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Imaging in rectal cancer with emphasis on local staging with MRI.

Arya S, Das D, Engineer R, Saklani A - Indian J Radiol Imaging (2015 Apr-Jun)

Bottom Line: Contrast-enhanced MRI is considered inappropriate for both primary staging and restaging.Diffusion-weighted sequence may be of value in restaging.Multidetector CT cannot replace MRI in local staging, but has an important role for evaluating distant metastases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India.

ABSTRACT
Imaging in rectal cancer has a vital role in staging disease, and in selecting and optimizing treatment planning. High-resolution MRI (HR-MRI) is the recommended method of first choice for local staging of rectal cancer for both primary staging and for restaging after preoperative chemoradiation (CT-RT). HR-MRI helps decide between upfront surgery and preoperative CT-RT. It provides high accuracy for prediction of circumferential resection margin at surgery, T category, and nodal status in that order. MRI also helps assess resectability after preoperative CT-RT and decide between sphincter saving or more radical surgery. Accurate technique is crucial for obtaining high-resolution images in the appropriate planes for correct staging. The phased array external coil has replaced the endorectal coil that is no longer recommended. Non-fat suppressed 2D T2-weighted (T2W) sequences in orthogonal planes to the tumor are sufficient for primary staging. Contrast-enhanced MRI is considered inappropriate for both primary staging and restaging. Diffusion-weighted sequence may be of value in restaging. Multidetector CT cannot replace MRI in local staging, but has an important role for evaluating distant metastases. Positron emission tomography-computed tomography (PET/CT) has a limited role in the initial staging of rectal cancer and is reserved for cases with resectable metastatic disease before contemplating surgery. This article briefly reviews the comprehensive role of imaging in rectal cancer, describes the role of MRI in local staging in detail, discusses the optimal MRI technique, and provides a synoptic report for both primary staging and restaging after CT-RT in routine practice.

No MeSH data available.


Related in: MedlinePlus

(A) Sagittal T2W MRI showing division into upper, mid, and lower rectum (R), bladder (b), prostate (P). (B and C) Axial T2W MRI. Arrows in (a and b) show rectosigmoid junction. (C) Section at the level of seminal vesicles (SV) shows normal rectum with hyperintense submucosa (*) and darkly hypointense muscularis propria (arrow)
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Figure 2: (A) Sagittal T2W MRI showing division into upper, mid, and lower rectum (R), bladder (b), prostate (P). (B and C) Axial T2W MRI. Arrows in (a and b) show rectosigmoid junction. (C) Section at the level of seminal vesicles (SV) shows normal rectum with hyperintense submucosa (*) and darkly hypointense muscularis propria (arrow)

Mentions: The rectum is the terminal part of the alimentary tract, located from the anal verge (AV) to 15 cm above, nestling along the sacral curve. It is divided into three parts based on distance from AV into low rectum (0-5 cm), mid-rectum (5-10 cm), and upper rectum (10-15 cm) as shown in Figure 2A. It should be noted that this division implies that low rectum comprises the anal canal as well as the lowermost part of the rectum just above the anorectal junction. The rectosigmoid junction has a variable location from sacral promontory to S3 level [Figure 2A]. On axial sections, it can be identified at the point where the rectum leaves the sacral curve to extend anteriorly to the sigmoid colon [Figure 2B].


Imaging in rectal cancer with emphasis on local staging with MRI.

Arya S, Das D, Engineer R, Saklani A - Indian J Radiol Imaging (2015 Apr-Jun)

(A) Sagittal T2W MRI showing division into upper, mid, and lower rectum (R), bladder (b), prostate (P). (B and C) Axial T2W MRI. Arrows in (a and b) show rectosigmoid junction. (C) Section at the level of seminal vesicles (SV) shows normal rectum with hyperintense submucosa (*) and darkly hypointense muscularis propria (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4419424&req=5

Figure 2: (A) Sagittal T2W MRI showing division into upper, mid, and lower rectum (R), bladder (b), prostate (P). (B and C) Axial T2W MRI. Arrows in (a and b) show rectosigmoid junction. (C) Section at the level of seminal vesicles (SV) shows normal rectum with hyperintense submucosa (*) and darkly hypointense muscularis propria (arrow)
Mentions: The rectum is the terminal part of the alimentary tract, located from the anal verge (AV) to 15 cm above, nestling along the sacral curve. It is divided into three parts based on distance from AV into low rectum (0-5 cm), mid-rectum (5-10 cm), and upper rectum (10-15 cm) as shown in Figure 2A. It should be noted that this division implies that low rectum comprises the anal canal as well as the lowermost part of the rectum just above the anorectal junction. The rectosigmoid junction has a variable location from sacral promontory to S3 level [Figure 2A]. On axial sections, it can be identified at the point where the rectum leaves the sacral curve to extend anteriorly to the sigmoid colon [Figure 2B].

Bottom Line: Contrast-enhanced MRI is considered inappropriate for both primary staging and restaging.Diffusion-weighted sequence may be of value in restaging.Multidetector CT cannot replace MRI in local staging, but has an important role for evaluating distant metastases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radio-Diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India.

ABSTRACT
Imaging in rectal cancer has a vital role in staging disease, and in selecting and optimizing treatment planning. High-resolution MRI (HR-MRI) is the recommended method of first choice for local staging of rectal cancer for both primary staging and for restaging after preoperative chemoradiation (CT-RT). HR-MRI helps decide between upfront surgery and preoperative CT-RT. It provides high accuracy for prediction of circumferential resection margin at surgery, T category, and nodal status in that order. MRI also helps assess resectability after preoperative CT-RT and decide between sphincter saving or more radical surgery. Accurate technique is crucial for obtaining high-resolution images in the appropriate planes for correct staging. The phased array external coil has replaced the endorectal coil that is no longer recommended. Non-fat suppressed 2D T2-weighted (T2W) sequences in orthogonal planes to the tumor are sufficient for primary staging. Contrast-enhanced MRI is considered inappropriate for both primary staging and restaging. Diffusion-weighted sequence may be of value in restaging. Multidetector CT cannot replace MRI in local staging, but has an important role for evaluating distant metastases. Positron emission tomography-computed tomography (PET/CT) has a limited role in the initial staging of rectal cancer and is reserved for cases with resectable metastatic disease before contemplating surgery. This article briefly reviews the comprehensive role of imaging in rectal cancer, describes the role of MRI in local staging in detail, discusses the optimal MRI technique, and provides a synoptic report for both primary staging and restaging after CT-RT in routine practice.

No MeSH data available.


Related in: MedlinePlus