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Keywords:
Neoplasia, Multidisciplinary cancer care, Cancer, Surgery, Diagnostic procedure, Decision analysis, MR-Diffusion/Perfusion, MR, Oncology, Abdomen
Authors:
J. R. Ramos Rodriguez, M. Atencia Ballesteros, M. D. M. Muñoz Ruiz, A. J. Márquez Moreno, M. D. Domínguez Pinos; Málaga/ES
DOI:
10.1594/ecr2015/C-0152
Results
29 patients have been studied,
excluding 10 due to not meeting the conditions of the study.
In the remaining 19 patients,
rectal MRI has correctly calculated the distance to anal margin in 89.47% of cases.
Involvement of mesorectal fascia was successfully set at 100%.
As for nodal staging,
was performed correctly in 73.68%.
Regarding degree of depth infiltration in rectal wall and mesorectal adipose tissue T staging was successful in 52.63%.
In our study diagnostic performance of MRI scanning in the preoperative assessment of rectal cancer,
especially determining distance to anal margin or anal sphincter complex and possible involvement of the mesorectal fascia is confirmed.
In the first case it must be stressed that the two cases in which MRI underestimated distance to anal verge these tumors were located in the rectosigmoid junction,
more than 14 cm from the anal margin.
Estimation of nodal involvement was satisfactory,
however valuation of infiltration in rectal wall had worse results,
especially in determining whether the lesion is confined to the muscular layer or infiltrates mesorectal fat minimally (T2/T3a) However,
from a practical point of view,
the most important implication for patients in terms of prognosis and therapeutic approach is to determine if tumor infiltrates mesorectal fat beyond 5 mm.
[2,5].
Taking this as the cutoff to determine whether or not the tumor extends beyond this distance (T3b or less/T3c or more) MRI correctly classifies 94.74 % of the injuries.
In all cases it was possible to locate tumor by DWI sequence without rectal gel or cleansing enema.