Résumé
La stratégie thérapeutique dans les tumeurs rectales nécessite de disposer d’un bilan préopératoire précis et exhaustif sur l’extension locale et à distance. Si l’extension à distance reste l’apanage du scanner thoracoabdomino-pelvien, l’IRM et l’échoendoscopie sont actuellement performantes et complémentaires pour le bilan d’extension local. Les buts essentiels de l’imagerie sont de déterminer la nécessité et le type de traitement néoadjuvant en fonction du stade de la tumeur et de la marge circonférentielle radiaire et de guider le chirurgien dans le choix de la technique chirurgicale la plus adaptée. Seule l’évaluation de l’atteinte ganglionnaire reste encore délicate en IRM.
Abstract
It’s essential in treating rectal cancer to have adequate preoperative imaging. Meticulous preoperative assessment remains key because contemporary therapy is dependent upon presurgical diagnostic imaging modalities, which influence the indication for neoadjuvant therapy and the decision process concerning the appropriate surgical approach. If the distant extension remains of the whole body computed tomography, the MRI and the endorectal ultrasound are currently powerful and complementary for the local staging of rectal cancer. Conventional TN staging now appears less crucial compared to assessing tumor distance from the potential plane of surgical resection (particularly the circumferential margin bounded by the mesorectal fascia), and this is reliant on high-quality imaging. The evaluation of nodal metastases remains a challenge with routine MRI.
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Laurent, V., Hoeffel, C. Aspects techniques et interprétation d’une IRM dans le bilan d’extension local des tumeurs rectales. Colon Rectum 4, 115–121 (2010). https://doi.org/10.1007/s11725-010-0218-9
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DOI: https://doi.org/10.1007/s11725-010-0218-9