Abstract
Opinion statementImaging determines the optimal treatment for rectal cancer patients. High-resolution magnetic resonance imaging (MRI) overcomes many of the known limitations of previous methods. When performed in accordance with the recommended standards, MRI enables accurate staging of both early and advanced rectal cancer, accurate response assessment, the delineation of recurrent disease and planning surgical treatment in a safe and effective manner. Tumour-related high-risk features with known adverse outcomes can be preoperatively identified and treated with neoadjuvant chemoradiotherapy. Further, MRI post-treatment tumour response assessment using TRG grading system also predicts the likely survival outcomes and in the future will be used to modify treatment further by stratification into good and poor responders. There is a paucity of literature with validated outcome data concerning use of diffusion-weighted imaging and positron emission tomography (PET)/computed tomography (CT), and in the absence of any validated methods and outcome data, their use in the initial assessment and restaging after treatment is limited to research protocols. Combination MRI and CT is essential for distant spread assessment and recurrent disease, and currently PET-CT is sometimes used in the workup of patients with recurrent and metastatic disease.
Highlights
Preoperative assessment of tumour spread has become essential for both early and locally advanced rectal cancer, response assessment to neoadjuvant chemoradiotherapy (CRT) and resectability of recurrent disease
There is a paucity of literature with validated outcome data concerning use of diffusion-weighted imaging and positron emission tomography (PET)/computed tomography (CT), and in the absence of any validated methods and outcome data, their use in the initial assessment and restaging after treatment is limited to research protocols
Combination magnetic resonance imaging (MRI) and CT is essential for distant spread assessment and recurrent disease, and currently PET-CT is sometimes used in the workup of patients with recurrent and metastatic disease
Summary
Preoperative assessment of tumour spread has become essential for both early and locally advanced rectal cancer, response assessment to neoadjuvant chemoradiotherapy (CRT) and resectability of recurrent disease. Imaging modalities involved in the local and distant staging of rectal cancer are the following: endorectal ultrasound (ERUS), MRI, computed tomography (CT) and positron emission tomography (PET)/CT (a summary of different methods performance is listed in a Table 1). Both ERUS and MRI are commonly recommended for ERC staging, and there is strong agreement that MRI has become a required standard for evaluating locally advanced disease those patients with potential CRM involvement. It has been suggested that the published literature overestimates the performance of ERUS in staging rectal cancer with median T stage accuracy of 69 % and N stage
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