Skip to main content
SpringerLink
Log in

Clinical Staging: CT and MRI

  • Chapter
  • First Online:
Rectal Cancer

Part of the book series: Current Clinical Oncology ((CCO))

  • 1176 Accesses

Abstract

The unique anatomy of the rectum, as well as its enveloping mesorectum and mesorectal fascia, provides interesting challenges for imaging modalities. Staging investigations should be able to identify the characteristics of tumor that determine prognosis as well as the anatomic delineators of local spread that predict surgical resectability with a clear radial margin. Multidetector CT with multiplanar formatting allows visualization of images in three dimensions. Though it is sometimes accurate in staging upper rectal tumors, it is less informative than MRI, and this is particularly so for lower rectal tumors. The ability of MRI to accurately image the relevant structures of the mesorectum in rectal cancer has become increasingly evident. Advances in imaging techniques, together with development of dedicated methods for performing MR examination in rectal cancer, have resulted in improved image quality. Standardized image interpretation using thin section (3 mm slices) magnetic resonance imaging and a small field of view (160–200 mm) allows accurate assessment of tumor infiltration within and beyond the rectal wall and several other important prognostic features in rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fishman EK, Spiral CT. Clinical applications in the gastrointestinal tract. Clin Imaging. 1997;21(2):111–121.

    Article  PubMed  CAS  Google Scholar 

  2. Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 2003;90(3):355–364.

    Article  PubMed  CAS  Google Scholar 

  3. Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg. 2008;95(2):229–236.

    Article  PubMed  CAS  Google Scholar 

  4. Blomqvist L, Holm T, Rubio C, Hindmarsh T. Rectal tumours – MR imaging with endorectal and/or phased-array coils, and histopathological staging on giant sections. A comparative study. Acta Radiol. 1997;38(3):437–444.

    PubMed  CAS  Google Scholar 

  5. Blomqvist L, Machado M, Rubio C, et al. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol. 2000;10(4):653–660.

    Article  PubMed  CAS  Google Scholar 

  6. Wang C, Zhou ZG, Yu YY, et al. Occurrence and prognostic value of circumferential resection margin involvement for patients with rectal cancer. Int J Colorectal Dis. 2009;24(4):385–390.

    Article  PubMed  CAS  Google Scholar 

  7. Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002;89(3):327–334.

    Article  PubMed  CAS  Google Scholar 

  8. Baik SH, Kim NK, Lee YC, et al. Prognostic significance of circumferential resection margin following total mesorectal excision and adjuvant chemoradiotherapy in patients with rectal cancer. Ann Surg Oncol. 2007;14(2):462–469.

    Article  PubMed  Google Scholar 

  9. Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002;235(4):449–457.

    Article  PubMed  Google Scholar 

  10. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2(8514):996–999.

    Article  PubMed  CAS  Google Scholar 

  11. Cawthorn SJ, Parums DV, Gibbs NM, et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet. 1990;335(8697):1055–1059.

    Article  PubMed  CAS  Google Scholar 

  12. Lindmark G, Gerdin B, Pahlman L, Bergstrom R, Glimelius B. Prognostic predictors in colorectal cancer. Dis Colon Rectum. 1994;37(12):1219–1227.

    Article  PubMed  CAS  Google Scholar 

  13. Hall NR, Finan PJ, al-Jaberi T, et al. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum. 1998;41(8):979–983.

    Article  PubMed  CAS  Google Scholar 

  14. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20(7):1729–1734.

    Article  PubMed  Google Scholar 

  15. Wolmark N, Fisher B, Wieand HS. The prognostic value of the modifications of the Dukes’ C class of colorectal cancer. An analysis of the NSABP clinical trials. Ann Surg. 1986;203(2):115–122.

    Article  PubMed  CAS  Google Scholar 

  16. Chapuis PH, Dent OF, Fisher R, et al. A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg. 1985;72(9):698–702.

    Article  PubMed  CAS  Google Scholar 

  17. Burton S, Brown G, Bees N, et al. Accuracy of CT prediction of poor prognostic features in colonic cancer. Br J Radiol. 2008;81(961):10–19.

    Article  PubMed  CAS  Google Scholar 

  18. Shepherd NA, Baxter KJ, Love SB. The prognostic importance of peritoneal involvement in colonic cancer: a prospective evaluation. Gastroenterology. 1997;112(4):1096–1102.

    Article  PubMed  CAS  Google Scholar 

  19. Thoeni RF. Colorectal cancer. Radiologic staging. Radiol Clin North Am. 1997;35(2):457–485.

    PubMed  CAS  Google Scholar 

  20. Potter KC, Husband JE, Houghton SL, Thomas K, Brown G. Diagnostic accuracy of serial CT/magnetic resonance imaging review vs. positron emission tomography/CT in colorectal cancer patients with suspected and known recurrence. Dis Colon Rectum. 2009;52(2):253–259.

    Article  PubMed  Google Scholar 

  21. Wong LS, Morris AG, Fraser IA. The exfoliation of free malignant cells in the peritoneal cavity during resection of colorectal cancer. Surg Oncol. 1996;5(3):115–121.

    Article  PubMed  CAS  Google Scholar 

  22. Sobin LH, Fleming ID. TNM Classification of Malignant Tumors, fifth edition. Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer. 1997;80(9):1803–1804.

    Article  PubMed  CAS  Google Scholar 

  23. Moreaux J. Cancer of the colon. Survival and prognosis after surgical treatment in a series of 1000 patients. Bull Acad Natl Med. 989;173(6):777–780; discussion 81–82.

    Google Scholar 

  24. Gardner B, Feldman J, Spivak Y, et al. Investigations of factors influencing the prognosis of colon cancer. Am J Surg. 1987;153(6):541–544.

    Article  PubMed  CAS  Google Scholar 

  25. Hojo K. TNM staging of cancer of the colon. Gan No Rinsho. 1986;32(10):1373–1377.

    PubMed  CAS  Google Scholar 

  26. Greene FL, Stewart AK, Norton HJ. A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg. 2002;236(4):416–421; discussion 21.

    Article  PubMed  Google Scholar 

  27. Freeny PC, Marks WM, Ryan JA, Bolen JW. Colorectal carcinoma evaluation with CT: preoperative staging and detection of postoperative recurrence. Radiology. 1986;158(2):347–353.

    PubMed  CAS  Google Scholar 

  28. Balthazar EJ, Megibow AJ, Hulnick D, Naidich DP. Carcinoma of the colon: detection and preoperative staging by CT. AJR Am J Roentgenol. 1988;150(2):301–306.

    PubMed  CAS  Google Scholar 

  29. Kanamoto T, Matsuki M, Okuda J, et al. Preoperative evaluation of local invasion and metastatic lymph nodes of colorectal cancer and mesenteric vascular variations using multidetector-row computed tomography before laparoscopic surgery. J Comput Assist Tomogr. 2007;31(6):831–839.

    Article  PubMed  Google Scholar 

  30. Zerhouni EA, Rutter C, Hamilton SR, et al. CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II. Radiology. 1996;200(2):443–451.

    PubMed  CAS  Google Scholar 

  31. Angelelli G, Macarini L. CT of the bowel: use of water to enhance depiction. Radiology. 1988;169(3):848–849.

    PubMed  CAS  Google Scholar 

  32. Gossios KJ, Tsianos EV, Kontogiannis DS, et al. Water as contrast medium for computed tomography study of colonic wall lesions. Gastrointest Radiol. 1992;17(2):125–128.

    Article  PubMed  CAS  Google Scholar 

  33. Amin Z, Boulos PB, Lees WR. Technical report: spiral CT pneumocolon for suspected colonic neoplasms. Clin Radiol. 1996;51(1):56–61.

    Article  PubMed  CAS  Google Scholar 

  34. Laghi A, Iannaccone R, Trenna S, et al. Multislice spiral CT colonography in the evaluation of colorectal neoplasms. Radiol Med (Torino). 2002;104(5–6):394–403.

    Google Scholar 

  35. Chung DJ, Huh KC, Choi WJ, Kim JK. CT colonography using 16-MDCT in the evaluation of colorectal cancer. AJR Am J Roentgenol. 2005;184(1):98–103.

    PubMed  Google Scholar 

  36. Sinha R, Verma R, Rajesh A, Richards CJ. Diagnostic value of multidetector row CT in rectal cancer staging: comparison of multiplanar and axial images with histopathology. Clin Radiol. 2006;61(11):924–931.

    Article  PubMed  CAS  Google Scholar 

  37. Kulinna C, Scheidler J, Strauss T, et al. Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound. J Comput Assist Tomogr. 2004;28(1):123–130.

    Article  PubMed  Google Scholar 

  38. Wolberink SV, Beets-Tan RG, de Haas-Kock DF, et al. Conventional CT for the prediction of an involved circumferential resection margin in primary rectal cancer. Dig Dis. 2007;25(1):80–85.

    Article  PubMed  Google Scholar 

  39. Vliegen R, Dresen R, Beets G, et al. The accuracy of Multi-detector row CT for the assessment of tumor invasion of the mesorectal fascia in primary rectal cancer. Abdom Imaging. 2008;33(5):604–610.

    Article  PubMed  Google Scholar 

  40. Acunas B, Rozanes I, Acunas G, Celik L, Sayi I, Gokmen E. Preoperative CT staging of colon carcinoma (excluding the recto-sigmoid region). Eur J Radiol. 1990;11(2):150–153.

    Article  PubMed  CAS  Google Scholar 

  41. Gazelle GS, Gaa J, Saini S, Shellito P. Staging of colon carcinoma using water enema CT. J Comput Assist Tomogr. 1995;19(1):87–91.

    Article  PubMed  CAS  Google Scholar 

  42. Harvey CJ, Amin Z, Hare CM, et al. Helical CT pneumocolon to assess colonic tumors: radiologic-pathologic correlation. AJR Am J Roentgenol. 1998;170(6):1439–1443.

    PubMed  CAS  Google Scholar 

  43. Ashraf K, Ashraf O, Haider Z, Rafique Z. Colorectal carcinoma, preoperative evaluation by spiral computed tomography. J Pak Med Assoc. 2006;56(4):149–153.

    PubMed  Google Scholar 

  44. Cademartiri F, Luccichenti G, Rossi A, Pavone P. Spiral hydro-CT in the evaluation of colo-sigmoideal cancer. Radiol Med (Torino). 2002;104(4):295–306.

    Google Scholar 

  45. Gomille T, Aleksic M, Ulrich B, Christ F. Significance of CT in the detection of regional lymph node metastases in colorectal carcinoma. Radiologe. 1998;38(12):1077–1082.

    Article  PubMed  CAS  Google Scholar 

  46. Keeney G, Jafri SZ, Mezwa DG. Computed tomographic evaluation and staging of cecal carcinoma. Gastrointest Radiol. 1989;14(1):65–69.

    Article  PubMed  CAS  Google Scholar 

  47. Thompson WM, Halvorsen RA, Foster WL Jr, Roberts L, Gibbons R. Preoperative and postoperative CT staging of rectosigmoid carcinoma. AJR Am J Roentgenol. 1986;146(4):703–710.

    PubMed  CAS  Google Scholar 

  48. Hundt W, Braunschweig R, Reiser M. Evaluation of spiral CT in staging of colon and rectum carcinoma. Eur Radiol. 1999;9(1):78–84.

    Article  PubMed  CAS  Google Scholar 

  49. Sun CH, Li ZP, Meng QF, Yu SP, Xu DS. Assessment of spiral CT pneumocolon in preoperative colorectal carcinoma. World J Gastroenterol. 2005;11(25):3866–3870.

    PubMed  Google Scholar 

  50. Filippone A, Ambrosini R, Fuschi M, Marinelli T, Genovesi D, Bonomo L. Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography – initial experience. Radiology. 2004;231(1):83–90.

    Article  PubMed  Google Scholar 

  51. Smith NJ, Bees N, Barbachano Y, Norman AR, Swift RI, Brown G. Preoperative computed tomography staging of nonmetastatic colon cancer predicts outcome: implications for clinical trials. Br J Cancer. 2007;96(7):1030–1036.

    Article  PubMed  CAS  Google Scholar 

  52. Jass JR, Love SB. Prognostic value of direct spread in Dukes’ C cases of rectal cancer. Dis Colon Rectum. 1989;32(6):477–480.

    Article  PubMed  CAS  Google Scholar 

  53. MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;24(1):132–139.

    Article  Google Scholar 

  54. Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999;211(1):215–222.

    PubMed  CAS  Google Scholar 

  55. Martling A, Holm T, Bremmer S, Lindholm J, Cedermark B, Blomqvist L. Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer. Br J Surg. 2003;90(11):1422–1428.

    Article  PubMed  CAS  Google Scholar 

  56. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994;344(8924):707–711.

    Article  PubMed  CAS  Google Scholar 

  57. Cawthorn SJ, Gibbs NM, Marks CG. Clearance technique for the detection of lymph nodes in colorectal cancer. Br J Surg. 1986;73(1):58–60.

    Article  PubMed  CAS  Google Scholar 

  58. Brown G, Davies S, Williams GT, et al. Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? Br J Cancer. 2004;91(1):23–29.

    Article  PubMed  CAS  Google Scholar 

  59. Laghi A, Ferri M, Catalano C, et al. Local staging of rectal cancer with MRI using a phased array body coil. Abdom Imaging. 2002;27(4):425–431.

    Article  PubMed  CAS  Google Scholar 

  60. Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet. 2001;357(9255):497–504.

    Article  PubMed  CAS  Google Scholar 

  61. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333(7572):779.

    Article  Google Scholar 

  62. Blomqvist L, Rubio C, Holm T, Machado M, Hindmarsh T. Rectal adenocarcinoma: assessment of tumour involvement of the lateral resection margin by MRI of resected specimen. Br J Radiol. 1999;72(853):18–23.

    PubMed  CAS  Google Scholar 

  63. Wieder HA, Rosenberg R, Lordick F, et al. Rectal cancer: MR imaging before neoadjuvant chemotherapy and radiation therapy for prediction of tumor-free circumferential resection margins and long-term survival. Radiology. 2007;243(3):744–751.

    Article  PubMed  Google Scholar 

  64. Purkayastha S, Tekkis PP, Athanasiou T, Tilney HS, Darzi AW, Heriot AG. Diagnostic precision of magnetic resonance imaging for preoperative prediction of the circumferential margin involvement in patients with rectal cancer. Colorectal Dis. 2007;9(5):402–411.

    Article  PubMed  CAS  Google Scholar 

  65. Herrera L, Villarreal JR. Incidence of metastases from rectal adenocarcinoma in small lymph nodes detected by a clearing technique. Dis Colon Rectum. 1992;35(8):783–788.

    Article  PubMed  CAS  Google Scholar 

  66. Kotanagi H, Fukuoka T, Shibata Y, et al. The size of regional lymph nodes does not correlate with the presence or absence of metastasis in lymph nodes in rectal cancer. J Surg Oncol. 1993;54(4):252–254.

    Article  PubMed  CAS  Google Scholar 

  67. Andreola S, Leo E, Belli F, et al. Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm. Cancer. 1996;77(4):607–612.

    Article  PubMed  CAS  Google Scholar 

  68. Gunther K, Dworak O, Remke S, et al. Prediction of distant metastases after curative surgery for rectal cancer. J Surg Res. 2002;103(1):68–78.

    Article  PubMed  Google Scholar 

  69. Kim JH, Beets GL, Kim MJ, Kessels AG, Beets-Tan RG. High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol. 2004;52(1):78–83.

    Article  PubMed  Google Scholar 

  70. Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227(2):371–377.

    Article  PubMed  Google Scholar 

  71. Yano H, Saito Y, Kirihara Y, Takashima J. Tumor invasion of lymph node capsules in patients with Dukes C colorectal adenocarcinoma. Dis Colon Rectum. 2006;49(12):1867–1877.

    Article  PubMed  Google Scholar 

  72. Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings – initial observations. Radiology. 2004;231(1):91–99.

    Article  PubMed  Google Scholar 

  73. Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer. 1983;52(7):1317–1329.

    Article  PubMed  CAS  Google Scholar 

  74. Vassallo P, Matei C, Heston WD, McLachlan SJ, Koutcher JA, Castellino RA. AMI-227-enhanced MR lymphography: usefulness for differentiating reactive from tumor-bearing lymph nodes. Radiology. 1994;193(2):501–506.

    PubMed  CAS  Google Scholar 

  75. Weissleder R, Elizondo G, Wittenberg J, Lee AS, Josephson L, Brady TJ. Ultrasmall superparamagnetic iron oxide: an intravenous contrast agent for assessing lymph nodes with MR imaging. Radiology. 1990;175(2):494–498.

    PubMed  CAS  Google Scholar 

  76. Krasna MJ, Flancbaum L, Cody RP, Shneibaum S, Ben Ari G. Vascular and neural invasion in colorectal carcinoma. Incidence and prognostic significance. Cancer. 1988;61(5):1018–1023.

    Article  PubMed  CAS  Google Scholar 

  77. Ouchi K, Sugawara T, Ono H, et al. Histologic features and clinical significance of venous invasion in colorectal carcinoma with hepatic metastasis. Cancer. 1996;78(11):2313–2317.

    Article  PubMed  CAS  Google Scholar 

  78. Sugihara K, Kobayashi H, Kato T, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49(11):1663–1672.

    Article  PubMed  Google Scholar 

  79. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12(1):19–23.

    Article  PubMed  CAS  Google Scholar 

  80. Bouzourene H, Bosman FT, Seelentag W, Matter M, Coucke P. Importance of tumor regression assessment in predicting the outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy. Cancer. 2002;94(4):1121–1130.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Royal Marsden Hospital, Sutton, Surrey, UK

    Gina Brown MD

  2. Mayday University Hospital, Croydon, UK

    Shwetal Dighe MS (Mum), DNB, MRCS & Fiona Taylor MBBS, MRCS

Authors
  1. Gina Brown MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shwetal Dighe MS (Mum), DNB, MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fiona Taylor MBBS, MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Dept. Radiation Oncology, Duke University Medical Center, Durham, USA

    Brian G. Czito

  2. Dept. Radiation Oncology, Duke University Medical Center, Durham, USA

    Christopher G. Willett

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Humana Press

About this chapter

Cite this chapter

Brown, G., Dighe, S., Taylor, F. (2010). Clinical Staging: CT and MRI. In: Czito, B., Willett, C. (eds) Rectal Cancer. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-567-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-567-5_2

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-566-8

  • Online ISBN: 978-1-60761-567-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation