI-defined dentate line was 24.0 ± 3.8 mm above the anal verge in patients with upper-mid rectal cancer. The dentate line invasion status agreed with the histological findings in 49/54 (91%) patients ( κ = 0.72 [95% CI 0.50–0.95]) for observer 1, and in 51/54 (94%) patients ( κ = 0.83 [0.65–1.00]) for observer 2 in patients with low rectal cancer. Interobserver agreement was good ( κ = 0.83 [0.65–1.00]). The MRI-derived distance between the distal tumor edge and the dentate line had significant correlation with the histological distance ( r = 0.86 for reader 1 and 0.75 for observer 2). Conclusion MRI demonstrates high accuracy in predicting dentate line invasion in low rectal cancer.