Abdominal Radiology

, Volume 44, Issue 2, pp 438–445 | Cite as

Can MR imaging be useful in differentiating low rectal cancer from anal cancer?

  • Kamonwon Cattapan
  • Thitinan Chulroek
  • Dearada Wancharoenrung
  • Hamed Kordbacheh
  • Mukesh HarisinghaniEmail author



To evaluate the role of pelvic MR imaging in differentiating between low rectal and anal cancers using the pathological results as the gold standard.

Materials and methods

In this study, retrospective analysis of 100 patients with a history of low rectal (n = 50) or anal (n = 50) cancers who underwent staging pelvic MR imaging before treatment was performed. The following parameters were analyzed: distance from the anal verge to the tumor, percentage of tumor above puborectalis muscle, tumor size, T2W signal intensity, sphincter/levator muscles invasion, organ invasion, and MRI diagnosis. Multivariable logistic regression was performed to determine factors associated with low rectal and anal cancers. Distances from the anal verge to the tumor were compared using receiver-operating characteristic (ROC) curves.


From the ROC curves, the cut-off value for the distance from the anal verge to the tumor in differentiating between low rectal and anal cancers was 2.1 cm and the area under the ROC curve was 0.90 (95% CI 0.84–0.97). Multivariate logistic regression revealed three significant factors in differentiating between low rectal and anal cancers, including T2 mixed hyper- and hyposignal intensity (OR 66.00, 95% CI 4.66–934.81), distance cut-off value (OR 34.72, 95% CI 5.73–210.27), and absence of sphincter invasion (OR 18.75, 95% CI 1.91–183.96), with sensitivity, specificity, PPV, and NPV of 98%, 88%, 89%, and 97%, respectively, and diagnostic accuracy increased from 79% (reader 1) and 82% (reader 2) to 93%.


MR imaging can be useful to differentiating between low rectal and anal cancers which benefits staging and treatment planning.


Low rectal cancer Anal cancer MRI Cancer imaging 



The authors thank Glenn Shingledecker for manuscript preparation.

Compliance with ethical standards


This study was not funded.


Noting to disclose.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyMassachusetts General HospitalBostonUSA
  2. 2.Department of RadiologyPrince of Songkla UniversitySongkhlaThailand
  3. 3.Department of Diagnostic Radiology, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkokThailand
  4. 4.Department of Diagnostic Radiology, Faculty of Medicine, Vajira HospitalNawamindradhiraj UniversityBangkokThailand

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