Application of MRI imaging features and tumor distance measurement in preoperative evaluation of rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Junbiao , ZHOU Jiwen , QIAO Lichao , ZHU Ping ,  YANG Bolin

Department of Anorectal Surgery, Affilited Hospital, Nanjing University of Traditional Chinese Medicine, Nanjing 210029, P. R. China;

Corresponding author：

YANG Bolin, Email: blyang1971@163.com

Keywords：

rectal cancer; magnetic resonance imaging; imaging diagnosis; tumor measurement; review

DOI：

10.7507/1007-9424.201805068

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the application of magnetic resonance imaging (MRI) in preoperative assessment of rectal cancer. Methods Combined with the literatures, the MRI features and measurements of rectal tumor staging, extramural vascular invasion, circumferential margin involvement, and the distance between distal margin of the tumor from the anorectal ring and the anal margin were described. Results On T2-weighted images (T2WI), T1 staging-tumors were those in which the normal submucosa was replaced by the iso-intensity of tumor tissue without invasion of muscularis propria; T2 staging-tumors were those with extension into the muscularis propria, but not invaded the high-intensity of mesorectal fat; T3 staging-tumors manifested as the rectal tumor penetrated into the muscularis propria and invaded the high-intensity of mesorectal fat; T4 staging-tumors manifested as the tumor invaded adjacent structures or organs. The metastatic lymph nodes were showed with irregular boundaries and mixed signals on T2WI. The tumor signals could be found in the extramural vascular on T1-weighted images (T1WI), accompanied by irregular distortion and expansion of the blood vessels. On T2WI, metastatic lymph nodes, extramural vascular invasion, and the distance between the residual tumor and the low-signal of mesorectal fascia was within 1 mm, indicated the positive circumferential margin. On T2WI, the distal margin of the tumor was located at the junction of hyperintense submucosa and iso-signal of tumor, the tip of the iso-signal puborectal muscle was the apex of the anorectal ring, and the lowest point of the iso-signal external sphincter was the anal margin. Conclusion MRI can provide reliable imaging information for preoperative staging, height measurement, and prognosis of rectal cancer, and it is helpful for early diagnosis and treatment of rectal cancer.

Citation： ZHANG Junbiao, ZHOU Jiwen, QIAO Lichao, ZHU Ping, YANG Bolin. Application of MRI imaging features and tumor distance measurement in preoperative evaluation of rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(11): 1384-1388. doi: 10.7507/1007-9424.201805068 Copy

1.	Kang H, O’Connell JB, Leonardi MJ, et al. Rare tumors of the colon and rectum: a national review. Int J Colorectal Dis, 2007, 22(2): 183-189.
2.	Jhaveri KS, Hosseini-Nik H. MRI of rectal cancer: an overview and update on recent advances. AJR Am J Roentgenol, 2015, 205(1): W42-W55.
3.	Bauer F. The importance of preoperative staging of rectal cancer using ultiparametric MRI partⅡ: TNM cancer staging. Chirurgia (Bucur), 2016, 111(6): 463-475.
4.	徐伟, 韦建宝. 影像学技术在直肠癌术前分期中的应用比较. 世界最新医学信息文摘, 2015, 15(18): 41-43.
5.	Ozis SE, Soydal C, Akyol C, et al. The role of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in the primary staging of rectal cancer. World J Surg Oncol, 2014, 12: 26.
6.	Tapan U, Ozbayrak M, Tatlı S. MRI in local staging of rectal cancer: an update. Diagn Interv Radiol, 2014, 20(5): 390-398.
7.	Nougaret S, Reinhold C, Mikhael HW, et al. The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the " DISTANCE”? Radiology, 2013, 268(2): 330-344.
8.	Bhoday J, Balyasnikova S, Wale A, et al. How should imaging direct/orient management of rectal cancer? Clin Colon Rectal Surg, 2017, 30(5): 297-312.
9.	Zheng N, Li YY, Cao YC, et al. Evaluation of magnetic resonance imaging in staging of rectal cancer and its relationship with P16 expression. Eur Rev Med Pharmacol Sci, 2018, 22(12): 3755-3762.
10.	Algebally AM, Mohey N, Szmigielski W, et al. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging. Pol J Radiol, 2015, 80: 115-121.
11.	杨仁保, 李良, 张军, 等. CT 和 MRI 对直肠癌术前 T、N 分期的对比研究. 中国普外基础与临床杂志, 2018, 25(4): 433-437.
12.	Nerad E, Lambregts DM, Kersten EL, et al. MRI for local staging of colon cancer: can MRI become the optimal staging modality for patients with colon cancer? Dis Colon Rectum, 2017, 60(4): 385-392.
13.	Poon JT. Evolving standards in preoperative staging and treatment of rectal cancer. Hong Kong Med J, 2014, 20(5): 364-365.
14.	Arya S, Das D, Engineer R, et al. Imaging in rectal cancer with emphasis on local staging with MRI. Indian J Radiol Imaging, 2015, 25(2): 148-161.
15.	Al-Sukhni E, Milot M, Friutman M, et al. User’s guide for the synoptic MRI report for rectal cancer. Cancer care ontario. Canadian Cancer Society. 2014-06-13. https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=133269.
16.	Gröne J, Loch FN, Taupitz M, et al. Accuracy of various lymph node staging criteria in rectal cancer with magnetic resonance imaging. J Gastrointest Surg, 2018, 22(1): 146-153.
17.	Balyasnikova S, Read J, Wotherspoon A, et al. Diagnostic accuracy of high-resolution MRI as a method to predict potentially safe endoscopic and surgical planes in patients with early rectal cancer. BMJ Open Gastroenterol, 2017, 4(1): e000151.
18.	Heijnen LA, Lambregts DM, Mondal D, et al. Diffusion-weighted MR imaging in primary rectal cancer staging demonstrates but does not characterise lymph nodes. Eur Radiol, 2013, 23(12): 3354-3360.
19.	Kim DJ, Kim JH, Ryu YH, et al. Nodal staging of rectal cancer: high-resolution pelvic MRI versus ¹⁸F-FDGPET/CT. J Comput Assist Tomogr, 2011, 35(5): 531-534.
20.	Bugg WG, Andreou AK, Biswas D, et al. The prognostic significance of MRI-detected extramural venous invasion in rectal carcinoma. Clin Radiol, 2014, 69(6): 619-623.
21.	Costa-Silva L, Brown G. Magnetic resonance imaging of rectal cancer. Magn Reson Imaging Clin N Am, 2013, 21(2): 385-408.
22.	Kim YC, Kim JK, Kim MJ, et al. Feasibility of mesorectal vascular invasion in predicting early distant metastasis in patients with stage T3 rectal cancer based on rectal MRI. Eur Radiol, 2016, 26(2): 297-305.
23.	Sun YQ, Li JW, Shen LJ, et al. Predictive value of MRI-detected extramural vascular invasion in stage T3 rectal cancer patients before neoadjuvant chemoradiation. Diagn Interv Radiol, 2018, 24(3): 128-134.
24.	Hunter CJ, Garant A, Vuong T, et al. Adverse features on rectal MRI identify a high-risk group that may benefit from more intensive preoperative staging and treatment. Ann Surg Oncol, 2012, 19(4): 1199-1205.
25.	Taylor FG, Quirke P, Heald RJ, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol, 2014, 32(1): 34-43.
26.	Iannicelli E, Di Renzo S, Ferri M, et al. Accuracy of high-resolution MRI with lumen distention in rectal cancer staging and circumferential margin involvement prediction. Korean J Radiol, 2014, 15(1): 37-44.
27.	Simpson GS, Eardley N, McNicol F, et al. Circumferential resection margin (CRM) positivity after MRI assessment and adjuvant treatment in 189 patients undergoing rectal cancer resection. Int J Colorectal Dis, 2014, 29(5): 585-590.
28.	Op de Beeck B, Smeets P, Penninckx F, et al. Accuracy of pre-treatment locoregional rectal cancer staging in a national improvement project. Acta Chir Belg, 2017, 117(2): 104-109.
29.	Piscatelli N, Hyman N, Osler T. Localizing colorectal cancer by colonoscopy. Arch Surg, 2005, 140(10): 932-935.
30.	Thumbe V, Iqbal M, Bhalerao S. Accuracy of digital rectal examination in the estimation of height of rectal lesions. Tech Coloproctol, 2007, 11(2): 111-113.
31.	National Cancer Institute and the National Institutes of Health. Rectal cancer treatment (PDQ®). 2013-07-11. http://www.cancer.gov/cancertopics/pdq/treatment/rectal/HealthProfessional/page1/AllPages.
32.	Beets-Tan RG, Lambregts DM, 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, 2013, 23(9): 2522-2531.
33.	Gollub MJ, Maas M, Weiser M, et al. Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol, 2013, 200(1): 97-101.
34.	Keller DS, Paspulati R, Kjellmo A, et al. MRI-defined height of rectal tumours. Br J Surg, 2014, 101(2): 127-132.
35.	Sato S, Kato T, Tanaka JI. Defining the distal margin of rectal cancer for surgical planning. J Gastrointest Oncol, 2017, 8(1): 194-198.
36.	Lichliter WE. Techniques in total mesorectal excision surgery. Clin Colon Rectal Surg, 2015, 28(1): 21-27.
37.	Zhu HB, Wang L, Li ZY, et al. Sphincter-preserving surgery for low-middle rectal cancer: can we predict feasibility with high-resolution magnetic resonance imaging? Medicine (Baltimore), 2017, 96(29): e7418.

1. Kang H, O’Connell JB, Leonardi MJ, et al. Rare tumors of the colon and rectum: a national review. Int J Colorectal Dis, 2007, 22(2): 183-189.
2. Jhaveri KS, Hosseini-Nik H. MRI of rectal cancer: an overview and update on recent advances. AJR Am J Roentgenol, 2015, 205(1): W42-W55.
3. Bauer F. The importance of preoperative staging of rectal cancer using ultiparametric MRI partⅡ: TNM cancer staging. Chirurgia (Bucur), 2016, 111(6): 463-475.
4. 徐伟, 韦建宝. 影像学技术在直肠癌术前分期中的应用比较. 世界最新医学信息文摘, 2015, 15(18): 41-43.
5. Ozis SE, Soydal C, Akyol C, et al. The role of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in the primary staging of rectal cancer. World J Surg Oncol, 2014, 12: 26.
6. Tapan U, Ozbayrak M, Tatlı S. MRI in local staging of rectal cancer: an update. Diagn Interv Radiol, 2014, 20(5): 390-398.
7. Nougaret S, Reinhold C, Mikhael HW, et al. The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the " DISTANCE”? Radiology, 2013, 268(2): 330-344.
8. Bhoday J, Balyasnikova S, Wale A, et al. How should imaging direct/orient management of rectal cancer? Clin Colon Rectal Surg, 2017, 30(5): 297-312.
9. Zheng N, Li YY, Cao YC, et al. Evaluation of magnetic resonance imaging in staging of rectal cancer and its relationship with P16 expression. Eur Rev Med Pharmacol Sci, 2018, 22(12): 3755-3762.
10. Algebally AM, Mohey N, Szmigielski W, et al. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging. Pol J Radiol, 2015, 80: 115-121.
11. 杨仁保, 李良, 张军, 等. CT 和 MRI 对直肠癌术前 T、N 分期的对比研究. 中国普外基础与临床杂志, 2018, 25(4): 433-437.
12. Nerad E, Lambregts DM, Kersten EL, et al. MRI for local staging of colon cancer: can MRI become the optimal staging modality for patients with colon cancer? Dis Colon Rectum, 2017, 60(4): 385-392.
13. Poon JT. Evolving standards in preoperative staging and treatment of rectal cancer. Hong Kong Med J, 2014, 20(5): 364-365.
14. Arya S, Das D, Engineer R, et al. Imaging in rectal cancer with emphasis on local staging with MRI. Indian J Radiol Imaging, 2015, 25(2): 148-161.
15. Al-Sukhni E, Milot M, Friutman M, et al. User’s guide for the synoptic MRI report for rectal cancer. Cancer care ontario. Canadian Cancer Society. 2014-06-13. https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=133269.
16. Gröne J, Loch FN, Taupitz M, et al. Accuracy of various lymph node staging criteria in rectal cancer with magnetic resonance imaging. J Gastrointest Surg, 2018, 22(1): 146-153.
17. Balyasnikova S, Read J, Wotherspoon A, et al. Diagnostic accuracy of high-resolution MRI as a method to predict potentially safe endoscopic and surgical planes in patients with early rectal cancer. BMJ Open Gastroenterol, 2017, 4(1): e000151.
18. Heijnen LA, Lambregts DM, Mondal D, et al. Diffusion-weighted MR imaging in primary rectal cancer staging demonstrates but does not characterise lymph nodes. Eur Radiol, 2013, 23(12): 3354-3360.
19. Kim DJ, Kim JH, Ryu YH, et al. Nodal staging of rectal cancer: high-resolution pelvic MRI versus ¹⁸F-FDGPET/CT. J Comput Assist Tomogr, 2011, 35(5): 531-534.
20. Bugg WG, Andreou AK, Biswas D, et al. The prognostic significance of MRI-detected extramural venous invasion in rectal carcinoma. Clin Radiol, 2014, 69(6): 619-623.
21. Costa-Silva L, Brown G. Magnetic resonance imaging of rectal cancer. Magn Reson Imaging Clin N Am, 2013, 21(2): 385-408.
22. Kim YC, Kim JK, Kim MJ, et al. Feasibility of mesorectal vascular invasion in predicting early distant metastasis in patients with stage T3 rectal cancer based on rectal MRI. Eur Radiol, 2016, 26(2): 297-305.
23. Sun YQ, Li JW, Shen LJ, et al. Predictive value of MRI-detected extramural vascular invasion in stage T3 rectal cancer patients before neoadjuvant chemoradiation. Diagn Interv Radiol, 2018, 24(3): 128-134.
24. Hunter CJ, Garant A, Vuong T, et al. Adverse features on rectal MRI identify a high-risk group that may benefit from more intensive preoperative staging and treatment. Ann Surg Oncol, 2012, 19(4): 1199-1205.
25. Taylor FG, Quirke P, Heald RJ, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol, 2014, 32(1): 34-43.
26. Iannicelli E, Di Renzo S, Ferri M, et al. Accuracy of high-resolution MRI with lumen distention in rectal cancer staging and circumferential margin involvement prediction. Korean J Radiol, 2014, 15(1): 37-44.
27. Simpson GS, Eardley N, McNicol F, et al. Circumferential resection margin (CRM) positivity after MRI assessment and adjuvant treatment in 189 patients undergoing rectal cancer resection. Int J Colorectal Dis, 2014, 29(5): 585-590.
28. Op de Beeck B, Smeets P, Penninckx F, et al. Accuracy of pre-treatment locoregional rectal cancer staging in a national improvement project. Acta Chir Belg, 2017, 117(2): 104-109.
29. Piscatelli N, Hyman N, Osler T. Localizing colorectal cancer by colonoscopy. Arch Surg, 2005, 140(10): 932-935.
30. Thumbe V, Iqbal M, Bhalerao S. Accuracy of digital rectal examination in the estimation of height of rectal lesions. Tech Coloproctol, 2007, 11(2): 111-113.
31. National Cancer Institute and the National Institutes of Health. Rectal cancer treatment (PDQ®). 2013-07-11. http://www.cancer.gov/cancertopics/pdq/treatment/rectal/HealthProfessional/page1/AllPages.
32. Beets-Tan RG, Lambregts DM, 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, 2013, 23(9): 2522-2531.
33. Gollub MJ, Maas M, Weiser M, et al. Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol, 2013, 200(1): 97-101.
34. Keller DS, Paspulati R, Kjellmo A, et al. MRI-defined height of rectal tumours. Br J Surg, 2014, 101(2): 127-132.
35. Sato S, Kato T, Tanaka JI. Defining the distal margin of rectal cancer for surgical planning. J Gastrointest Oncol, 2017, 8(1): 194-198.
36. Lichliter WE. Techniques in total mesorectal excision surgery. Clin Colon Rectal Surg, 2015, 28(1): 21-27.
37. Zhu HB, Wang L, Li ZY, et al. Sphincter-preserving surgery for low-middle rectal cancer: can we predict feasibility with high-resolution magnetic resonance imaging? Medicine (Baltimore), 2017, 96(29): e7418.

Previous Article
Research status of hereditary pancreatitis
Next Article
Research progress of recognition of parathyroid gland anatomy and its clinical application

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of MRI imaging features and tumor distance measurement in preoperative evaluation of rectal cancer

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content