Zusammenfassung
Über die vergangenen 20 Jahre hinweg hat die Magnetresonanztomographie (MRT) beim Rektumkarzinom stetig an Bedeutung gewonnen und nimmt heute entscheidenden Einfluss auf moderne Therapiestrategien. Sowohl im Primärstaging als auch im Restaging entkoppelt sich die Methode zunehmend vom TNM-System und nimmt die Rolle eines Gamechangers ein, indem sie morphologische und funktionelle Merkmale identifiziert, die ihrerseits High- und Low-risk-Patienten definieren. Zu den morphologischen Aspekten zählen neben der Bedrohung der mesorektalen Faszie die extramurale vaskuläre Infiltration, Tumordeposits und das muzinöse Karzinom. Unter die funktionellen Parameter fallen Zellularität und Vaskularisationsgrad. Die kombinierte Betrachtung von Morphologie und Funktion verbessert die Differenzierung von Respondern und Nonrespondern, ermöglicht eine exakte Operationsplanung, intensivierte Strahlentherapie und eine Watch-and-wait-Strategie.
Abstract
Over the last two decades, magnetic resonance imaging (MRI) has continuously been gaining influence in modern management of rectal cancer. Bringing morphological and functional features together improves the differentiation of responders from nonresponders, provides for accurate surgical planning, intensified radiation therapy regimes, and watch-and-wait strategies. A shift from TNM staging towards risk stratification of rectal cancer patients, patient selection to increasingly individualized therapies, and intensified surveillance has contributed to the transformation of rectal MRI into a true gamechanger.
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Schäfer, AO. Update Rektumkarzinom: postneoadjuvantes Staging. Radiologie 63, 451–456 (2023). https://doi.org/10.1007/s00117-023-01152-5
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DOI: https://doi.org/10.1007/s00117-023-01152-5