The Role of MRI in Rectal Cancer: An Updated Review
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GERIATRICS (G GUGLIELMI, SECTION EDITOR)
The Role of MRI in Rectal Cancer: An Updated Review L. La Tegola1 • G. Guglielmi1
Published online: 26 August 2020 Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To bring the radiologists up to date on the state of the art of the magnetic resonance imaging protocol of the rectal cancer and on the findings to consider for reports. Recent Findings Recently, the European Society of Gastrointestinal and Abdominal Radiology updated the 2012 guidelines with new recommendations on the acquisition and reporting of MRI for staging and restaging of rectal cancer; furthermore latest advanced MRI techniques (diffusion-weighted imaging, dynamic contrast-enhanced imaging, kurtosis) are object of ongoing studies with promising results. Summary Magnetic resonance imaging plays a fundamental role in rectal cancer staging and restaging; moreover, it allows the detection of some findings with prognostic value. This review includes the last 2016 European Society of Gastrointestinal and Abdominal Radiology Updated Recommendations on magnetic resonance imaging protocol, interpretation, and reporting. Keywords MRI Rectal cancer Structured report Protocol Technique
Introduction The only standard curative therapy of colorectal cancer is radical surgery with negative resection margins. Therefore, attention has been put on how to best manage the treatment with curative intent using chemotherapy, radiotherapy, and surgery in different combinations. In addition, in recent years there has been an improvement in organ-preserving surgical techniques as alternative to surgical resection in patients responding well to chemoradiotherapy [1, 2]. Therefore, evaluation of response after chemoradiotherapy (CRT) is relevant and restaging MRI has become a topic of interest among researchers. As reinforced in the updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting [3••], MRI is the first-choice technique for both primary staging and restaging of rectal cancer; only in early tumors considered for local excision EUS shows better diagnostic performance in differentiating T1 from T2 tumors and so it should be performed instead or in addition to MRI. For all these reasons, in last years there has been an increase in the demand for an accurate radiological evaluation of rectum MRI, so it is essential that radiologists know the correct MR protocol to be applied and the information to be provided to surgeons, preferably in a structured report.
This article is part of the Topical Collection on Geriatrics. & G. Guglielmi [email protected] 1
Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto, 1, 71121 Foggia, Italy
Technique MRI should be performed at a high field strength, because of faster sequences, higher spatial resolution and higher SNR (signal-to-noise ratio) that improve image quality; in
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