Abstract
One of the most common clinical applications of DWI in the rectum is rectal cancer detection. DWI has shown to increase the detection of rectal cancer in combination with T2-weighted images as compared to the use only of T2-weighted images, being especially useful for the detection of small polyps. ADC calculation allows reducing the number of false positives as rectal cancer usually shows low ADC values. Furthermore, DWI is also useful for delineating the cancer extension in the initial staging of rectal carcinomas, since differentiation of cancer fibrous and inflammatory changes is possible. DWI also allows the detection of a greater number of lymph nodes, even those smaller than 3 mm, compared to morphological MRI sequences. Besides, recent data anticipate a role for DWI in the differentiation between metastatic and benign lymph nodes in the primary staging of rectal carcinoma. Perhaps, the most revolutionary application that has emerged from DWI in rectal cancer evaluation is the ability to predict whether a patient with rectal cancer will respond to neoadjuvant chemotherapy and radiotherapy. In a similar fashion, DWI is a useful tool in the restaging of rectal cancer after neoadjuvant therapy and it may also distinguish between fibrosis and recurrent tumor. DWI also is useful to further characterize masses other than rectal adenocarcinoma, such as enteric cyst or retrorectal cystic hamartomas, that will show higher ADC values than malignant ones. Another application of DWI is to identify areas of activity in patients with inflammatory bowel disease and to distinguish acute and chronic areas of inflammation. Even more, in the rectosigmoid colon, DWI has demonstrated its capability to accurately differentiate between inflammatory bowel disease and neoplastic involvement. DWI, in combination with T2-weighted sequence, has recently shown to be superior in the detection of anal fistula compared to only T2-weighted sequence and to perform similarly to postcontrast sequences and T2-weighted sequences together. DWI may also differentiate between inactive fibrous fistula and active inflammatory ones.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Further Reading
Barbaro B, Vitale R, Leccisotti L et al (2010) Restaging locally advanced rectal cancer after chemoradiation therapy with MR imaging. Radiographics 30(3):699–716
Dahan H, Arrivé L, Wendum D et al (2001) Retrorectal developmental cysts in adults: clinical and radiologic-histopathologic review, differential diagnosis, and treatment. Radiographics 21(3):575–584
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):958–965
Dzik-Jurasz A, Domenig C, George M et al (2002) Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet 360(9329):307–308
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):214–222
Heverhagen JT, Klose KJ (2009) MR imaging for acute lower abdominal and pelvic pain. Radiographics 29(6):1781–1796
Hori M, Oto A, Orrin S et al (2009) Diffusion-weighted MRI: a new tool for the diagnosis of fistula in ano. J Magn Reson Imaging 30(5):1021–1026
Hosonuma T, Tozaki M, Ichiba N et al (2006) Clinical usefulness of diffusion-weighted imaging using low and high b-values to detect rectal cancer. Magn Reson Med Sci 5(4):173–177
Ichikawa T, Ertuk SM, Motosugi U et al (2006) High-b-value diffusion weighted MRI in colorectal cancer. Am J Roentgenol 187:181–184
Kilickesmez O, Atilla S, Soylu A et al (2009) Diffusion-weighted imaging of the rectosigmoid colon: preliminary findings. J Comput Assist Tomogr 33(6):863–866
Kim DJ, Kim JH, Lim JS et al (2010) Restaging of rectal cancer with MR imaging after concurrent chemotherapy and radiation therapy. Radiographics 30(2):503–516
Kim JK, Kim KA, Park BW et al (2008) Feasibility of diffusion-weighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes: early experience. J Magn Reson Imaging 28:714–719
Kim SH, Lee JM, Hong SH et al (2009) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology 253(1):116–125
Kim SH, Lee JY, Lee JM et al (2011) Apparent diffusion coefficient for evaluating tumour response to neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Eur Radiol 21(5):987–995
Koh DM, Chau I, Tait D et al (2008) Evaluating mesorectal lymph nodes in rectal cancer before and after neoadjuvant chemoradiation using thin-section T2-weighted magnetic resonance imaging. Int J Radiat Oncol Biol Phys 71:456–461
Lambrecht M, Deroose C, Roels S et al (2010) The use of FDG-PET/CT and diffusion-weighted magnetic resonance imaging for response prediction before, during and after preoperative chemoradiotherapy for rectal cancer. Acta Oncol 49(7):956–963
Lambregts DM, Maas M, Riedl RG et al (2011) Value of ADC measurements for nodal staging after chemoradiation in locally advanced rectal cancer-a per lesion validation study. Eur Radiol 21(2):265–273
Levy AD, Remotti HE, Thompson WM et al (2003) Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 23(2):283–304
Lin G, Ho KC, Wang JJ et al (2008) Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging 28:128–135
Menu Y (2007) Evaluation of tumour response to treatment with targeted therapies: standard or targeted criteria? Bull Cancer 94(7 Suppl):F231–F239
MERCURY Study Group (2007) Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 243(1):132–139
Nasu K, Kuroki Y, Kuroki S et al (2004) Diffusion-weighted single shot echo planar imaging of colorectal cancer using a sensitivity-encoding technique. Jpn J Clin Oncol 34:620–626
Ono K, Ochiai R, Yoshida T et al (2009) Comparison of diffusion-weighted MRI and 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for detecting primary colorectal cancer and regional lymph node metastases. J Magn Reson Imaging 29:336–340
Oussalah A, Laurent V, Bruot O et al (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59(8):1056–1065
Padhani AR, Liu G, Koh DM et al (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11(2):102–125
Rao SX, Zeng MS, Chen CZ et al (2008) The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection. Eur J Radiol 65(2):299–303
Shankar S, Dundamadappa SK, Karam AR et al (2009) Imaging of gastrointestinal stromal tumors before and after imatinib mesylate therapy. Acta Radiol 50(8):837–844
Soyer P, Lagadec M, Sirol M et al (2010) Free-breathing diffusion-weighted single-shot echo-planar MR imaging using parallel imaging (GRAPPA 2) and high b value for the detection of primary rectal adenocarcinoma. Cancer Imaging 10(1):32–39
Sun YS, Zhang XP, Tang L et al (2010) Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted MR imaging for early detection of tumor histopathologic downstaging. Radiology 254(1):170–178
Yasui O, Sato M, Kamada A (2009) Diffusion-weighted imaging in the detection of lymph node metastasis in colorectal cancer. Tohoku J Exp Med 218(3):177–183
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2012 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Alcalá, L., Martín, T., Luna, A. (2012). Diffusion-Weighted Imaging of Anorectal Region. In: Diffusion MRI Outside the Brain. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-21052-5_12
Download citation
DOI: https://doi.org/10.1007/978-3-642-21052-5_12
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-21051-8
Online ISBN: 978-3-642-21052-5
eBook Packages: MedicineMedicine (R0)