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Magnetic Resonance Imaging of the Rectum

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Rectal Cancer

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Abstract

In recent years preoperative staging and assessment of rectal cancer has moved away from reliance on clinical and ultrasonographic assessment to detailed prognostic assessment afforded by high-resolution MRI. As with surgery and other modes of treatment, the use of preoperative staging is variable, and a minimum standard for both the technique and interpretation in staging rectal cancer needs to be followed to obtain the best results for patients. This chapter aims to highlight the important standards to establish or maintain in rectal cancer staging and the techniques in interpretation that will enable consistently accurate assessment as demonstrated in published multicentre studies.

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References

  1. Cawthorn SJ, Parums DV, Gibbs NM, A'Hern RP, Caffarey SM, Broughton CI, Marks CG. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet. 1990;335(8697):1055–9.

    Article  CAS  PubMed  Google Scholar 

  2. Willett CG, Badizadegan K, Ancukiewicz M, Shellito PC. Prognostic factors in stage T3N0 rectal cancer: do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum. 1999;42(2):167–73.

    Article  CAS  PubMed  Google Scholar 

  3. 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(5):298–304.

    Google Scholar 

  4. Compton CC, Greene FL. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin. 2004;54(6):295–308.

    Article  PubMed  Google Scholar 

  5. MERCURYStudyGroup. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243(1):132–9.

    Article  Google Scholar 

  6. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, Sebag-Montefiore DJ, Tekkis P, Brown G. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011;253(4):711–9.

    Article  PubMed  Google Scholar 

  7. Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, Soreide O. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002;89(3):327–34.

    Article  CAS  PubMed  Google Scholar 

  8. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, Dixon MF, Quirke P. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994;344(8924):707–11.

    Article  CAS  PubMed  Google Scholar 

  9. Bissett IP, Fernando CC, Hough DM, Cowan BR, Chau KY, Young AA, Parry BR, Hill GL. Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer. Dis Colon Rectum. 2001;44(2):259–65.

    Article  CAS  PubMed  Google Scholar 

  10. 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(3):355–64.

    Article  CAS  PubMed  Google Scholar 

  11. MERCURYStudyGroup. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333(7572):779.

    Article  Google Scholar 

  12. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, St Rose S, Sebag-Montefiore DJ, Tekkis P, Brown G. One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. Br J Surg. 2011;98(6):872–9.

    Article  CAS  PubMed  Google Scholar 

  13. SwedishRectalCancerTrial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336(14):980–7.

    Article  Google Scholar 

  14. Pahlman L, Karlbom U. Teaching efforts to spread TME surgery in Sweden. Recent Results Cancer Res. 2005;165:82–5.

    Article  PubMed  Google Scholar 

  15. Chand M, Heald RJ, Brown G. The importance of not overstaging mesorectal lymph nodes seen on MRI. Color Dis. 2013;15(10):1201–4.

    Article  CAS  Google Scholar 

  16. Dworak O. Number and size of lymph nodes and node metastases in rectal carcinomas. Surg Endosc. 1989;3(2):96–9.

    Article  CAS  PubMed  Google Scholar 

  17. Talbot IC, Ritchie S, Leighton MH, Hughes AO, Bussey HJ, Morson BC. The clinical significance of invasion of veins by rectal cancer. Br J Surg. 1980;67(6):439–42.

    Article  CAS  PubMed  Google Scholar 

  18. Gunther K, Dworak O, Remke S, Pfluger R, Merkel S, Hohenberger W, Reymond MA. Prediction of distant metastases after curative surgery for rectal cancer. J Surg Res. 2002;103(1):68–78.

    Article  PubMed  Google Scholar 

  19. Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer. 1983;52(7):1317–29.

    Article  CAS  PubMed  Google Scholar 

  20. 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(2):229–36.

    Article  CAS  PubMed  Google Scholar 

  21. Kirsch R, Messenger DE, Riddell RH, Pollett A, Cook M, Al-Haddad S, Streutker CJ, Divaris DX, Pandit R, Newell KJ, Liu J, Price RG, Smith S, Parfitt JR, Driman DK. Venous invasion in colorectal cancer: impact of an elastin stain on detection and interobserver agreement among gastrointestinal and nongastrointestinal pathologists. Am J Surg Pathol. 2013;37(2):200–10.

    Article  PubMed  Google Scholar 

  22. Messenger DE, Driman DK, Kirsch R. Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome. Hum Pathol. 2012;43(7):965–73.

    Article  PubMed  Google Scholar 

  23. Messenger DE, Driman DK, Kirsch R. Authors’ response – the prognostic benefits of routine staining with elastica to increase detection of venous invasion in colorectal cancer specimens. J Clin Pathol. 2012;65(5):470.

    Article  PubMed  Google Scholar 

  24. Messenger DE, Driman DK, McLeod RS, Riddell RH, Kirsch R. Current practice patterns among pathologists in the assessment of venous invasion in colorectal cancer. J Clin Pathol. 2011;64(11):983–9.

    Article  PubMed  Google Scholar 

  25. Howlett CJ, Tweedie EJ, Driman DK. Use of an elastic stain to show venous invasion in colorectal carcinoma: a simple technique for detection of an important prognostic factor. J Clin Pathol. 2009;62(11):1021–5.

    Article  CAS  PubMed  Google Scholar 

  26. Smith NJ, Shihab O, Arnaout A, Swift RI, Brown G. MRI for detection of extramural vascular invasion in rectal cancer. AJR Am J Roentgenol. 2008;191(5):1517–22.

    Article  PubMed  Google Scholar 

  27. Chand M, Evans J, Swift RI, Tekkis PP, West NP, Stamp G, Heald RJ, Brown G. The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer. Ann Surg. 2015;261(3):473–9.

    Article  PubMed  Google Scholar 

  28. 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  PubMed  Google Scholar 

  29. Moran BJ, Holm T, Brannagan G, Chave H, Quirke P, West N, Brown G, Glynne-Jones R, Sebag D, Cunningham C, Janjua AZ, Battersby N, Crane S, McMeeking A. The English national low rectal cancer development programme (LOREC): key messages and future perspectives. Color Dis. 2014;16:173.

    Article  CAS  Google Scholar 

  30. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.

    Article  PubMed  Google Scholar 

  31. Marr R, Birbeck K, Garvican J, Macklin CP, Tiffin NJ, Parsons WJ, Dixon MF, Mapstone NP, Sebag-Montefiore D, Scott N, Johnston D, Sagar P, Finan P, Quirke P. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg. 2005;242(1):74–82.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Nagtegaal ID, van de Velde CJ, Marijnen CA, van Krieken JH, Quirke P. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol. 2005;23(36):9257–64.

    Article  PubMed  Google Scholar 

  33. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol. 2008;26(2):303–12.

    Article  PubMed  Google Scholar 

  34. Jorgren F, Johansson R, Damber L, Lindmark G. Oncological outcome after incidental perforation in radical rectal cancer surgery. Int J Color Dis. 2010;25(6):731–40.

    Article  Google Scholar 

  35. Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, Abbott CR, Scott N, Finan PJ, Johnston D, Quirke P. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002;235(4):449–57.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Moran BJ. Predicting the risk and diminishing the consequences of anastomotic leakage after anterior resection for rectal cancer. Acta Chir Iugosl. 2010;57(3):47–50.

    Article  CAS  PubMed  Google Scholar 

  37. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85(3):355–8.

    Article  CAS  PubMed  Google Scholar 

  38. Battersby NJ, How P, Moran B, Stelzner S, West NP, Branagan G, Strassburg J, Quirke P, Tekkis P, Pedersen BG, Gudgeon M, Heald B, Brown G, MERCURY II Study Group. Prospective validation of a low rectal cancer magnetic resonance imaging staging system and development of a local recurrence risk stratification model: the MERCURY II study. Ann Surg. 2015;263:751.

    Article  Google Scholar 

  39. Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF, Roussel A, Jacob JH, Segol P, Samama G, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73(11):2680–6.

    Article  CAS  PubMed  Google Scholar 

  40. Patel UB, Taylor F, Blomqvist L, George C, Evans H, Tekkis P, Quirke P, Sebag-Montefiore D, Moran B, Heald R, Guthrie A, Bees N, Swift I, Pennert K, Brown G. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol. 2011;29(28):3753–60.

    Article  PubMed  Google Scholar 

  41. Salerno GV, Daniels IR, Moran BJ, Heald RJ, Thomas K, Brown G. Magnetic resonance imaging prediction of an involved surgical resection margin in low rectal cancer. Dis Colon Rectum. 2009;52(4):632–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, The Royal Marsden NHS Foundation Trust, Imperial College London, London, UK

    Gina Brown

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  1. Gina Brown
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Correspondence to Gina Brown .

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Editors and Affiliations

  1. Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA

    George J. Chang

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Brown, G. (2018). Magnetic Resonance Imaging of the Rectum. In: Chang, G. (eds) Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-16384-0_3

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  • DOI: https://doi.org/10.1007/978-3-319-16384-0_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16383-3

  • Online ISBN: 978-3-319-16384-0

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