Skip to main content
SpringerLink
Log in

The Role of MRI in Assessment of Rectal Cancers

  • Chapter
  • First Online:
Comprehensive Rectal Cancer Care

  • 648 Accesses

Abstract

High resolution magnetic resonance imaging offers detailed analysis of rectal tumours during the staging process. It is able to accurately assess overall tumour stage and can differentiate between T1sm1/2 and T1sm3/early T2 tumours as well as sub-classify T3 lesions into T3a/b (<5 mm beyond the muscularis propria) and T3c/d (>5 mm beyond the muscularis propria). This modality allows identification of patients with malignant nodal disease and identifies a subgroup of high risk patients who have extra-nodal (vascular) deposits. It is highly accurate in identifying risk of circumferential resection margin involvement and risk of local recurrence. MRI identified EMVI (mrEMVI) is an independent prognostic factor for local and distant recurrence and is thus an important indicator for preoperative chemoradiotherapy. The current role of MRI is being tested to determine whether its assessment of regression can be used to further direct patient specific therapy and surveillance.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Patel UB, Taylor F, Blomqvist L, George C, Evans H, Tekkis P, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(28):3753–60.

    Article  Google Scholar 

  2. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, et al. 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 

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

    Article  PubMed Central  Google Scholar 

  4. 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 

  5. Chand M, Siddiqui MR, Swift I, Brown G. Systematic review of prognostic importance of extramural venous invasion in rectal cancer. World J Gastroenterol. 2016;22(4):1721–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. 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 

  7. Patel UB, Brown G, Rutten H, West N, Sebag-Montefiore D, Glynne-Jones R, et al. Comparison of magnetic resonance imaging and histopathological response to chemoradiotherapy in locally advanced rectal cancer. Ann Surg Oncol. 2012;19(9):2842–52.

    Article  PubMed  Google Scholar 

  8. Siddiqui MRS, Bhoday J, Battersby NJ, Chand M, West NP, Abulafi AM, et al. Defining response to radiotherapy in rectal cancer using magnetic resonance imaging and histopathological scales. World J Gastroenterol. 2016;22(37):8414–34.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nikolovski Z, Watters DA, Stupart D, Guest GD. Colorectal multidisciplinary meetings: how do they affect the timeliness of treatment? ANZ J Surg. 2017;87(10):E112–5.

    Article  PubMed  Google Scholar 

  10. Blomqvist L, Machado M, Rubio C, Gabrielsson N, Granqvist S, Goldman S, et al. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol. 2000;10(4):653–60.

    Article  CAS  PubMed  Google Scholar 

  11. Drew PJ, Farouk R, Turnbull LW, Ward SC, Hartley JE, Monson JR. Preoperative magnetic resonance staging of rectal cancer with an endorectal coil and dynamic gadolinium enhancement. Br J Surg. 1999;86(2):250–4.

    Article  CAS  PubMed  Google Scholar 

  12. Stoker J, Rociu E, Zwamborn AW, Schouten WR, Lameris JS. Endoluminal MR imaging of the rectum and anus: technique, applications, and pitfalls. Radiographics. 1999;19(2):383–98.

    Article  CAS  PubMed  Google Scholar 

  13. Taylor FG, Swift RI, Blomqvist L, Brown G. A systematic approach to the interpretation of preoperative staging MRI for rectal cancer. AJR Am J Roentgenol. 2008;191(6):1827–35.

    Article  PubMed  Google Scholar 

  14. Wale A, Brown G. A practical review of the performance and interpretation of staging magnetic resonance imaging for rectal cancer. Top Magn Reson Imaging: TMRI. 2014;23(4):213–23.

    Article  PubMed  Google Scholar 

  15. Brown G, Daniels IR, Richardson C, Revell P, Peppercorn D, Bourne M. Techniques and trouble-shooting in high spatial resolution thin slice MRI for rectal cancer. Br J Radiol. 2005;78(927):245–51.

    Article  CAS  PubMed  Google Scholar 

  16. Chand M, Evans J, Swift RI, Tekkis PP, West NP, Stamp G, et al. 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 

  17. American Joint Committee on Cancer (AJCC). AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Book  Google Scholar 

  18. Battersby NJ, How P, Moran B, Stelzner S, West NP, Branagan G, et al. 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. 2016;263(4):751–60.

    Article  PubMed  Google Scholar 

  19. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum. 2000;43(8):1064–71. discussion 71–4

    Article  CAS  PubMed  Google Scholar 

  20. Arbman G, Nilsson E, Hallbook O, Sjodahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg. 1996;83(3):375–9.

    Article  CAS  PubMed  Google Scholar 

  21. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet (London, England). 1993;341(8843):457–60.

    Article  CAS  Google Scholar 

  22. Balyasnikova S, Read J, Wotherspoon A, Rasheed S, Tekkis P, Tait D, et al. Diagnostic accuracy of High-resolution MRI as a method to predict potentially safe endoscopic and surgical planes in early rectal cancer patients. BMJ Open Gastroenterol. 2017;4(1):e000151. https://doi.org/10.1136/bmjgast-2017-000151.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Balyasnikova S, Brown G. Optimal Imaging Strategies for Rectal Cancer Staging and Ongoing Management. Curr Treat Options in Oncol. 2016;17(6):32.

    Article  Google Scholar 

  24. Read J, Brown G. MRI in staging rectal polyp planes (MINSTREL). Color Dis. 2016;18(S1):1–138: T07.

    Google Scholar 

  25. http://minstrelstudy.co.uk/. Accessed 11 Aug 2017.

  26. https://clinicaltrials.gov/ct2/show/NCT02532803. Accessed 11 Aug 2017.

  27. Zhang G, Cai YZ, Xu GH. Diagnostic accuracy of MRI for assessment of T category and circumferential resection margin involvement in patients with rectal cancer: a meta-analysis. Dis Colon Rectum. 2016;59(8):789–99.

    Article  PubMed  Google Scholar 

  28. Hermanek P, Henson DE, RVP H, Sobin LH, editors. International Union Against Cancer (UICC): TNM Supplement 1993. A commentary on uniform use. Berlin/Heidelberg/New York: Springer; 1993. p. 122.

    Google Scholar 

  29. Mercury Study Group. 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 

  30. Akagi Y, Shirouzu K, Fujita S, Ueno H, Takii Y, Komori K, et al. Predicting oncologic outcomes by stratifying mesorectal extension in patients with pT3 rectal cancer: a Japanese multi-institutional study. Int J Cancer. 2012;131(5):1220–7.

    Article  CAS  PubMed  Google Scholar 

  31. Brandt WS, Yong S, Abood G, Micetich K, Walther A, Shoup M. The depth of post-treatment perirectal tissue invasion is a predictor of outcome in patients with clinical T3N1M0 rectal cancer treated with neoadjuvant chemoradiation followed by surgical resection. Am J Surg. 2014;207(3):357–60. discussion 60

    Article  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  33. Cho SH, Kim SH, Bae JH, Jang YJ, Kim HJ, Lee D, et al. Prognostic stratification by extramural depth of tumor invasion of primary rectal cancer based on the Radiological Society of North America proposal. AJR Am J Roentgenol. 2014;202(6):1238–44.

    Article  PubMed  Google Scholar 

  34. Cianchi F, Messerini L, Comin CE, Boddi V, Perna F, Perigli G, et al. Pathologic determinants of survival after resection of T3N0 (Stage IIA) colorectal cancer: proposal for a new prognostic model. Dis Colon Rectum. 2007;50(9):1332–41.

    Article  PubMed  Google Scholar 

  35. Miyoshi M, Ueno H, Hashiguchi Y, Mochizuki H, Talbot IC. Extent of mesorectal tumor invasion as a prognostic factor after curative surgery for T3 rectal cancer patients. Ann Surg. 2006;243(4):492–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P. The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Color Dis. 2001;16(5):298–304.

    Article  CAS  Google Scholar 

  37. Merkel S, Weber K, Schellerer V, Gohl J, Fietkau R, Agaimy A, et al. Prognostic subdivision of ypT3 rectal tumours according to extension beyond the muscularis propria. Br J Surg. 2014;101(5):566–72.

    Article  CAS  PubMed  Google Scholar 

  38. Mrak K, Jagoditsch M, Leibl S, Klingler A, Tschmelitsch J. Influence of pT3 subgroups on outcome of R0-resected colorectal tumors. South Med J. 2011;104(11):722–30.

    Article  PubMed  Google Scholar 

  39. Pollheimer MJ, Kornprat P, Pollheimer VS, Lindtner RA, Schlemmer A, Rehak P, et al. Clinical significance of pT sub-classification in surgical pathology of colorectal cancer. Int J Color Dis. 2010;25(2):187–96.

    Article  Google Scholar 

  40. Shin R, Jeong SY, Yoo HY, Park KJ, Heo SC, Kang GH, et al. Depth of mesorectal extension has prognostic significance in patients with T3 rectal cancer. Dis Colon Rectum. 2012;55(12):1220–8.

    Article  PubMed  Google Scholar 

  41. Shirouzu K, Akagi Y, Fujita S, Ueno H, Takii Y, Komori K, et al. Clinical significance of the mesorectal extension of rectal cancer: a Japanese multi-institutional study. Ann Surg. 2011;253(4):704–10.

    Article  PubMed  Google Scholar 

  42. Yoshida K, Yoshimatsu K, Otani T, Yokomizo H, Ogawa K. The depth of tumor invasion beyond the outer border of the muscularis propria as a prognostic factor for T3 rectal/rectosigmoid cancer. Anticancer Res. 2008;28(3b):1773–8.

    PubMed  Google Scholar 

  43. Siddiqui MRS, Simillis C, Bhoday J, Battersby NJ, Rasheed S, Tekkis PP, et al. A meta-analysis assessing the survival implications of sub-classifying T3 rectal tumours. Special Issue: Abstracts of the 11th Scientific and Annual Meeting of the European Society of Coloproctology, 28–30 September 2016, Milan, Italy. Color Dis. 18(S1):1–138.

    Google Scholar 

  44. Siddiqui MRS, Balyansikova S, Battersby NJ, Wale A, Bhoday J, Rasheed S, et al. Prognostic implications of rectal tumours with more versus less than 5mm extension beyond the muscularis propria on baseline MRI scans [Unpublished data – personal communication with Siddiqui M.R.S on 20th April 2017]. 2017.

    Google Scholar 

  45. Brown G, Kirkham A, Williams GT, Bourne M, Radcliffe AG, Sayman J, et al. High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. AJR Am J Roentgenol. 2004;182(2):431–9.

    Article  PubMed  Google Scholar 

  46. Al-Sukhni E, Milot L, Fruitman M, Beyene J, Victor JC, Schmocker S, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19(7):2212–23.

    Article  PubMed  Google Scholar 

  47. Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227(2):371–7.

    Article  PubMed  Google Scholar 

  48. Kono Y, Togashi K, Utano K, Horie H, Miyakura Y, Fukushima N, et al. Lymph node size alone is not an accurate predictor of metastases in rectal cancer: a node-for-node comparative study of specimens and histology. Am Surg. 2015;81(12):1263–71.

    PubMed  Google Scholar 

  49. Perez RO, Pereira DD, Proscurshim I, Gama-Rodrigues J, Rawet V, Sao Juliao GP, et al. Lymph node size in rectal cancer following neoadjuvant chemoradiation--can we rely on radiologic nodal staging after chemoradiation? Dis Colon Rectum. 2009;52(7):1278–84.

    Article  PubMed  Google Scholar 

  50. Hermanek P, Merkel S, Fietkau R, Rodel C, Hohenberger W. Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TME surgery. Implications for treatment decisions. Int J Color Dis. 2010;25(3):359–68.

    Article  Google Scholar 

  51. Jass JR, Love SB, Northover JM. A new prognostic classification of rectal cancer. Lancet (London, England). 1987;1(8545):1303–6.

    Article  CAS  Google Scholar 

  52. Evans J, Patel U, Brown G. Rectal cancer: primary staging and assessment after chemoradiotherapy. Semin Radiat Oncol. 2011;21(3):169–77.

    Article  PubMed  Google Scholar 

  53. Koh DM, Brown G, Temple L, Blake H, Raja A, Toomey P, et al. Distribution of mesorectal lymph nodes in rectal cancer: in vivo MR imaging compared with histopathological examination. Initial observations. Eur Radiol. 2005;15(8):1650–7.

    Article  CAS  PubMed  Google Scholar 

  54. Gurawalia J, Dev K, Nayak SP, Kurpad V, Pandey A. Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer? J Gastrointest Oncol. 2016;7(6):946–57.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Vychnevskaia K, Dumont F, Agostini J, Julie C, Dartigues P, Lazure T, et al. Prognostic value of sterilized lymph nodes after preoperative chemoradiotherapy for patients with ypN0 rectal cancer. Ann Surg Oncol. 2017;24(5):1304–11.

    Article  PubMed  Google Scholar 

  56. Lord AC, D’Souza N, Pucher PH, Moran BJ, Abulafi AM, Wotherspoon A, et al. Significance of extranodal tumour deposits in colorectal cancer: a systematic review and meta-analysis. Eur J Cancer (Oxford, England: 1990). 2017;82:92–102.

    Article  Google Scholar 

  57. Nagtegaal ID, Knijn N, Hugen N, Marshall HC, Sugihara K, Tot T, et al. Tumor deposits in colorectal cancer: improving the value of modern staging-a systematic review and meta-analysis. J Clin Oncol Off J Am Soc Clin Oncol. 2017;35(10):1119–27.

    Article  Google Scholar 

  58. Shihab OC, Taylor F, Bees N, Blake H, Jeyadevan N, Bleehen R, et al. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg. 2011;98(12):1798–804.

    Article  CAS  PubMed  Google Scholar 

  59. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet (London, England). 1994;344(8924):707–11.

    Article  CAS  Google Scholar 

  60. Moreira LF, Kenmotsu M, Gochi A, Tanaka N, Orita K. Lymphovascular and neural invasion in low-lying rectal carcinoma. Cancer Detect Prev. 1999;23(2):123–8.

    Article  CAS  PubMed  Google Scholar 

  61. Shihab OC, Quirke P, Heald RJ, Moran BJ, Brown G. Magnetic resonance imaging-detected lymph nodes close to the mesorectal fascia are rarely a cause of margin involvement after total mesorectal excision. Br J Surg. 2010;97(9):1431–6.

    Article  CAS  PubMed  Google Scholar 

  62. Balyasnikova S, Brown G. Imaging advances in colorectal cancer. Curr Color Cancer Rep. 2016;12:162–9.

    Article  Google Scholar 

  63. Rullier A, Gourgou-Bourgade S, Jarlier M, Bibeau F, Chassagne-Clement C, Hennequin C, et al. Predictive factors of positive circumferential resection margin after radiochemotherapy for rectal cancer: the French randomised trial ACCORD12/0405 PRODIGE 2. Eur J Cancer (Oxford, England: 1990). 2013;49(1):82–9.

    Article  Google Scholar 

  64. 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 

  65. Chand M, Swift RI, Tekkis PP, Chau I, Brown G. Extramural venous invasion is a potential imaging predictive biomarker of neoadjuvant treatment in rectal cancer. Br J Cancer. 2014;110(1):19–25.

    Article  CAS  PubMed  Google Scholar 

  66. Siddiqui MRS, Simillis C, Hunter C, Chand M, Bhoday J, Garant A, et al. A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion vs mrEMVI-negative cases. Br J Cancer. 2017;116(12):1513–9. https://doi.org/10.1038/bjc.2017.99.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Sohn B, Lim JS, Kim H, Myoung S, Choi J, Kim NK, et al. MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol. 2015;25(5):1347–55.

    Article  PubMed  Google Scholar 

  68. Bugg WG, Andreou AK, Biswas D, Toms AP, Williams SM. The prognostic significance of MRI-detected extramural venous invasion in rectal carcinoma. Clin Radiol. 2014;69(6):619–23.

    Article  CAS  PubMed  Google Scholar 

  69. Hunter CJ, Garant A, Vuong T, Artho G, Lisbona R, Tekkis P, et al. Adverse features on rectal MRI identify a high-risk group that may benefit from more intensive preoperative staging and treatment. Ann Surg Oncol. 2012;19(4):1199–205.

    Article  PubMed  Google Scholar 

  70. Seehaus A, Vaccaro C, Quadrelli M, Calvo M, Rossi G, Savluk L, et al. Magnetic resonance and extramural vascular invasion in patients with rectal cancer and liver metastases. Acta Gastroenterol Latinoam. 2015;45(1):31–6.

    PubMed  Google Scholar 

  71. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet (London, England). 1986;2(8514):996–9.

    Article  CAS  Google Scholar 

  72. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg. 1982;69(10):613–6.

    Article  CAS  PubMed  Google Scholar 

  73. Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, et al. 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 

  74. Hall NR, Finan PJ, al-Jaberi T, Tsang CS, Brown SR, Dixon MF, et al. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum. 1998;41(8):979–83.

    Article  CAS  PubMed  Google Scholar 

  75. Brown G, Richards CJ, Newcombe RG, Dallimore NS, Radcliffe AG, Carey DP, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999;211(1):215–22.

    Article  CAS  PubMed  Google Scholar 

  76. Bissett IP, Fernando CC, Hough DM, Cowan BR, Chau KY, Young AA, et al. 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 

  77. Jass JR. Lymphocytic infiltration and survival in rectal cancer. J Clin Pathol. 1986;39(6):585–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Purkayastha S, Tekkis PP, Athanasiou T, Tilney HS, Darzi AW, Heriot AG. Diagnostic precision of magnetic resonance imaging for preoperative prediction of the circumferential margin involvement in patients with rectal cancer. Color Dis. 2007;9(5):402–11.

    Article  CAS  Google Scholar 

  79. Algebally AM, Mohey N, Szmigielski W, Yousef RR, Kohla S. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging. Pol J Radiol. 2015;80:115–21.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, et al. 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 

  81. Taylor FG, Quirke P, Heald RJ, Moran BJ, Blomqvist L, Swift IR, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(1):34–43.

    Article  Google Scholar 

  82. Beyond TMEC. Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg. 2013;100(8):E1–33.

    Article  Google Scholar 

  83. Georgiou PA, Tekkis PP, Brown G. Pelvic colorectal recurrence: crucial role of radiologists in oncologic and surgical treatment options. Cancer Imaging. 2011;11 Spec No A:S103–11.

    Google Scholar 

  84. Georgiou PA, Tekkis PP, Constantinides VA, Patel U, Goldin RD, Darzi AW, et al. Diagnostic accuracy and value of magnetic resonance imaging (MRI) in planning exenterative pelvic surgery for advanced colorectal cancer. Eur J of Cancer (Oxford, England: 1990). 2013;49(1):72–81.

    Article  Google Scholar 

  85. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.

    Article  CAS  PubMed  Google Scholar 

  86. Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(15):1554–62.

    Article  Google Scholar 

  87. Bhangu A, Ali SM, Cunningham D, Brown G, Tekkis P. Comparison of long-term survival outcome of operative vs nonoperative management of recurrent rectal cancer. Color Dis. 2013;15(2):156–63.

    Article  CAS  Google Scholar 

  88. Wheeler JM, Warren BF, Mortensen NJ, Ekanyaka N, Kulacoglu H, Jones AC, et al. Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system. Dis Colon Rectum. 2002;45(8):1051–6.

    Article  CAS  PubMed  Google Scholar 

  89. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Color Dis. 1997;12(1):19–23.

    Article  CAS  Google Scholar 

  90. Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(34):8688–96.

    Article  Google Scholar 

  91. Ryan R, Gibbons D, Hyland JM, Treanor D, White A, Mulcahy HE, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005;47(2):141–6.

    Article  CAS  PubMed  Google Scholar 

  92. Wittekind C, Tannapfel A. Regression grading of colorectal carcinoma after preoperative radiochemotherapy. An inventory. Pathologe. 2003;24(1):61–5.

    CAS  PubMed  Google Scholar 

  93. Ruo L, Tickoo S, Klimstra DS, Minsky BD, Saltz L, Mazumdar M, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg. 2002;236(1):75–81.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Schneider PM, Baldus SE, Metzger R, Kocher M, Bongartz R, Bollschweiler E, et al. Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer: implications for response classification. Ann Surg. 2005;242(5):684–92.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Werner M, Hofler H. Pathologie. In: Roder JD, Stein HJ, Fink U (Hrsg) Therapie gastrointestinaler Tumoren. Berlin: Springer;. 2000. p. 45–63.

    Google Scholar 

  96. Brown G. Staging rectal cancer: endoscopic ultrasound and pelvic MRI. Cancer Imaging. 2008;8 Spec No A:S43–5.

    Google Scholar 

  97. Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF, 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 

  98. Glynne-Jones R, Anyamene N. Just how useful an endpoint is complete pathological response after neoadjuvant chemoradiation in rectal cancer? Int J Radiat Oncol Biol Phys. 2006;66(2):319–20.

    Article  PubMed  Google Scholar 

  99. Bateman AC, Jaynes E, Bateman AR. Rectal cancer staging post neoadjuvant therapy--how should the changes be assessed? Histopathology. 2009;54(6):713–21.

    Article  PubMed  Google Scholar 

  100. Junker K, Muller KM, Bosse U, Klinke F, Heinecke A, Thomas M. Apoptosis and tumor regression in locally advanced non-small cell lung cancer with neoadjuvant therapy. Pathologe. 2003;24(3):214–9.

    CAS  PubMed  Google Scholar 

  101. Bujko K, Kolodziejczyk M, Nasierowska-Guttmejer A, Michalski W, Kepka L, Chmielik E, et al. Tumour regression grading in patients with residual rectal cancer after preoperative chemoradiation. Radiother Oncol. 2010;95(3):298–302.

    Article  PubMed  Google Scholar 

  102. Quah HM, Chou JF, Gonen M, Shia J, Schrag D, Saltz LB, et al. Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation. Cancer. 2008;113(1):57–64.

    Article  PubMed  Google Scholar 

  103. Kaur H, Choi H, You YN, Rauch GM, Jensen CT, Hou P, et al. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. Radiographics. 2012;32(2):389–409.

    Article  PubMed  Google Scholar 

  104. Swellengrebel HA, Bosch SL, Cats A, Vincent AD, Dewit LG, Verwaal VJ, et al. Tumour regression grading after chemoradiotherapy for locally advanced rectal cancer: a near pathologic complete response does not translate into good clinical outcome. Radiother Oncol. 2014;112(1):44–51.

    Article  CAS  PubMed  Google Scholar 

  105. Washington MK, Berlin J, Branton PA, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinomas of the colon and rectum. Arch Pathol Lab Med. 2008;132(7):1182–93.

    PubMed  Google Scholar 

  106. Dhadda AS, Bessell EM, Scholefield J, Dickinson P, Zaitoun AM. Mandard tumour regression grade, perineural invasion, circumferential resection margin and post-chemoradiation nodal status strongly predict outcome in locally advanced rectal cancer treated with preoperative chemoradiotherapy. Clin Oncol (R Coll Radiol (Great Britain)). 2014;26(4):197–202.

    Article  CAS  Google Scholar 

  107. MacGregor TP, Maughan TS, Sharma RA. Pathological grading of regression following neoadjuvant chemoradiation therapy: the clinical need is now. J Clin Pathol. 2012;65(10):867–71.

    Article  PubMed  Google Scholar 

  108. Siddiqui MR, Gormly KL, Bhoday J, Balyansikova S, Battersby NJ, Chand M, et al. Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG). Clin Radiol. 2016;71(9):854–62.

    Article  CAS  PubMed  Google Scholar 

  109. Patel UB, Blomqvist LK, Taylor F, George C, Guthrie A, Bees N, et al. MRI after treatment of locally advanced rectal cancer: how to report tumor response--the MERCURY experience. AJR Am J Roentgenol. 2012;199(4):W486–95.

    Article  PubMed  Google Scholar 

  110. Shihab OC, Taylor F, Salerno G, Heald RJ, Quirke P, Moran BJ, et al. MRI predictive factors for long-term outcomes of low rectal tumours. Ann Surg Oncol. 2011;18(12):3278–84.

    Article  PubMed  Google Scholar 

  111. Siddiqui MRS, Simillis C, Bhoday J, Battersby NJ, Rasheed S, Tekkis PP, et al. Special Issue: Abstracts of the 11th Scientific and Annual Meeting of the European Society of Coloproctology, 28–30 September 2016, Milan, Italy. Prognostic implications of rectal tumours with more versus less than 5mm extension beyond the muscularis propria on post neoadjuvant therapy MRI scans. Color Dis. 18(S1):1–138.

    Google Scholar 

  112. Chand M, Bhangu A, Wotherspoon A, Stamp GW, Swift RI, Chau I, et al. EMVI-positive stage II rectal cancer has similar clinical outcomes as stage III disease following pre-operative chemoradiotherapy. Ann Oncol. 2014;25(4):858–63.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Croydon University Hospital, Croydon, Surrey, UK

    Muhammed R. S. Siddiqui

  2. Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK

    Muhammed R. S. Siddiqui, Svetlana Balyansikova & Gina Brown

Authors
  1. Muhammed R. S. Siddiqui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Svetlana Balyansikova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gina Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gina Brown .

Editor information

Editors and Affiliations

  1. University of California, Los Angeles, Los Angeles, CA, USA

    Mary Kwaan

  2. University of Melbourne, Victoria, VIC, Australia

    Andrew Zbar

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Siddiqui, M.R.S., Balyansikova, S., Brown, G. (2019). The Role of MRI in Assessment of Rectal Cancers. In: Kwaan, M., Zbar, A. (eds) Comprehensive Rectal Cancer Care. Springer, Cham. https://doi.org/10.1007/978-3-319-98902-0_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98902-0_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98901-3

  • Online ISBN: 978-3-319-98902-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation