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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

  • Gastrointestinal
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To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer.


A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus). Items not reaching 80 % consensus were noted.


Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these.


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

Key Points

These guidelines recommend standardised imaging for staging and restaging of rectal cancer.

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

Consensus was reached by in 88 % of 236 items discussed.

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  1. Valentini V, Aristei C, Glimelius B et al (2009) Multidisciplinary rectal cancer management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Radiother Oncol 92:148–163

    Article  PubMed  Google Scholar 

  2. Glimelius B, Pahlman L, Cervantes A (2010) Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2:v82–v86

    Article  Google Scholar 

  3. 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 232:773–783

    Article  PubMed  Google Scholar 

  4. Lahaye MJ, Engelen SM, Nelemans PJ et al (2005) Imaging for predicting the risk factors—the circumferential resection margin and nodal disease—of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 26:259–268

    Article  PubMed  CAS  Google Scholar 

  5. Maas M, Beets-Tan RG, Lambregts DM et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29:4633–4640

    Article  PubMed  Google Scholar 

  6. Lezoche G, Baldarelli M, Guerrieri M et al (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22:352–358

    Article  PubMed  CAS  Google Scholar 

  7. 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 Service, Rockville

    Google Scholar 

  8. 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 61:65–70

    Article  PubMed  CAS  Google Scholar 

  9. Shihab OC, Moran BJ, Heald RJ, Quirke P, Brown G (2009) MRI staging of low rectal cancer. Eur Radiol 19:643–650

    Article  PubMed  Google Scholar 

  10. Torkzad MR, Suzuki C, Tanaka S, Palmer G, Holm T, Blomqvist L (2008) Morphological assessment of the interface between tumor and neighboring tissues, by magnetic resonance imaging, before and after radiotherapy in patients with locally advanced rectal cancer. Acta Radiol 49:1099–1103

    Article  PubMed  CAS  Google Scholar 

  11. 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 253:116–125

    Article  PubMed  Google Scholar 

  12. 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 18:2224–2231

    Article  PubMed  Google Scholar 

  13. Song I, Kim SH, Lee SJ, Choi JY, Kim MJ, Rhim H (2012) Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison with T2-weighted and PET/CT imaging. Br J Radiol 85:577–586

    Article  PubMed  CAS  Google Scholar 

  14. Kim SH, Lee JM, Moon SK et al (2012) Evaluation of lymph node metastases: comparison of gadofluorine M-enhanced MRI and diffusion-weighted MRI in a rabbit VX2 rectal cancer model. J Magn Reson Imaging 35:1179–1186

    Article  PubMed  Google Scholar 

  15. 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 21:265–273

    Article  PubMed  Google Scholar 

  16. Mizukami Y, Ueda S, Mizumoto A et al (2011) Diffusion-weighted magnetic resonance imaging for detecting lymph node metastasis of rectal cancer. World J Surg 35:895–899

    Article  PubMed  Google Scholar 

  17. Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H (2011) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology 260:771–780

    Article  PubMed  Google Scholar 

  18. Mir N, Sohaib SA, Collins D, Koh DM (2010) Fusion of high b-value diffusion-weighted and T2-weighted MR images improves identification of lymph nodes in the pelvis. J Med Imaging Radiat Oncol 54:358–364

    Article  PubMed  CAS  Google Scholar 

  19. 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 22:821–831

    Article  PubMed  CAS  Google Scholar 

  20. Koh DM, Brown G, Collins DJ (2009) Nanoparticles in rectal cancer imaging. Cancer Biomark 5:89–98

    PubMed  Google Scholar 

  21. Lambregts DM, Beets GL, Maas M et al (2011) Accuracy of gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer. Ann Surg 253:539–545

    Article  PubMed  Google Scholar 

  22. Brown G, Richards CJ, Bourne MW et al (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377

    Article  PubMed  Google Scholar 

  23. 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 95:229–236

    Article  PubMed  CAS  Google Scholar 

  24. Koh DM, Smith NJ, Swift RI, Brown G (2008) The relationship between mr demonstration of extramural venous invasion and nodal disease in rectal cancer. Clin Med Oncol 2:267–273

    PubMed  Google Scholar 

  25. Brown G, Kirkham A, Williams GT et al (2004) High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. AJR Am J Roentgenol 182:431–439

    Article  PubMed  Google Scholar 

  26. Gollub MJ, Maas M, Weiser M et al (2013) Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol 200:97–101

    Article  PubMed  Google Scholar 

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Correspondence to Regina G. H. Beets-Tan.

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Beets-Tan, R.G.H., Lambregts, D.M.J., Maas, M. et al. 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, 2522–2531 (2013).

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