{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:15:17Z","timestamp":1783433717264,"version":"3.54.6"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"DOI":"10.1007\/s00330-026-12516-5","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T09:52:52Z","timestamp":1776505972000},"page":"6798-6809","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Contrast-enhanced vs T2-weighted MRI for mesorectal nodal staging in rectal cancer"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1397-9030","authenticated-orcid":false,"given":"Markus","family":"Lurz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnd-Oliver","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,18]]},"reference":[{"key":"12516_CR1","doi-asserted-by":"publisher","unstructured":"Hofheinz RD, Fokas E, Benhaim L et al (2025) Localised rectal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. https:\/\/doi.org\/10.1016\/j.annonc.2025.05.528","DOI":"10.1016\/j.annonc.2025.05.528"},{"key":"12516_CR2","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1056\/NEJMoa2303269","volume":"389","author":"D Schrag","year":"2023","unstructured":"Schrag D, Shi Q, Weiser MR et al (2023) Preoperative treatment of locally advanced rectal cancer. N Engl J Med 389:322\u2013334","journal-title":"N Engl J Med"},{"key":"12516_CR3","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1007\/s00330-017-5026-2","volume":"28","author":"RGH Beets-Tan","year":"2018","unstructured":"Beets-Tan RGH, Lambregts DMJ, Maas M et al (2018) Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 28:1465\u20131475","journal-title":"Eur Radiol"},{"key":"12516_CR4","doi-asserted-by":"publisher","first-page":"2792","DOI":"10.1007\/s00261-023-03893-2","volume":"48","author":"S Lee","year":"2023","unstructured":"Lee S, Kassam Z, Baheti AD et al (2023) Rectal cancer lexicon 2023 revised and updated consensus statement from the Society of Abdominal Radiology Colorectal and Anal Cancer Disease-Focused Panel. Abdom Radiol (NY) 48:2792\u20132806","journal-title":"Abdom Radiol (NY)"},{"key":"12516_CR5","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1245\/s10434-011-2210-5","volume":"19","author":"E Al-Sukhni","year":"2012","unstructured":"Al-Sukhni E, Milot L, Fruitman M et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19:2212\u20132223","journal-title":"Ann Surg Oncol"},{"key":"12516_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2021.110113","volume":"147","author":"S Stelzner","year":"2022","unstructured":"Stelzner S, Ruppert R, Kube R et al (2022) Selection of patients with rectal cancer for neoadjuvant therapy using pre-therapeutic MRI\u2014results from OCUM trial. Eur J Radiol 147:110113","journal-title":"Eur J Radiol"},{"key":"12516_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/jso.27852","volume":"130","author":"E Milanzi","year":"2024","unstructured":"Milanzi E, Pelly RM, Hayes IP et al (2024) Accuracy of baseline magnetic resonance imaging for staging rectal cancer patients proceeding directly to surgery. J Surg Oncol 130:1\u20139","journal-title":"J Surg Oncol"},{"key":"12516_CR8","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.2214\/AJR.21.25556","volume":"217","author":"H Kaur","year":"2021","unstructured":"Kaur H, Gabriel H, Taggart M et al (2021) MRI staging in an evolving management paradigm for rectal cancer, from the AJR special series on cancer staging. AJR Am J Roentgenol 217:1282\u20131294","journal-title":"AJR Am J Roentgenol"},{"key":"12516_CR9","doi-asserted-by":"publisher","first-page":"5714","DOI":"10.1007\/s00330-025-11463-x","volume":"35","author":"X Gong","year":"2025","unstructured":"Gong X, Ye Z, Shen Y, Song B (2025) Enhancing the role of MRI in rectal cancer: advances from staging to prognosis prediction. Eur Radiol 35:5714\u20135732","journal-title":"Eur Radiol"},{"key":"12516_CR10","doi-asserted-by":"publisher","unstructured":"Lurz M, Sch\u00e4fer AO (2025) The avocado sign: a novel imaging marker for nodal staging in rectal cancer. Eur Radiol. https:\/\/doi.org\/10.1007\/s00330-025-11462-y","DOI":"10.1007\/s00330-025-11462-y"},{"key":"12516_CR11","doi-asserted-by":"publisher","first-page":"4080","DOI":"10.1007\/s00330-025-11361-2","volume":"35","author":"MK Ruteg\u00e5rd","year":"2025","unstructured":"Ruteg\u00e5rd MK, B\u00e5tsman M, Blomqvist L et al (2025) Evaluation of MRI characterisation of histopathologically matched lymph nodes and other mesorectal nodal structures in rectal cancer. Eur Radiol 35:4080\u20134090","journal-title":"Eur Radiol"},{"key":"12516_CR12","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1007\/s11605-017-3568-x","volume":"22","author":"J Gr\u00f6ne","year":"2018","unstructured":"Gr\u00f6ne J, Loch FN, Taupitz M, Schmidt C, Kreis ME (2018) Accuracy of various lymph node staging criteria in rectal cancer with magnetic resonance imaging. J Gastrointest Surg 22:146\u2013153","journal-title":"J Gastrointest Surg"},{"key":"12516_CR13","doi-asserted-by":"publisher","unstructured":"Jiang L, Zhuang Z, Tang X et al (2025) Diagnostic performance of node-RADS classification for primary lymph node assessment in rectal cancer: a modality benchmarking study. J Cancer Res Clin Oncol. https:\/\/doi.org\/10.1007\/s00432-025-04812-x","DOI":"10.1007\/s00432-025-04812-x"},{"key":"12516_CR14","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1007\/s00261-020-02708-y","volume":"46","author":"S Pangarkar","year":"2021","unstructured":"Pangarkar S, Mistry K, Choudhari A et al (2021) Accuracy of MRI for nodal restaging in rectal cancer: a retrospective study of 166 cases. Abdom Radiol (NY) 46:498\u2013505","journal-title":"Abdom Radiol (NY)"},{"key":"12516_CR15","doi-asserted-by":"publisher","DOI":"10.1186\/s40644-023-00589-0","volume":"23","author":"Z Zhang","year":"2023","unstructured":"Zhang Z, Chen Y, Wen Z et al (2023) MRI for nodal restaging after neoadjuvant therapy in rectal cancer with histopathologic comparison. Cancer Imaging 23:67","journal-title":"Cancer Imaging"},{"key":"12516_CR16","doi-asserted-by":"publisher","first-page":"3205","DOI":"10.1007\/s00330-023-10265-3","volume":"34","author":"F Crim\u00ec","year":"2024","unstructured":"Crim\u00ec F, Cabrelle G, Campi C et al (2024) Nodal staging with MRI after neoadjuvant chemo-radiotherapy for locally advanced rectal cancer: a fast and reliable method. Eur Radiol 34:3205\u20133214","journal-title":"Eur Radiol"},{"key":"12516_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110124","volume":"193","author":"B Barbaro","year":"2024","unstructured":"Barbaro B, Carafa MRP, Minordi LM et al (2024) Magnetic resonance imaging for assessment of rectal cancer nodes after chemoradiotherapy: a single center experience. Radiother Oncol 193:110124","journal-title":"Radiother Oncol"},{"key":"12516_CR18","doi-asserted-by":"publisher","first-page":"2757","DOI":"10.21873\/anticanres.14247","volume":"40","author":"K Alml\u00f6v","year":"2020","unstructured":"Alml\u00f6v K, Woisetschl\u00e4ger M, Loft\u00e5s P, Hallb\u00f6\u00f6k O, Elander NO, Sandstr\u00f6m P (2020) MRI lymph node evaluation for prediction of metastases in rectal cancer. Anticancer Res 40:2757\u20132763","journal-title":"Anticancer Res"},{"key":"12516_CR19","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/j.ijrobp.2007.10.016","volume":"71","author":"DM Koh","year":"2008","unstructured":"Koh DM, Chau I, Tait D, Wotherspoon A, Cunningham D, Brown G (2008) Evaluating mesorectal lymph nodes in rectal cancer before and after neoadjuvant chemoradiation using thin-section T2-weighted magnetic resonance imaging. Int J Radiat Oncol Biol Phys 71:456\u2013461","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"12516_CR20","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.709070","volume":"11","author":"Z Zhuang","year":"2021","unstructured":"Zhuang Z, Zhang Y, Wei M, Yang X, Wang Z (2021) Magnetic resonance imaging evaluation of the accuracy of various lymph node staging criteria in rectal cancer: a systematic review and meta-analysis. Front Oncol 11:709070","journal-title":"Front Oncol"},{"key":"12516_CR21","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159\u2013174","journal-title":"Biometrics"},{"key":"12516_CR22","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.2214\/AJR.19.21383","volume":"213","author":"X Jia","year":"2019","unstructured":"Jia X, Zhang Y, Wang Y et al (2019) MRI for restaging locally advanced rectal cancer: detailed analysis of discrepancies with the pathologic reference standard. AJR Am J Roentgenol 213:1081\u20131090","journal-title":"AJR Am J Roentgenol"},{"key":"12516_CR23","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1007\/s00261-012-9957-4","volume":"38","author":"DMJ Lambregts","year":"2013","unstructured":"Lambregts DMJ, Heijnen LA, Maas M et al (2013) Gadofosveset-enhanced MRI for the assessment of rectal cancer lymph nodes: predictive criteria. Abdom Imaging 38:720\u2013727","journal-title":"Abdom Imaging"},{"key":"12516_CR24","doi-asserted-by":"publisher","first-page":"2546","DOI":"10.1200\/JCO.22.00032","volume":"40","author":"J Garcia-Aguilar","year":"2022","unstructured":"Garcia-Aguilar J, Patil S, Gollub MJ et al (2022) Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy. J Clin Oncol 40:2546\u20132556","journal-title":"J Clin Oncol"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12516-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12516-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12516-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:31:06Z","timestamp":1783431066000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12516-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,18]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["12516"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12516-5","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,18]]},"assertion":[{"value":"24 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Markus Lurz, MD.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Statistical methods in this paper were performed by the authors. Methods include DeLong tests for AUC comparison, bootstrap CIs, and stratified k-fold cross-validation, all implemented using established R packages.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was waived by the Institutional Review Board due to the retrospective nature of the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Some study subjects or cohorts have been previously reported in Lurz M, Sch\u00e4fer AO (2025) [\n                      \n                      ]. The present cohort (\n                      n\n                      \u2009=\u2009120) includes 106 patients from the original publication plus 14 additional patients recruited subsequently. Both readers remained unchanged, ensuring consistency in image interpretation. The previous publication focused on the initial morphological description and definition of the sign. The present study performs a distinct, blinded head-to-head statistical comparison against established T2-weighted criteria.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}