26 Chapter 2 Figure 3 Sagittal image (A) showing a stenosing tumour in the mid-rectum with corresponding crosssection (B) at the mid-tumour level. Adjacent to the tumour there is some desmoplastic stranding as well as several small vessels that radiate outward from the edge of the muscularis propria into the perirectal fat (arrows in B). Because no tumour signal extends into, interrupts or expands these vessels, this case was scored as EMVI-negative by expert consensus. There was however, considerable variation among the study readers; 57% considered this case as EMVI+, 33% as EMVI- and 10% assigned an equivocal score. EMVI IOA to assess EMVI was relatively low and >80% consensus between readers was only reached in 55% of the study cases, with a mean agreement with the expert reference of 77%. Agreement with the expert reference to diagnose EMVI+ tumours (69%) was poorer than for the diagnosis of EMVI- tumours (82%), see Figure 3.
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