Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting

  • Regina G. H. Beets-Tan
  • Doenja M. J. Lambregts
  • Monique Maas
  • Shandra Bipat
  • Brunella Barbaro
  • Luís Curvo-Semedo
  • Helen M. Fenlon
  • Marc J. Gollub
  • Sofia Gourtsoyianni
  • Steve Halligan
  • Christine Hoeffel
  • Seung Ho Kim
  • Andrea Laghi
  • Andrea Maier
  • Søren R. Rafaelsen
  • Jaap Stoker
  • Stuart A. Taylor
  • Michael R. Torkzad
  • Lennart Blomqvist
Gastrointestinal
  • 612 Downloads

Abstract

Objectives

To update the 2012 ESGAR consensus guidelines on the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer.

Methods

Fourteen abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) participated in a consensus meeting, organised according to an adaptation of the RAND-UCLA Appropriateness Method. Two independent (non-voting) Chairs facilitated the meeting. 246 items were scored (comprising 229 items from the previous 2012 consensus and 17 additional items) and classified as ‘appropriate’ or ‘inappropriate’ (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus).

Results

Consensus was reached for 226 (92 %) of items. From these recommendations regarding hardware, patient preparation, imaging sequences and acquisition, criteria for MR imaging evaluation and reporting structure were constructed. The main additions to the 2012 consensus include recommendations regarding use of diffusion-weighted imaging, criteria for nodal staging and a recommended structured report template.

Conclusions

These updated expert consensus recommendations should be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI.

Key Points

These guidelines present recommendations for staging and reporting of rectal cancer.

The guidelines were constructed through consensus amongst 14 pelvic imaging experts.

Consensus was reached by the experts for 92 % of the 246 items discussed.

Practical guidelines for nodal staging are proposed.

A structured reporting template is presented.

Keywords

Magnetic resonance imaging Cancer rectal neoplasms Standards Staging Structured reporting 

Supplementary material

330_2017_5026_MOESM1_ESM.xls (74 kb)
ESM 1(XLS 74 kb)

References

  1. 1.
    Beets-Tan RG, Lambregts DM, Maas M et al (2013) Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 23:2522–2531CrossRefPubMedGoogle Scholar
  2. 2.
    Habr-Gama A, Gama-Rodrigues J, Sao Juliao GP et al (2014) Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 88:822–828CrossRefPubMedGoogle Scholar
  3. 3.
    Martens MH, Maas M, Heijnen LA, et al (2016) Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer. J Natl Cancer Inst. 108Google Scholar
  4. 4.
    Appelt AL, Ploen J, Harling H et al (2015) High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study. Lancet Oncol 16:919–927CrossRefPubMedGoogle Scholar
  5. 5.
    Fitch K, Bernstein S, Aguilar M et al (2001) The RAND/UCLA Appropriateness Method User’s Manual. AHCPR Pub No 95-0009. Public Health Service, US Department of Health and Human Services, RockvilleGoogle Scholar
  6. 6.
    Sobin L, Gospodarowicz M, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. International Union Against CancerGoogle Scholar
  7. 7.
    Sobin L, Wittekind C (2002) TNM classification of malignant tumours, 6th edn. International Union Against CancerGoogle Scholar
  8. 8.
    Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging-a meta-analysis. Radiology 232:773–783CrossRefPubMedGoogle Scholar
  9. 9.
    Marone P, de Bellis M, D'Angelo V et al (2015) Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer. World journal of gastrointestinal endoscopy 7:688–701PubMedPubMedCentralGoogle Scholar
  10. 10.
    Maas M, Lambregts DM, Nelemans PJ et al (2015) Assessment of Clinical Complete Response After Chemoradiation for Rectal Cancer with Digital Rectal Examination, Endoscopy, and MRI: Selection for Organ-Saving Treatment. Ann Surg Oncol 22:3873–3880CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Sloothaak DA, Geijsen DE, van Leersum NJ et al (2013) Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br J Surg 100:933–939CrossRefPubMedGoogle Scholar
  12. 12.
    West MA, Dimitrov BD, Moyses GJ et al (2016) Timing of surgery following neoadjuvant cehmoradiotherapy in locally advanced rectal cancer – a comparison of magnetic resonance imaging at two time points and histopathological responses. Eur J Surg Oncol 42:1350–1358CrossRefPubMedGoogle Scholar
  13. 13.
    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 61:65–70CrossRefPubMedGoogle Scholar
  14. 14.
    Dal Lago A, Minetti AE, Biondetti P, Corsetti M, Basilisco G (2005) Magnetic resonance imaging of the rectum during distension. Dis Colon Rectum 48:1220–1227CrossRefPubMedGoogle Scholar
  15. 15.
    Van Griethuysen J, Bus E, Hauptmann M et al (2017) Air artefacts on diffusion-weighted MRI of the rectum: effect of applyting a rectal micro-enema. Insights Imaging 8(Suppl 1):S187 (abstract)Google Scholar
  16. 16.
    Lim C, Quon J, McInnes M, Shabana WM, El-Khodary M, Schieda N (2015) Does a cleansing enema improve image quality of 3T surface coil multiparametric prostate MRI? J Magn Reson Imaging 42:689–697CrossRefPubMedGoogle Scholar
  17. 17.
    National working group gastrointestinal tumours (2014) National guideline on rectal cancer, version 3.0. www.oncoline.nl (last update 16 April 2014)
  18. 18.
    Joye I, Haustermans K (2014) Early and late toxicity of radiotherapy for rectal cancer. Recent Results Cancer Res 203:189–201CrossRefPubMedGoogle Scholar
  19. 19.
    Taylor FG, Quirke P, Heald RJ et al (2011) 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 253:711–719CrossRefPubMedGoogle Scholar
  20. 20.
    Gollub MJ, Maas M, Weiser M et al (2013) Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol 200:97–101CrossRefPubMedGoogle Scholar
  21. 21.
    Sahni VA, Silveira PC, Sainani NI, Khorasani R (2015) Impact of a Structured Report Template on the Quality of MRI Reports for Rectal Cancer Staging. AJR Am J Roentgenol 205:584–588CrossRefPubMedGoogle Scholar
  22. 22.
    Norenberg D, Sommer WH, Thasler W et al (2016) Structured Reporting of Rectal Magnetic Resonance Imaging in Suspected Primary Rectal Cancer: Potential Benefits for Surgical Planning and Interdisciplinary Communication. Invest Radiol 52:232–239CrossRefGoogle Scholar
  23. 23.
    Martens MH, van Heeswijk MM, van den Broek JJ et al (2015) Prospective, Multicenter Validation Study of Magnetic Resonance Volumetry for Response Assessment After Preoperative Chemoradiation in Rectal Cancer: Can the Results in the Literature be Reproduced? Int J Radiat Oncol Biol Phys 93:1005–1014CrossRefPubMedGoogle Scholar
  24. 24.
    Hotker AM, Tarlinton L, Mazaheri Y et al (2016) Multiparametric MRI in the assessment of response of rectal cancer to neoadjuvant chemoradiotherapy: A comparison of morphological, volumetric and functional MRI parameters. Eur Radiol 26:4303–4312CrossRefPubMedGoogle Scholar
  25. 25.
    Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G (2008) Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 95:229–236CrossRefPubMedGoogle Scholar
  26. 26.
    Chand M, Siddiqui MR, Swift I, Brown G (2016) Systematic review of prognostic importance of extramural venous invasion in rectal cancer. World J Gastroenterol. 22:1721–1726CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Tripathi P, Rao SX, Zeng MS (2016) Clinical value of MRI-detected extramural venous invasion in rectal cancer. J Dig Dis 18:2–12CrossRefGoogle Scholar
  28. 28.
    van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S (2013) Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology 269:101–112CrossRefPubMedGoogle Scholar
  29. 29.
    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 253:116–125CrossRefPubMedGoogle Scholar
  30. 30.
    Lambregts DM, Vandecaveye V, Barbaro B et al (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18:2224–2231CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sassen S, de Booij M, Sosef M et al (2013) Locally advanced rectal cancer: is diffusion weighted MRI helpful for the identification of complete responders (ypT0N0) after neoadjuvant chemoradiation therapy? Eur Radiol 23:3440–3449CrossRefPubMedGoogle Scholar
  32. 32.
    Foti PV, Privitera G, Piana S et al (2016) Locally advanced rectal cancer: Qualitative and quantitative evaluation of diffusion-weighted MR imaging in the response assessment after neoadjuvant chemo-radiotherapy. Eur J bRadiol Open 3:145–152CrossRefGoogle Scholar
  33. 33.
    Tong T, Sun Y, Gollub MJ et al (2015) Dynamic contrast-enhanced MRI: Use in predicting pathological complete response to neoadjuvant chemoradiation in locally advanced rectal cancer. J Magn Reson Imaging 42:673–680CrossRefPubMedGoogle Scholar
  34. 34.
    Lollert A, Junginger T, Schimanski CC et al (2014) Rectal cancer: dynamic contrast-enhanced MRI correlates with lymph node status and epidermal growth factor receptor expression. J Magn Reson Imaging 39:1436–1442CrossRefPubMedGoogle Scholar
  35. 35.
    Martens MH, Subhani S, Heijnen LA et al (2015) Can perfusion MRI predict response to preoperative treatment in rectal cancer? Radiother Oncol 114:218–223CrossRefPubMedGoogle Scholar
  36. 36.
    Kim SH, Lee JM, Gupta SN, Han JK, Choi BI (2014) Dynamic contrast-enhanced MRI to evaluate the therapeutic response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer. J Magn Reson Imaging 40:730–737CrossRefPubMedGoogle Scholar
  37. 37.
    Gollub MJ, Gultekin DH, Akin O et al (2012) Dynamic contrast enhanced-MRI for the detection of pathological complete response to neoadjuvant chemotherapy for locally advanced rectal cancer. Eur Radiol 22:821–831CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Regina G. H. Beets-Tan
    • 1
  • Doenja M. J. Lambregts
    • 1
  • Monique Maas
    • 1
  • Shandra Bipat
    • 2
  • Brunella Barbaro
    • 3
  • Luís Curvo-Semedo
    • 4
  • Helen M. Fenlon
    • 5
  • Marc J. Gollub
    • 6
  • Sofia Gourtsoyianni
    • 7
  • Steve Halligan
    • 8
  • Christine Hoeffel
    • 9
  • Seung Ho Kim
    • 10
  • Andrea Laghi
    • 11
  • Andrea Maier
    • 12
  • Søren R. Rafaelsen
    • 13
  • Jaap Stoker
    • 2
  • Stuart A. Taylor
    • 8
  • Michael R. Torkzad
    • 8
  • Lennart Blomqvist
    • 14
  1. 1.Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Academic Medical CentreAmsterdamThe Netherlands
  3. 3.Catholic University School of MedicineRomeItaly
  4. 4.Coimbra University HospitalsCoimbraPortugal
  5. 5.Mater Misericordiae University HospitalDublinIreland
  6. 6.Memorial Sloan-Kettering Cancer CenterNew YorkUSA
  7. 7.Guy’s & St Thomas’ NHS FTLondonUK
  8. 8.Centre for Medical ImagingUniversity College LondonLondonUK
  9. 9.Reims University HospitalReimsFrance
  10. 10.Inje University Haeundae Paik HospitalBusanSouth Korea
  11. 11.Sapienza - University of RomeRomeItaly
  12. 12.Medical University of ViennaViennaAustria
  13. 13.Clinical Cancer CentreVejle HospitalVejleDenmark
  14. 14.Karolinska University Hospital and Karolinska InstitutetStockholmSweden

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