Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017
To propose guidelines based on an expert-panel-derived unified approach to the technical performance, interpretation, and reporting of MRI for baseline and post-treatment staging of rectal carcinoma.
A consensus-based questionnaire adopted with permission and modified from the European Society of Gastrointestinal and Abdominal Radiologists was sent to a 17-member expert panel from the Rectal Cancer Disease-Focused Panel of the Society of Abdominal Radiology containing 268 question parts. Consensus on an answer was defined as ≥ 70% agreement. Answers not reaching consensus (< 70%) were noted.
Consensus was reached for 87% of items from which recommendations regarding patient preparation, technical performance, pulse sequence acquisition, and criteria for MRI assessment at initial staging and restaging exams and for MRI reporting were constructed.
These expert consensus recommendations can be used as guidelines for primary and post-treatment staging of rectal cancer using MRI.
KeywordsRectal MRI Rectal cancer Expert panel Consensus recommendations White paper
The authors would like to thank Drs. Doenja Lambregts and Monique Maas for help with the European questionnaire. We would also like to thank several members of the DFP that were not on the expert panel but contributed to the formation of the dictation templates including Drs. Bruce Minsky, Martin Weiser, Raj Paspulati, Dhakshin Ganeshan, Naomi Campbell, and Randy Ernst. Grant Support: National Institutes of Health (R25CA020449).
Compliance with ethical standards
This study was funded by the National Institutes of Health (R25CA020449).
Conflict of interest
All authors report nothing to disclose and no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
- 5.Lezoche G, Baldarelli M, Guerrieri M, et al. (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22(2):352–358. https://doi.org/10.1007/s00464-007-9596-y CrossRefPubMedGoogle Scholar
- 6.Habr-Gama A, Gama-Rodrigues J, Sao Juliao GP, et al. (2014) Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 88(4):822–828. https://doi.org/10.1016/j.ijrobp.2013.12.012 CrossRefPubMedGoogle Scholar
- 9.Beets-Tan RGH, Lambregts DMJ, Mass M, et al. (2013) Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 23(9):2522–2531. https://doi.org/10.1007/s00330-013-2864-4 CrossRefPubMedGoogle Scholar
- 10.Beets-Tan RGH, Lambregts DMJ, Mass 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(4):1465–1475. https://doi.org/10.1007/s00330-017-5026-2 CrossRefPubMedGoogle Scholar
- 13.Al-Sukhni E, Messenger DE, Charles Victor J, McLeod RS, Kennedy ED (2013) Do MRI reports contain adequate preoperative staging information for end users to Make appropriate treatment decisions for rectal cancer? Ann Surg Oncol 20(4):1148–1155. https://doi.org/10.1245/s10434-012-2738-z CrossRefPubMedGoogle Scholar
- 15.Norenberg D, Sommer WH, Thasler W, et al. (2017) Structured reporting of rectal magnetic resonance imaging in suspected primary rectal cancer: potential benefits for surgical planning and interdisciplinary communication. Investig Radiol 52(4):232–239. https://doi.org/10.1097/RLI.0000000000000336 CrossRefGoogle Scholar
- 16.Dobranowski J (2015) Structured reporting in cancer imaging: reaching the quality dimension in communication. HealthManagement 15(4):268–271Google Scholar
- 17.Al-Sukhni E, Milto L, Fruitman M, Brown G, Schmocker S, Kennedy E (2014) MR Rectal Tumour.Google Scholar
- 19.Maas M, Lambregts DM, Nelemans PJ, et al. (2015) Assessment of clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI: selection for organ-saving treatment. Ann Surg Oncol 22(12):3873–3880. https://doi.org/10.1245/s10434-015-4687-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Brown G, Richards CJ, Newcombe RG, et al. (1999) Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 211(1):215–222. https://doi.org/10.1148/radiology.211.1.r99ap35215 CrossRefPubMedGoogle Scholar
- 26.Sassen S, de Booij M, Sosef M, et al. (2013) Locally advanced rectal cancer: is diffusion weighted MRI helpful for the identification of complete responders (ypT0N0) after neoadjuvant chemoradiation therapy? Eur Radiol 23(12):3440–3449. https://doi.org/10.1007/s00330-013-2956-1 CrossRefPubMedGoogle Scholar
- 27.Lahaye MJ, Beets GL, Engelen SME, et al. (2009) Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy part II. What are the criteria to predict involved lymph nodes? Radiology 252(1):81–91. https://doi.org/10.1148/radiol.2521081364 CrossRefPubMedGoogle Scholar
- 30.Helmer-Hirschberg O (1967) Analysis of the future: the Delphi method. Santa Monica: The Rand Corporation, p 11Google Scholar
- 36.Lambregts DM, Vandecaveye V, Barbaro B, et al. (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18(8):2224–2231. https://doi.org/10.1245/s10434-011-1607-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Song I, Kim SH, Lee SJ, et al. (2012) Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison with T2 weighted and PET/CT imaging. Br J Radiol 85(1013):577–586. https://doi.org/10.1259/bjr/68424021 CrossRefPubMedPubMedCentralGoogle Scholar
- 38.van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S (2013) Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology 269(1):101–112. https://doi.org/10.1148/radiol.13122833 CrossRefPubMedGoogle Scholar
- 41.Slater A, Halligan S, Taylor SA, Marshall M (2006) Distance between the rectal wall and mesorectal fascia measured by MRI: effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin. Clin Radiol 61(1):65–70. https://doi.org/10.1016/j.crad.2005.08.010 CrossRefPubMedGoogle Scholar
- 43.Van Griethuysen JJM, Bus, E., Hauptmann, M. et al. (2017) Air artefacts on diffusion-weighted MRI of the rectum: effect of applying a rectal micro-enema. Insights into Imaging ECR 2017—BOOK OF ABSTRACTS 8(1):S187. https://doi.org/10.1007/s13244-017-0546-5
- 48.Stijns RCH STJ, de Wilt JHW, Fütterer JJ, Beets-Tan RGH (2018) The influence of endorectal filling on rectal cancer staging with MRI. Br J RadiolGoogle Scholar
- 63.Petrillo A, Fusco R, Petrillo M, et al. (2017) Standardized index of shape (DCE-MRI) and standardized uptake value (PET/CT): two quantitative approaches to discriminate chemo-radiotherapy locally advanced rectal cancer responders under a functional profile. Oncotarget 8(5):8143–8153. https://doi.org/10.18632/oncotarget.14106 CrossRefPubMedGoogle Scholar
- 64.Joye I, Deroose CM, Vandecaveye V, Haustermans K (2014) The role of diffusion-weighted MRI and 18F-FDG PET/CT in the prediction of pathologic complete response after radiochemotherapy for rectal cancer: a systematic review. Radiother Oncol 113(2):158–165. https://doi.org/10.1016/j.radonc.2014.11.026 CrossRefPubMedGoogle Scholar
- 67.Lambregts DM, Rao SX, Sassen S, et al. (2015) MRI and diffusion-weighted MRI volumetry for identification of complete tumor responders after preoperative chemoradiotherapy in patients with rectal cancer: a Bi-institutional Validation Study. Ann Surg 262(6):1034–1039. https://doi.org/10.1097/sla.0000000000000909 CrossRefPubMedGoogle Scholar
- 74.National working group gastrointestinal tumours (2014) National Guideline on Rectal Cancer, version 3.0. https://www.oncoline.nl
- 79.Lee ES, Kim MJ, Park SC, et al. (2018) Magnetic resonance imaging-detected extramural venous invasion in rectal cancer before and after preoperative chemoradiotherapy: diagnostic performance and prognostic significance. Eur Radiol 28(2):496–505. https://doi.org/10.1007/s00330-017-4978-6 CrossRefPubMedGoogle Scholar
- 84.Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H (2011) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology 260(3):771–780. https://doi.org/10.1148/radiol.11102135 CrossRefPubMedGoogle Scholar
- 85.PROSPECT: chemotherapy alone or chemotherapy plus radiation therapy in treating patients with locally advanced rectal cancer undergoing surgery. https://ClinicalTrials.gov/show/NCT01515787,
- 86.Rymer B, Curtis NJ, Siddiqui MR, Chand M (2016) FDG PET/CT can assess the response of locally advanced rectal cancer to neoadjuvant chemoradiotherapy: evidence from meta-analysis and systematic review. Clin Nucl Med 41(5):371–375. https://doi.org/10.1097/RLU.0000000000001166 CrossRefPubMedGoogle Scholar