Abstract
Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience.
Highlights
Magnetic resonance imaging (MRI) has emerged as the dominant method of pelvic imaging in rectal cancer [1,2,3,4], MRI is not always available [5]
Multi-disciplinary meetings using MRI have led to improved possibilities of selecting the most appropriate treatment for patients with rectal cancer [7,8,9,10]
In the Magnetic Resonance Imaging and Rectal Cancer European Equivalence Study (MERCURY), imaging workshops were held for participating radiologists to ensure standardisation of image acquisition techniques and interpretation of the images [14]
Summary
Magnetic resonance imaging (MRI) has emerged as the dominant method of pelvic imaging in rectal cancer [1,2,3,4], MRI is not always available [5]. In the MERCURY study, 93% of the studies were technically satisfactory and among these, the Both T1-weighted images and CT can give the same information in locations where there is enough fat between the rectum and the mesorectal fascia as long as we can differentiate between the tumour and the rectal wall based on other information. The decision to give neo-adjuvant therapy can be decided based on EMD, provided there is no endangerment of the mesorectal fascia or nearby organs, and if there are no malignant lymph nodes or signs of intravascular growth. This places great pressure on the radiologist to ascertain the exact EMD in T3 tumours. The aims of studies concerning MRI2 could be summarised as the following: 1. Comparison between MRI2 and histopathology or between MRI2 and MRI1
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