Objectives This study aimed to evaluate the diagnostic accuracy of MRI-based Node Reporting and Data System (Node-RADS) in diagnosing lymph node metastasis (LNM) and to investigate its prognostic significance in rectal cancer (RC) patients. Materials and methods Patients with RC who underwent radical rectal resection (including LN dissection) without any prior anti-tumour therapy between May 2019 and April 2023 were retrospectively included. Two radiologists independently scored lymph nodes using the MRI-based Node-RADS. The diagnostic performance of Node-RADS was estimated using the area under receiver operating characteristic (ROC) curves (AUC) and compared with size criteria and MRI reports conducted by experienced radiologists. Intra- and inter-observer agreement were both assessed. Disease-free survival (DFS), which served as a key postoperative prognostic indicator, was evaluated and compared between patients with low (1–3) and high (4–5) scores. Results Overall, 163 patients with RC were enrolled, including 53 with LNM. There were 98 men and 65 women with a mean age of 62.6 ± 10.1 years. Node-RADS showed a larger AUC (0.912) with higher sensitivity (81%) and specificity (97.3%) compared to size criteria (75.5% and 71.8%) and MRI reports (91.0% and 41.8%). Node-RADS scores were also evaluated and correlated with the prognosis in patients who had undergone radical rectal resection. A multivariable Cox model combining Node-RADS and extramural venous invasion (EMVI) showed good predictive performance for DFS (C-index: 0.718). Conclusion The Node-RADS scoring system, based on MRI, enhanced both sensitivity and specificity in detecting LNM in RC patients who directly received radical rectal resection and showed potential prognostic significance for RCs. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> What is the clinical utility of the MRI-based Node-RADS for treatment-naive RC? <Emphasis Type="BoldItalic">Findings</Emphasis> The MRI-based Node-RADS demonstrated better diagnostic accuracy (AUC 0.912) for LNM and provided significant prognostic value for DFS in treatment-naive RC patients. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> The MRI-based Node-RADS is a reliable diagnostic method for lymph node assessment in treatment-naive RC with higher sensitivity and specificity. It is also useful in predicting postoperative outcomes. Graphical Abstract

Diagnostic and prognostic performance of MRI-based Node-RADS for regional lymph node assessment in treatment-naive rectal cancer

期刊论文
发表日期：

2026年1月29日

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Runzhe Xue,
Jingjuan Liu,
Hongbo Li,
Shitian Wang,
Lei Wang,
Weidong Pan,
Huadan Xue,
Yi Xiao

摘要

Objectives

This study aimed to evaluate the diagnostic accuracy of MRI-based Node Reporting and Data System (Node-RADS) in diagnosing lymph node metastasis (LNM) and to investigate its prognostic significance in rectal cancer (RC) patients.

Materials and methods

Patients with RC who underwent radical rectal resection (including LN dissection) without any prior anti-tumour therapy between May 2019 and April 2023 were retrospectively included. Two radiologists independently scored lymph nodes using the MRI-based Node-RADS. The diagnostic performance of Node-RADS was estimated using the area under receiver operating characteristic (ROC) curves (AUC) and compared with size criteria and MRI reports conducted by experienced radiologists. Intra- and inter-observer agreement were both assessed. Disease-free survival (DFS), which served as a key postoperative prognostic indicator, was evaluated and compared between patients with low (1–3) and high (4–5) scores.

Results

Overall, 163 patients with RC were enrolled, including 53 with LNM. There were 98 men and 65 women with a mean age of 62.6 ± 10.1 years. Node-RADS showed a larger AUC (0.912) with higher sensitivity (81%) and specificity (97.3%) compared to size criteria (75.5% and 71.8%) and MRI reports (91.0% and 41.8%). Node-RADS scores were also evaluated and correlated with the prognosis in patients who had undergone radical rectal resection. A multivariable Cox model combining Node-RADS and extramural venous invasion (EMVI) showed good predictive performance for DFS (C-index: 0.718).

Conclusion

The Node-RADS scoring system, based on MRI, enhanced both sensitivity and specificity in detecting LNM in RC patients who directly received radical rectal resection and showed potential prognostic significance for RCs.

Key Points

Question What is the clinical utility of the MRI-based Node-RADS for treatment-naive RC?

Findings The MRI-based Node-RADS demonstrated better diagnostic accuracy (AUC 0.912) for LNM and provided significant prognostic value for DFS in treatment-naive RC patients.

Clinical relevance The MRI-based Node-RADS is a reliable diagnostic method for lymph node assessment in treatment-naive RC with higher sensitivity and specificity. It is also useful in predicting postoperative outcomes.

Graphical Abstract