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CRM (T stage) Low rectal cancer Nodal disease Risk Factors for Loc recurrence
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Wang et al. Langenbecks Arch Surg 2005; 91: 167-172 Size as a criterium?
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Based on Wang et al. Langenbecks Arch Surg 2005 Size as a criterium?
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Lahaye, Beets-Tan et al. Semin US CT MR 2005 AUC 0.96 USPIO MRI Nodal detection
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> 2 mm </= 2 mm LOCALLY ADVANCED N2N1 NO EARLY TUMOR Distaal Mid rectaal Hoog rectaal NON LOCALLY ADVANCED LOCALLY ADVANCED T3 T1-2 Hoog/mid rectaal DistaalCRM EARLY TUMOR LOCALLY ADVANCED NON LOCALLY ADVANCED BeetsTan, vd Velde, Beets et al. Maastricht MR multicenter study MR stratifies patients into a tailored RX multicenter study
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LOCALLY ADVANCED EARLY TUMOR NON LOCALLY ADVANCED TME (local excision) 5x5 Gy + TME Chemoradiation + surgery* * 2nd MRI before surgery
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2003-2008: n=319 university hospital, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center: Rx stratification Maastricht MR multicenter study Rx stratification based on MRI prospective multicenter study
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2003-2008: n=319 university hospitals, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center:Rx stratification Loc Recurrence, OS, DFS, death # complete resections Accuracy MRI in expert vs general centers Impact of double reading setting on radiologists performance Maastricht MR multicenter study Rx stratification based on MRI prospective multicenter study
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2003-2008: n=319 university hospitals, 3 regional hospitals Each MRI prospective reading by local radiologist Each MRI double read by expert center:Rx stratification Loc Recurrence, OS, DFS, death # complete resections Accuracy MRI in expert vs general centers Impact of double reading setting on radiologists performance Maastricht MR multicenter study Rx stratification based on MRI prospective multicenter study
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No USPIO GeneralExpert Sens0.620.90 Spec0.830.53 PPV0.620.47 NPV0.830.92 MRI for nodal disease
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No USPIOWITH USPIO Genera l Expert Genera l Expert Sens 0.620.900.920.95 Spec 0.830.530.690.81 PPV 0.620.470.570.70 NPV 0.830.920.950.97 MRI for nodal disease
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Maastricht MR multicenter study Conventional MRI not reliable for detection of tumor less than 5 mm Lessons to learn
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Maastricht MR multicenter study Conventional MRI not reliable for detection of tumor less than 5 mm USPIO MRI selects N0 Lessons to learn
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Maastricht MR multicenter study Conventional MRI not reliable for detection of tumor less than 5 mm USPIO MRI selects N0 MR stratification also in general hands Lessons to learn
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Conventional MRI not reliable for detection of tumor less than 5 mm USPIO MRI selects N0 MR stratification also in general hands USPIO not on the market Maastricht MR multicenter study Lessons to learn
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Maastricht MR multicenter study MS 325 enhanced MRI
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n= 132 lymph nodes (15/132 N+) Sensitivity 93 % (14/14 +1) Specificity 97 % (113/113+4) PPV 78 % (14/14+4) NPV 99 % (113/113+1) Maastricht MR multicenter study MS 325 MRI for nodal disease
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