European Radiology

, Volume 19, Issue 3, pp 643–650 | Cite as

MRI staging of low rectal cancer

  • Oliver C. Shihab
  • Brendan J. Moran
  • Richard J. Heald
  • Philip Quirke
  • Gina BrownEmail author


Low rectal tumours, especially those treated by abdominoperineal excision (APE), have a high rate of margin involvement when compared with tumours elsewhere in the rectum. Correct surgical management to minimise this rate of margin involvement is reliant on highly accurate imaging, which can be used to plan the planes of excision. In this article we describe the techniques for accurate magnetic resonance imaging (MRI) assessment and a novel staging system for low rectal tumours. Using this staging system it is possible for the radiologist to demonstrate accurately tumour-free planes for surgical excision of low rectal tumours.


MRI Rectal cancer Staging Low rectal cancer 



The authors wish to acknowledge the Trial Management Group. Trial PIs: Professor RJ Heald, Mr BJ Moran, Dr. Torbjorn Holm, Mr. Ian Daniels (Surgery), Dr Gina Brown, Dr Lennart Blomqvist (Radiology), Professor Philip Quirke (Histopathology), Dr Diana Tait (Clinical Oncology), Dr Andy Norman, Dr Yolanda Barbachano (Statistics).


  1. 1.
    Hospital Episode Statistics online (2008) The Information Centre. Accessed 15 December 2007
  2. 2.
    Salerno G, Daniels I, Brown G, Norman A, Moran B, Heald R (2007) Variations in pelvic dimensions do not predict the risk of circumferential resection margin (CRM) involvement in rectal cancer. World J Surg 31:1315–1322CrossRefGoogle Scholar
  3. 3.
    Mercury Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 333:779–784CrossRefGoogle Scholar
  4. 4.
    Nagtegaal ID, van de Velde CJH, Marijnen CAM, van Krieken JHJM, Quirke P (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264CrossRefPubMedGoogle Scholar
  5. 5.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMedGoogle Scholar
  6. 6.
    Marr R, Birbeck K, Garvican J, Macklin C, Tiffin N, Parsons W et al (2005) The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 242:74–82CrossRefPubMedGoogle Scholar
  7. 7.
    Salerno G, Daniels I, Heald RJ, Brown G, Moran BJ (2004) Management and imaging of low rectal carcinoma. Surg Oncol 13:55–61CrossRefPubMedGoogle Scholar
  8. 8.
    Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94:232–238CrossRefPubMedGoogle Scholar
  9. 9.
    Brown G, Daniels I, Richardson C, Revell P, Peppercorn D, Bourne M (2005) Techniques and trouble-shooting in high spatial resolution thin slice MRI for rectal cancer. Br J Radiol 78:245–251CrossRefPubMedGoogle Scholar
  10. 10.
    Quirke P, Dixon MF (1988) The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorectal Dis 3:127–131CrossRefPubMedGoogle Scholar
  11. 11.
    Wotherspoon AC (2006) Pathological assessment of rectal carcinoma after preoperative therapy. Colorectal Dis 8:37–39CrossRefPubMedGoogle Scholar
  12. 12.
    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 90:355–364CrossRefPubMedGoogle Scholar
  13. 13.
    Beets-Tan R (2003) MRI in rectal cancer: the T stage and circumferential resection margin. Colorectal Dis 5(5):392–395CrossRefPubMedGoogle Scholar
  14. 14.
    Allen S, Padhani A, Dzik-Jurasz A, Glynne-Jones R (2007) Rectal carcinoma: MRI with histologic correlation before and after chemoradiation therapy. AJR Am J Rountgenol 188:442–451CrossRefGoogle Scholar
  15. 15.
    Peschaud F, Cuenod CA, Benoist S et al (2005) Accuracy of magnetic resonance imaging in rectal cancer depends on location of the tumor. Dis Colon Rectum 48:1603–1609CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  • Oliver C. Shihab
    • 1
  • Brendan J. Moran
    • 2
  • Richard J. Heald
    • 1
  • Philip Quirke
    • 3
  • Gina Brown
    • 4
    Email author
  1. 1.Pelican Cancer Foundation, North Hampshire HospitalBasingstokeUK
  2. 2.Colorectal Research Unit, North Hampshire HospitalBasingstokeUK
  3. 3.Leeds Institute for Molecular MedicineSt James’s HospitalLeedsUK
  4. 4.Department of RadiologyRoyal Marsden HospitalSurreyUK

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