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MRI Evaluation of Rectal Carcinoma

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Cross-Sectional Imaging of the Abdomen and Pelvis

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Abstract

MR imaging plays a key role in the initial staging of rectal cancer as well as in the assessment of tumor response to preoperative chemoradiotherapy. The excellent spatial and temporal resolution of MRI helps to evaluate the various key structures such as the mesorectal fascia, peritoneal reflection, and pelvic viscera that may be involved by the tumor. Although MRI is limited in nodal assessment, certain morphological characteristics on T1- and T2-weighted images may be useful for predicting nodal involvement. Diffusion weighted imaging is a useful functional imaging technique and may be helpful in evaluating tumor response following chemoradiotherapy.

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References

  1. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594–642.

    Article  CAS  Google Scholar 

  2. Salerno G, Sinnatamby C, Branagan G, Daniels IR, Heald RJ, Moran BJ. Defining the rectum: surgically, radiologically and anatomically. Colorectal Dis. 2006;8 Suppl 3:5–9.

    Article  Google Scholar 

  3. Smith N, Brown G. Preoperative staging of rectal cancer. Acta Oncol. 2008;47:20–31.

    Article  Google Scholar 

  4. McDermott FT, Hughes ES, Pihl E, Johnson WR, Price AB. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg. 1985;72:34–7.

    Article  CAS  Google Scholar 

  5. Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg. 1995;181:335–46.

    CAS  PubMed  Google Scholar 

  6. Nagtegaal ID, van de Velde CJ, Marijnen CA, et al. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol. 2005;23:9257–64.

    Article  Google Scholar 

  7. Rödel C, Sauer R. Neoadjuvant radiotherapy and radiochemotherapy for rectal cancer. Recent Results Cancer Res. 2005;165:221–30.

    Article  Google Scholar 

  8. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.

    Article  CAS  Google Scholar 

  9. Sauer R. Adjuvant and neoadjuvant radiotherapy and concurrent radiochemotherapy for rectal cancer. Pathol Oncol Res. 2002;8:7–17.

    Article  CAS  Google Scholar 

  10. Kaur H, Choi H, You YN, et al. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. Radiographics. 2012;32:389–409.

    Article  Google Scholar 

  11. Shin US, Yu CS, Kim JH, et al. Mucinous rectal cancer: effectiveness of preoperative chemoradiotherapy and prognosis. Ann Surg Oncol. 2011;18:2232–9.

    Article  Google Scholar 

  12. Donmez FY, Tunaci M, Yekeler E, Balik E, Tunaci A, Acunas G. Effect of using endorectal coil in preoperative staging of rectal carcinomas by pelvic MR imaging. Eur J Radiol. 2008;67:139–45.

    Article  Google Scholar 

  13. Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging–a meta-analysis. Radiology. 2004;232:773–83.

    Article  Google Scholar 

  14. Bianchi PP, Ceriani C, Rottoli M, et al. Endoscopic ultrasonography and magnetic resonance in preoperative staging of rectal cancer: comparison with histologic findings. J Gastrointest Surg. 2005;9:1222–7; discussion 1227–8.

    Article  Google Scholar 

  15. Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P. The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Colorectal Dis. 2001;16:298–304.

    Article  CAS  Google Scholar 

  16. Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 2003;90:355–64.

    Article  CAS  Google Scholar 

  17. MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243:132–9.

    Article  Google Scholar 

  18. Vliegen R, Dresen R, Beets G, et al. The accuracy of Multi-detector row CT for the assessment of tumor invasion of the mesorectal fascia in primary rectal cancer. Abdom Imaging. 2008;33:604–10.

    Article  Google Scholar 

  19. Evans J, Patel U, Brown G. Rectal cancer: primary staging and assessment after chemoradiotherapy. Semin Radiat Oncol. 2011;21:169–77.

    Article  Google Scholar 

  20. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.

    Article  CAS  Google Scholar 

  21. Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002;235:449–57.

    Article  Google Scholar 

  22. Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet. 2001;357:497–504.

    Article  CAS  Google Scholar 

  23. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333:779.

    Article  Google Scholar 

  24. Taylor FG, Quirke P, Heald RJ, et al. One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. Br J Surg. 2011;98:872–9.

    Article  CAS  Google Scholar 

  25. Taylor FG, Swift RI, Blomqvist L, Brown G. A systematic approach to the interpretation of preoperative staging MRI for rectal cancer. AJR Am J Roentgenol. 2008;191:1827–35.

    Article  Google Scholar 

  26. Lahaye MJ, Engelen SM, Nelemans PJ, et al. Imaging for predicting the risk factors–the circumferential resection margin and nodal disease–of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR. 2005;26:259–68.

    Article  CAS  Google Scholar 

  27. Koh DM, George C, Temple L, et al. Diagnostic accuracy of nodal enhancement pattern of rectal cancer at MRI enhanced with ultrasmall superparamagnetic iron oxide: findings in pathologically matched mesorectal lymph nodes. AJR Am J Roentgenol. 2010;194:W505–13.

    Article  Google Scholar 

  28. Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings–initial observations. Radiology. 2004;231:91–9.

    Article  Google Scholar 

  29. Lahaye MJ, Engelen SM, Kessels AG, et al. USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology. 2008;246:804–11.

    Article  Google Scholar 

  30. MERCURY Study Group. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg. 2011;98:1798–804.

    Article  Google Scholar 

  31. Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg. 2008;95:229–36.

    Article  CAS  Google Scholar 

  32. Taylor A, Slater A, Mapstone N, Taylor S, Halligan S. Staging rectal cancer: MRI compared to MDCT. Abdom Imaging. 2007;32:323–7.

    Article  Google Scholar 

  33. Muthusamy VR, Chang KJ. Optimal methods for staging rectal cancer. Clin Cancer Res. 2007;13:6877s–84.

    Article  Google Scholar 

  34. Thompson WM, Halvorsen RA, Foster WL, Roberts L, Gibbons R. Preoperative and postoperative CT staging of rectosigmoid carcinoma. AJR Am J Roentgenol. 1986;146:703–10.

    Article  CAS  Google Scholar 

  35. Dworák O. Number and size of lymph nodes and node metastases in rectal carcinomas. Surg Endosc. 1989;3:96–9.

    Article  Google Scholar 

  36. Meyenberger C, Huch Böni RA, Bertschinger P, Zala GF, Klotz HP, Krestin GP. Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancer. Endoscopy. 1995;27:469–79.

    Article  CAS  Google Scholar 

  37. Massari M, De Simone M, Cioffi U, Rosso L, Chiarelli M, Gabrielli F. Value and limits of endorectal ultrasonography for preoperative staging of rectal carcinoma. Surg Laparosc Endosc. 1998;8:438–44.

    Article  CAS  Google Scholar 

  38. Ptok H, Marusch F, Meyer F, et al. Feasibility and accuracy of TRUS in the pre-treatment staging for rectal carcinoma in general practice. Eur J Surg Oncol. 2006;32:420–5.

    Article  CAS  Google Scholar 

  39. Ashraf S, Hompes R, Slater A, et al. A critical appraisal of endorectal ultrasound and transanal endoscopic microsurgery and decision-making in early rectal cancer. Colorectal Dis. 2012;14(7):821–6.

    Article  CAS  Google Scholar 

  40. Puli SR, Reddy JB, Bechtold ML, Choudhary A, Antillon MR, Brugge WR. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. Ann Surg Oncol. 2009;16:1255–65.

    Article  Google Scholar 

  41. Marone P, de Bellis M, Avallone A, et al. Accuracy of endoscopic ultrasound in staging and restaging patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Clin Res Hepatol Gastroenterol. 2011;35:666–70.

    Article  Google Scholar 

  42. Thornton A, Lee P. Publication bias in meta-analysis: its causes and consequences. J Clin Epidemiol. 2000;53:207–16.

    Article  CAS  Google Scholar 

  43. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer. Int J Colorectal Dis. 2000;15:9–20.

    Article  CAS  Google Scholar 

  44. Maizlin ZV, Brown JA, So G, et al. Can CT replace MRI in preoperative assessment of the circumferential resection margin in rectal cancer? Dis Colon Rectum. 2010;53:308–14.

    Article  Google Scholar 

  45. Ahmetoğlu A, Cansu A, Baki D, et al. MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. Abdom Imaging. 2011;36:31–7.

    Article  Google Scholar 

  46. García-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003;46:298–304.

    Article  Google Scholar 

  47. Stipa F, Chessin DB, Shia J, et al. A pathologic complete response of rectal cancer to preoperative combined-modality therapy results in improved oncological outcome compared with those who achieve no downstaging on the basis of preoperative endorectal ultrasonography. Ann Surg Oncol. 2006;13:1047–53.

    Article  Google Scholar 

  48. Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol. 2011;29:3753–60.

    Article  Google Scholar 

  49. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12:19–23.

    Article  CAS  Google Scholar 

  50. Barbaro B, Fiorucci C, Tebala C, et al. Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology. 2009;250:730–9.

    Article  Google Scholar 

  51. Maretto I, Pomerri F, Pucciarelli S, et al. The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol. 2007;14:455–61.

    Article  Google Scholar 

  52. Chen CC, Lee RC, Lin JK, Wang LW, Yang SH. How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum. 2005;48:722–8.

    Article  Google Scholar 

  53. Kim SH, Lee JM, Hong SH, et al. Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology. 2009;253:116–25.

    Article  Google Scholar 

  54. Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H. 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. 2011;260:771–80.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Dhakshina Moorthy Ganeshan MD & Khaled M. Elsayes MD

  2. Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Harmeet Kaur MD & Randy D. Ernst MD

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  1. Dhakshina Moorthy Ganeshan MD
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  2. Harmeet Kaur MD
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  3. Randy D. Ernst MD
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  4. Khaled M. Elsayes MD
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Correspondence to Dhakshina Moorthy Ganeshan MD .

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Editors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Khaled M. Elsayes MD

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Ganeshan, D.M., Kaur, H., Ernst, R.D., Elsayes, K.M. (2015). MRI Evaluation of Rectal Carcinoma. In: Elsayes, K.M. (eds) Cross-Sectional Imaging of the Abdomen and Pelvis. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1884-3_14

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  • DOI: https://doi.org/10.1007/978-1-4939-1884-3_14

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  • Online ISBN: 978-1-4939-1884-3

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