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Open Access 01-02-2007 | Gastrointestinal

Local staging of rectal cancer: the current role of MRI

Authors: Christian Klessen, Patrik Rogalla, Matthias Taupitz

Published in: European Radiology | Issue 2/2007

Abstract

With the advent of powerful gradient coil systems and high-resolution surface coils, magnetic resonance imaging (MRI) has recently extended its role in the staging of rectal cancer. MRI is superior to endorectal ultrasound, the most widely used staging modality in patients with rectal tumors, in that it visualizes not only the intestinal wall but also the surrounding pelvic anatomy. The crucial advantage of MRI is not that it enables exact T-staging but precise evaluation of the topographic relationship of a tumor to the mesorectal fascia. This fascia is the most important anatomic landmark for the feasibility of total mesorectal excision, which has evolved into the standard operative procedure for the resection of cancer located in the middle or lower third of the rectum. MRI is currently the only imaging modality that is highly accurate in predicting whether or not it is likely that a tumor-free margin can be achieved and thus provides important information for planning of an effective therapeutic strategy, especially in patients with advanced rectal cancer.

Jemal A, Murray T, Ward E et al (2005) Cancer statistics 2005. CA Cancer J Clin 55(1):10–30PubMedCrossRef

Eddy DM (1990) Screening for colorectal cancer. Ann Intern Med 113(5):373–384PubMed

Vogelstein B, Fearon ER, Hamilton SR et al (1988) Genetic alterations during colorectal-tumor development. N Engl J Med 319(9):525–532PubMedCrossRef

Muto T, Bussey HJ, Morson BC (1975) The evolution of cancer of the colon and rectum. Cancer 36(6):2251–2270PubMed

Winawer S, Fletcher R, Rex D et al (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology 124(2):544–560PubMedCrossRef

Sobin LH, Wittekind C (2002) International Union Against Cancer (UICC). TNM classification of malignant tumours: Wiley, New York

Bisset IP, Chau KY, Hill GL (2000) Extrafascial excision of the rectum: surgical anatomy of the fascia propria. Dis Colon Rectum 43(7):903–910PubMedCrossRef

Grabbe E, Lierse W, Winkler R (1983) The perirectal fascia: morphology and use in staging of rectal carcinoma. Radiology 149(1):241–246PubMed

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69(10):613–616PubMedCrossRef

10.

Akasu T, Kondo H, Moriya Y et al (2000) Endorectal ultrasonography and treatment of early stage rectal cancer. World J Surg 24(9):1061–1068PubMedCrossRef

11.

Sagar PM, Pemberton JH (1996) Surgical management of locally recurrent rectal cancer. Br J Surg 83(3):293–304PubMedCrossRef

12.

Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482PubMedCrossRef

13.

MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341(8843):457–460PubMedCrossRef

14.

Enker WE (1992) Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 127(12):1396–1401; discussion 1402PubMed

15.

Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2(8514):996–999PubMedCrossRef

16.

Adam IJ, Mohamdee MO, Martin IG et al (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344(8924):707–711PubMedCrossRef

17.

Martling A, Holm T, Bremmer S, Lindholm J, Cedermark B, Blomqvist L (2003) Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer. Br J Surg 90(11):1422–1428PubMedCrossRef

18.

Williamson PR, Hellinger MD, Larach SW, Ferrara A (1996) Endorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation. Dis Colon Rectum 39(1):45–49PubMedCrossRef

19.

Chari RS, Tyler DS, Anscher MS et al (1995) Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum. Ann Surg 221(6):778–786; discussion 786–777PubMedCrossRef

20.

Minsky BD (1995) Conservative treatment of rectal cancer with local excision and postoperative radiation therapy. Eur J Cancer 31A(7–8):1343–1346PubMedCrossRef

21.

Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997;336(14):980–987

22.

Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646PubMedCrossRef

23.

NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. Jama 1990;264(11):1444–1450

24.

Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D (2006) MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer 94(3):351–357PubMedCrossRef

25.

Rifkin MD, Ehrlich SM, Marks G (1989) Staging of rectal carcinoma: prospective comparison of endorectal US and CT. Radiology 170(2):319–322PubMed

26.

Glaser F, Schlag P, Herfarth C (1990) Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement. Br J Surg 77(8):883–887PubMedCrossRef

27.

Hulsmans FJ, Tio TL, Fockens P, Bosma A, Tytgat GN (1994) Assessment of tumor infiltration depth in rectal cancer with transrectal sonography: caution is necessary. Radiology 190(3):715–720PubMed

28.

Herzog U, von Flue M, Tondelli P, Schuppisser JP (1993) How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum 36(2):127–134PubMedCrossRef

29.

Milsom JW, Graffner H (1990) Intrarectal ultrasonography in rectal cancer staging and in the evaluation of pelvic disease. Clinical uses of intrarectal ultrasound. Ann Surg 212(5):602–606PubMedCrossRef

30.

Garcia-Aguilar J, Pollack J, Lee SH et al (2002) Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum 45(1):10–15PubMedCrossRef

31.

Gualdi GF, Casciani E, Guadalaxara A, d’Orta C, Polettini E, Pappalardo G (2000) Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings. Dis Colon Rectum 43(3):338–345PubMedCrossRef

32.

Kim NK, Kim MJ, Yun SH, Sohn SK, Min JS (1999) Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum 42(6):770–775PubMedCrossRef

33.

Maldjian C, Smith R, Kilger A, Schnall M, Ginsberg G, Kochman M (2000) Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonography. Abdom Imaging 25(1):75–80PubMedCrossRef

34.

Knaebel HP, Koch M, Feise T, Benner A, Kienle P (2005) Diagnostics of rectal cancer: endorectal ultrasound. Recent Results Cancer Res 165:46–57PubMed

35.

Kauer WK, Prantl L, Dittler HJ, Siewert JR (2004) The value of endosonographic rectal carcinoma staging in routine diagnostics: a 10-year analysis. Surg Endosc 18(7):1075–1078PubMedCrossRef

36.

Solomon MJ, McLeod RS (1993) Endoluminal transrectal ultrasonography: accuracy, reliability, and validity. Dis Colon Rectum 36(2):200–205PubMedCrossRef

37.

Goldman S, Arvidsson H, Norming U, Lagerstedt U, Magnusson I, Frisell J (1991) Transrectal ultrasound and computed tomography in preoperative staging of lower rectal adenocarcinoma. Gastrointest Radiol 16(3):259–263PubMedCrossRef

38.

Shank B, Dershaw DD, Caravelli J, Barth J, Enker W (1990) A prospective study of the accuracy of preoperative computed tomographic staging of patients with biopsy-proven rectal carcinoma. Dis Colon Rectum 33(4):285–290PubMedCrossRef

39.

Zerhouni EA, Rutter C, Hamilton SR et al (1996) CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II. Radiology 200(2):443–451PubMed

40.

Balthazar EJ, Megibow AJ, Hulnick D, Naidich DP (1988) Carcinoma of the colon: detection and preoperative staging by CT. AJR Am J Roentgenol 150(2):301–306PubMed

41.

Thoeni RF (1997) Colorectal cancer. Radiologic staging. Radiol Clin North Am 35(2):457–485PubMed

42.

Kulinna C, Scheidler J, Strauss T et al (2004) Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound. J Comput Assist Tomogr 28(1):123–130PubMedCrossRef

43.

Filippone A, Ambrosini R, Fuschi M, Marinelli T, Genovesi D, Bonomo L (2004) Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography—initial experience. Radiology 231(1):83–90PubMedCrossRef

44.

Butch RJ, Stark DD, Wittenberg J et al (1986) Staging rectal cancer by MR and CT. AJR Am J Roentgenol 146(6):1155–1160PubMed

45.

Hodgman CG, MacCarty RL, Wolff BG et al (1986) Preoperative staging of rectal carcinoma by computed tomography and 0.15T magnetic resonance imaging. Preliminary report. Dis Colon Rectum 29(7):446–450PubMedCrossRef

46.

Guinet C, Buy JN, Ghossain MA et al (1990) Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer. Arch Surg 125(3):385–388PubMed

47.

Chan TW, Kressel HY, Milestone B et al (1991) Rectal carcinoma: staging at MR imaging with endorectal surface coil. Work in progress. Radiology 181(2):461–467PubMed

48.

Schnall MD, Furth EE, Rosato EF, Kressel HY (1994) Rectal tumor stage: correlation of endorectal MR imaging and pathologic findings. Radiology 190(3):709–714PubMed

49.

Vogl TJ, Pegios W, Mack MG et al (1997) Accuracy of staging rectal tumors with contrast-enhanced transrectal MR imaging. AJR Am J Roentgenol 168(6):1427–1434PubMed

50.

Slater A, Halligan S, Taylor SA, Marshall M (2006) Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin. Clin Radiol 61(1):65–70PubMedCrossRef

51.

Okizuka H, Sugimura K, Yoshizako T, Kaji Y, Wada A (1996) Rectal carcinoma: prospective comparison of conventional and gadopentetate dimeglumine enhanced fat-suppressed MR imaging. J Magn Reson Imaging 6(3):465–471PubMedCrossRef

52.

Vliegen RF, Beets GL, von Meyenfeldt MF et al (2005) Rectal cancer: MR imaging in local staging—is gadolinium-based contrast material helpful? Radiology 234(1):179–188PubMedCrossRef

53.

Blomqvist L, Holm T, Rubio C, Hindmarsh T (1997) Rectal tumours—MR imaging with endorectal and/or phased-array coils, and histopathological staging on giant sections. A comparative study. Acta Radiol 38(3):437–444PubMedCrossRef

54.

Beets-Tan RG, Beets GL, Vliegen RF et al (2001) Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 357(9255):497–504PubMedCrossRef

55.

Gagliardi G, Bayar S, Smith R, Salem RR (2002) Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils. Arch Surg 137(4):447–451PubMedCrossRef

56.

Poon FW, McDonald A, Anderson JH et al (2005) Accuracy of thin section magnetic resonance using phased-array pelvic coil in predicting the T-staging of rectal cancer. Eur J Radiol 53(2):256–262PubMedCrossRef

57.

Brown G, Richards CJ, Newcombe RG et al (1999) Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 211(1):215–222PubMed

58.

Blomqvist L, Rubio C, Holm T, Machado M, Hindmarsh T (1999) Rectal adenocarcinoma: assessment of tumour involvement of the lateral resection margin by MRI of resected specimen. Br J Radiol 72(853):18–23PubMed

59.

Bissett IP, Fernando CC, Hough DM et al (2001) Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer. Dis Colon Rectum 44(2):259–265PubMedCrossRef

60.

Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90(3):355–364PubMedCrossRef

61.

Beets-Tan RG, Beets GL (2004) Rectal cancer: review with emphasis on MR imaging. Radiology 232(2):335–346PubMedCrossRef

62.

Oberholzer K, Junginger T, Kreitner KF et al (2005) Local staging of rectal carcinoma and assessment of the circumferential resection margin with high-resolution MRI using an integrated parallel acquisition technique. J Magn Reson Imaging 22(1):101–108PubMedCrossRef

63.

Tang R, Wang JY, Chen JS et al (1995) Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum. J Am Coll Surg 180(6):705–712PubMed

64.

Suzuki K, Muto T, Sawada T (1995) Prevention of local recurrence by extended lymphadenectomy for rectal cancer. Surg Today 25(9):795–801PubMedCrossRef

65.

Monig SP, Baldus SE, Zirbes TK et al (1999) Lymph node size and metastatic infiltration in colon cancer. Ann Surg Oncol 6(6):579–581PubMedCrossRef

66.

Bjelovic M, Kalezic V, Petrovic M et al (1998) Correlation of macroscopic and histological characteristics in the regional lymph nodes of patients with rectal and sigmoidal adenocarcinoma. Hepatogastroenterology 45(20):433–438PubMed

67.

Detry RJ, Kartheuser AH, Lagneaux G, Rahier J (1996) Preoperative lymph node staging in rectal cancer: a difficult challenge. Int J Colorectal Dis 11(5):217–221PubMedCrossRef

68.

Angelelli G, Macarini L, Lupo L, Caputi-Jambrenghi O, Pannarale O, Memeo V (1990) Rectal carcinoma: CT staging with water as contrast medium. Radiology 177(2):511–514PubMed

69.

Chiesura-Corona M, Muzzio PC, Giust G, Zuliani M, Pucciarelli S, Toppan P (2001) Rectal cancer: CT local staging with histopathologic correlation. Abdom Imaging 26(2):134–138PubMedCrossRef

70.

Lahaye MJ, Engelen SM, Nelemans PJ et al (2005) 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 26(4):259–268PubMedCrossRef

71.

Brown G, Richards CJ, Bourne MW et al (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227(2):371–377PubMedCrossRef

72.

Taupitz M, Schmitz S, Hamm B (2003) (Superparamagnetic iron oxide particles: current state and future development). Rofo 175(6):752–765PubMed

73.

Koh DM, Brown G, Temple L et al (2004) Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings-initial observations. Radiology 231(1):91–99PubMedCrossRef

74.

Nakanishi K, Kobayashi M, Takahashi S et al (2005) Whole body MRI for detecting metastatic bone tumor: comparison with bone scintigrams. Magn Reson Med Sci 4(1):11–17PubMedCrossRef

75.

Engelhard K, Hollenbach HP, Wohlfart K, von Imhoff E, Fellner FA (2004) Comparison of whole-body MRI with automatic moving table technique and bone scintigraphy for screening for bone metastases in patients with breast cancer. Eur Radiol 14(1):99–105PubMedCrossRef

76.

Brennan DD, Gleeson T, Coate LE, Cronin C, Carney D, Eustace SJ (2005) A Comparison of Whole-Body MRI and CT for the Staging of Lymphoma. AJR Am J Roentgenol 185(3):711–716PubMed

77.

Lauenstein TC, Freudenberg LS, Goehde SC et al (2002) Whole-body MRI using a rolling table platform for the detection of bone metastases. Eur Radiol 12(8):2091–2099PubMed

78.

Dzik-Jurasz A, Domenig C, George M et al (2002) Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet 360(9329):307–308PubMedCrossRef

79.

Devries AF, Griebel J, Kremser C et al (2001) Tumor microcirculation evaluated by dynamic magnetic resonance imaging predicts therapy outcome for primary rectal carcinoma. Cancer Res 61(6):2513–2516PubMed

80.

DeVries AF, Kremser C, Hein PA et al (2003) Tumor microcirculation and diffusion predict therapy outcome for primary rectal carcinoma. Int J Radiat Oncol Biol Phys 56(4):958–965PubMedCrossRef

81.

Hein PA, Kremser C, Judmaier W et al (2003) Diffusion-weighted magnetic resonance imaging for monitoring diffusion changes in rectal carcinoma during combined, preoperative chemoradiation: preliminary results of a prospective study. Eur J Radiol 45(3):214–222PubMedCrossRef

82.

Denecke T, Rau B, Hoffmann KT et al (2005) Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging? Eur Radiol 15(8):1658–1666PubMedCrossRef

Title: Local staging of rectal cancer: the current role of MRI
Authors: Christian Klessen
Patrik Rogalla
Matthias Taupitz
Publication date: 01-02-2007
Publisher: Springer-Verlag
Published in: European Radiology / Issue 2/2007
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-006-0388-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Local staging of rectal cancer: the current role of MRI

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