Short summary

MRI scan of 200 patients with colon cancer. The MRI focus on staging colon cancer. This staging will be compared to the standard CT scan that all patients undergoes. 

The MRI staging will be compared to the histopathology  (Gold standard)

Rationale

Colon cancer is a frequent disease in Denmark, with over 3200 new cases and about 1350 death per year. 

Previously, surgery was the only treatment, and around 50% of the operated patients had incurable recurrence. With adjuvant chemotherapy, a moderate improvement in the survival rate in patients with stage II and III colon cancer is achievable. In rectal cancer, neoadjuvant treatment has proven effective. Neoadjuvant chemotherapy (NEC) has the potential to improve the outcome of advanced colon cancer with effective control and size reduction of colon tumors.

CT scanning I currently the national standard method for determining the stage of disease planning for treatment. CT-scan can sufficiently distinct between minor and advanced colon tumors. Advanced colon tumors are defined by having more than 55 mm growth into the tumor. Prevalence of advanced tumors was well over 40% in the CT study from Vejle in 2013, and 34% in a recent study. Sensitivity and specificity of detection of advanced colon tumors in the CT study was approx. 70% and 80%. A small MRI pilot study showed 89% and 96%.

MRI scan is currently performed on most patients with rectal cancer, which has resulted in better treatment planning and increased survival. MRI scan of the rectum is documented with higher accurately than CT scan. There has been reluctance to introduce MRI scan to patients with colon cancer, as the colon has more peristalsis than the rectum, and movement of the bowel can result in image quality reduction in MRI. However, in recent years MRI has become faster and thus less sensitive to movements. 

Neoadjuvant chemotherapy has proven effective in larger colon tumors. In this study, patient with colon cancer are therefore offered MRI just before surgery, to assess whether MRI is better than CT. MRI scanning may in the future help to select the patients who benefit from neoadjuvant treatment. In addition, MRI has the advantages that it may be possible to perform MRI diffusion measurements of the tumor, which gives an estimate of the tumors cell density. It will be possible to investigate whether this changes with the Neoadjuvant treatment. 

Previously studies of the diagnostic accuracy are very few, and all of them are retrospectively. 

This study is prospective and uses state of the art equipment. No studies on the usefulness of MRI scan after neoadjuvant treatment in colon cancer are yet available. 

Main purpose

The main purpose of this study is to investigate whether MRI can be used in treatment planning with assessment of diagnostic accuracy. With the inclusion of 150 patients, we want to investigate whether MRI is useful and better than CT in patients with colon tumors. And also if MRI is useful after neoadjuvant treatment. 

Endpoint

 Investigate the degree of accuracy in tumor stage compared to the histopathological surgical composition. 

Description of the cohort

All patients with newly diagnosed colon cancer at Vejle Hospital.

Collaborating researchers and departments

Department of Radiolgy, Vejle Hospital

• Claus Dam, MD
• Chris Vagn-Hansen, MD 
• Jakob Møller, MD 

Department of surgery, Vejle Hospital

• Hans Rahr, MD, DMSc
• Mikkel Sjöström, MD 

Department of Pathology, Vejle Hospital

• Jan Lindebjerg, MD 

Department of Oncology, Vejle Hospital

• Professor Anders Jakobsen, MD, DMSc