Abdominal Radiology

, Volume 43, Issue 5, pp 1101–1119 | Cite as

The bottom line: MRI and CT findings of unusual rectal and perirectal pathology

  • Stephanie Font
  • Candice Bolan
  • Melanie Caserta
Pictorial essay


Although common nonspecific symptoms (i.e., rectal bleeding, pelvic pressure, and change in bowel habits) are associated with rectal cancer, occasionally these are related to a different underlying disease. Over the past few years, considerable progress has been made in imaging of the rectum. Specifically, new magnetic resonance techniques and capabilities provide impressive high-resolution assessment of the rectal wall and enable evaluation and characterization of the perirectal tissues. This paper reviews imaging findings of uncommon causes of rectal and perirectal pathology that may be clinically confounded with rectal cancer. Radiologists need to be aware of uncommon pathologies in this region in order to facilitate optimal management decisions.


MR Perirectal mass Presacral mass Rectal mass 


Compliance with ethical standards


Not applicable.

Conflict of interest

None. All authors declare no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Kenig J, Richter P (2013) Definition of the rectum and level of the peritoneal reflection—still a matter of debate? Wideochir Inne Tech Maloinwazyjne 8:183–186. PubMedPubMedCentralGoogle Scholar
  2. 2.
    Iafrate F, Laghi A, Paolantonio P, et al. (2006) Preoperative staging of rectal cancer with MR imaging: correlation with surgical and histopathologic findings. Radiographics 26:701–714. CrossRefPubMedGoogle Scholar
  3. 3.
    Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Anorectal gastrointestinal stromal tumors: CT and MR imaging features with clinical and pathologic correlation. AJR Am J Roentgenol 180:1607–1612. CrossRefPubMedGoogle Scholar
  4. 4.
    Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 23:283–304 (quiz 532). CrossRefPubMedGoogle Scholar
  5. 5.
    Rouse HC, Godoy MC, Lee WK, et al. (2008) Imaging findings of unusual anorectal and perirectal pathology: a multi-modality approach. Clin Radiol 63:1350–1360. CrossRefPubMedGoogle Scholar
  6. 6.
    Kim H, Kim JH, Lim JS, et al. (2011) MRI findings of rectal submucosal tumors. Korean J Radiol 12:487–498. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hong X, Choi H, Loyer EM, et al. (2006) Gastrointestinal stromal tumor: role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. Radiographics 26:481–495. CrossRefPubMedGoogle Scholar
  8. 8.
    Franquemont DW (1995) Differentiation and risk assessment of gastrointestinal stromal tumors. Am J Clin Pathol 103:41–47CrossRefPubMedGoogle Scholar
  9. 9.
    Fletcher CD, Berman JJ, Corless C, et al. (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465CrossRefPubMedGoogle Scholar
  10. 10.
    Suster S (1996) Gastrointestinal stromal tumors. Semin Diagn Pathol 13:297–313PubMedGoogle Scholar
  11. 11.
    Hain KS, Pickhardt PJ, Lubner MG, Menias CO, Bhalla S (2013) Presacral masses: multimodality imaging of a multidisciplinary space. Radiographics 33:1145–1167. CrossRefPubMedGoogle Scholar
  12. 12.
    Jiang ZX, Zhang SJ, Peng WJ, Yu BH (2013) Rectal gastrointestinal stromal tumors: imaging features with clinical and pathological correlation. World J Gastroenterol 19:3108–3116. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Pickhardt PJ, Kim DH, Menias CO, et al. (2007) Evaluation of submucosal lesions of the large intestine: part 1. Neoplasms. Radiographics 27:1681–1692. CrossRefPubMedGoogle Scholar
  14. 14.
    Jacob AG, Driscoll DJ, Shaughnessy WJ, et al. (1998) Klippel–Trenaunay syndrome: spectrum and management. Mayo Clin Proc 73:28–36. CrossRefPubMedGoogle Scholar
  15. 15.
    Cha SH, Romeo MA, Neutze JA (2005) Visceral manifestations of Klippel–Trenaunay syndrome. Radiographics 25:1694–1697. CrossRefPubMedGoogle Scholar
  16. 16.
    Servelle M, Bastin R, Loygue J, et al. (1976) Hematuria and rectal bleeding in the child with Klippel and Trenaunay syndrome. Ann Surg 183:418–428CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wilson CL, Song LM, Chua H, et al. (2001) Bleeding from cavernous angiomatosis of the rectum in Klippel–Trenaunay syndrome: report of three cases and literature review. Am J Gastroenterol 96:2783–2788. PubMedGoogle Scholar
  18. 18.
    Levy AD, Sobin LH (2007) From the archives of the AFIP: gastrointestinal carcinoids: imaging features with clinicopathologic comparison. Radiographics 27:237–257. CrossRefPubMedGoogle Scholar
  19. 19.
    Wong WL, Johns TA, Herlihy WG, Martin HL (2004) Best cases from the AFIP: multicystic mesothelioma. Radiographics 24:247–250. CrossRefPubMedGoogle Scholar
  20. 20.
    Onaitis MW, Kirshbom PM, Hayward TZ, et al. (2000) Gastrointestinal carcinoids: characterization by site of origin and hormone production. Ann Surg 232:549–556CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Jiang C, Gu L, Luo M, Xu Q, Zhou H (2015) Primary rectal lymphoma: a case report and literature review. Oncol Lett 10:43–44. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ghai S, Pattison J, O’Malley ME, Khalili K, Stephens M (2007) Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics 27:1371–1388. CrossRefPubMedGoogle Scholar
  23. 23.
    Toledano-Massiah S, Luciani A, Itti E, et al. (2015) Whole-body diffusion-weighted imaging in Hodgkin lymphoma and diffuse large B-cell lymphoma. Radiographics 35:747–764. CrossRefPubMedGoogle Scholar
  24. 24.
    van Schaik PM, Ernst MF, Meijer HA, Bosscha K (2008) Melanoma of the rectum: a rare entity. World J Gastroenterol 14:1633–1635CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Healy JC (2001) Detection of peritoneal metastases. Cancer Imaging 1:4–12. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hoeffel CC, Azizi L, Mourra N, et al. (2006) MRI of rectal disorders. AJR Am J Roentgenol 187:W275–W284. CrossRefPubMedGoogle Scholar
  27. 27.
    Montgomery E, Goldblum JR, Fisher C (2001) Myofibrosarcoma: a clinicopathologic study. Am J Surg Pathol 25:219–228CrossRefPubMedGoogle Scholar
  28. 28.
    Inan N, Arslan AS, Akansel G, et al. (2007) Colitis cystica profunda: MRI appearance. Abdom Imaging 32:239–242. CrossRefPubMedGoogle Scholar
  29. 29.
    Sunagawa H, Kinjyou T, Nagahama M, Nishimaki T, Nakayama T (2005) Enteritis cystica profunda presenting as ileoileal intussusception in a child: report of a case. Surg Today 35:164–167. CrossRefPubMedGoogle Scholar
  30. 30.
    Hulsmans FJ, Tio TL, Reeders JW, Tytgat GN (1991) Transrectal US in the diagnosis of localized colitis cystica profunda. Radiology 181:201–203. CrossRefPubMedGoogle Scholar
  31. 31.
    Dahan H, Arrive L, Wendum D, et al. (2001) Retrorectal developmental cysts in adults: clinical and radiologic-histopathologic review, differential diagnosis, and treatment. Radiographics 21:575–584. CrossRefPubMedGoogle Scholar
  32. 32.
    Yang DM, Park CH, Jin W, et al. (2005) Tailgut cyst: MRI evaluation. AJR Am J Roentgenol 184:1519–1523. CrossRefPubMedGoogle Scholar
  33. 33.
    Kim MJ, Kim WH, Kim NK, et al. (1997) Tailgut cyst: multilocular cystic appearance on MRI. J Comput Assist Tomogr 21:731–732CrossRefPubMedGoogle Scholar
  34. 34.
    Mesurolle B, Sayag E, Meingan P, et al. (1996) Retroperitoneal extramedullary hematopoiesis: sonographic, CT, and MR imaging appearance. AJR Am J Roentgenol 167:1139–1140. CrossRefPubMedGoogle Scholar
  35. 35.
    Sauer B, Buy X, Gangi A, Roy C (2007) Exceptional localization of extramedullary hematopoiesis: presacral and periureteral masses. Acta Radiol 48:246–248. CrossRefPubMedGoogle Scholar
  36. 36.
    Del Frate C, Girometti R, Pittino M, et al. (2006) Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics 26:1705–1718. CrossRefPubMedGoogle Scholar
  37. 37.
    Coutinho A Jr, Bittencourt LK, Pires CE, et al. (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics 31:549–567. CrossRefPubMedGoogle Scholar
  38. 38.
    O’Neil JD, Ros PR, Storm BL, Buck JL, Wilkinson EJ (1989) Cystic mesothelioma of the peritoneum. Radiology 170:333–337. CrossRefPubMedGoogle Scholar
  39. 39.
    Koo PJ, Wills JS (2009) Case 146: benign multicystic mesothelioma. Radiology 251:944–946. CrossRefPubMedGoogle Scholar
  40. 40.
    Jerbi M, Hidar S, Ziadi S, Khairi H (2006) Benign multicystic peritoneal mesothelioma. Int J Gynaecol Obstet 93:267–268. CrossRefPubMedGoogle Scholar
  41. 41.
    Diel J, Ortiz O, Losada RA, et al. (2001) The sacrum: pathologic spectrum, multimodality imaging, and subspecialty approach. Radiographics 21:83–104. CrossRefPubMedGoogle Scholar
  42. 42.
    Wells RG, Sty JR (1990) Imaging of sacrococcygeal germ cell tumors. Radiographics 10:701–713. CrossRefPubMedGoogle Scholar
  43. 43.
    Farsad K, Kattapuram SV, Sacknoff R, Ono J, Nielsen GP (2009) Sacral chordoma. Radiographics 29:1525–1530. CrossRefPubMedGoogle Scholar
  44. 44.
    Sciubba DM, Chi JH, Rhines LD, Gokaslan ZL (2008) Chordoma of the spinal column. Neurosurg Clin N Am 19:5–15. CrossRefPubMedGoogle Scholar
  45. 45.
    York JE, Kaczaraj A, Abi-Said D, et al. (1999) Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery 44:74–79 (discussion 79–80)CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2018

Authors and Affiliations

  1. 1.Division of Diagnostic RadiologyMayo ClinicJacksonvilleUSA

Personalised recommendations