Importance and Qualitative Requirements of Magnetic Resonance Imaging for Therapy Planning in Rectal Cancer – Interdisciplinary Recommendations of AIO, ARO, ACO and the German Radiological Society

Abstract

Due to its excellent intrinsic soft tissue contrast, magnetic resonance imaging allows excellent visualization and anatomical separation of therapy-relevant risk structures such as the mesorectal fascia, local lymph nodes, and vascular structures in patients with rectal carcinoma. This makes magnetic resonance imaging (MRI) a valuable evaluation method for further therapeutic stratification. In particular, MRI is indispensable for the decision to refrain from neoadjuvant therapy and to choose a primary surgical approach. In addition to the oncologically generally relevant T-, N-, and M-criteria, two further parameters are included: the extramural vascular infiltration and the circumferential resection margin. Due to the significant impact of MRI on further therapeutic decision-making, standardized MR image quality is considered essential.

Key Points: 

• Magnetic resonance imaging is a valuable evaluation method for further therapeutic stratification.

• Critical anatomic landmarks for evaluation are circumferential resection margins.

Citation Format

• Attenberger UI, Clasen S, Ghadimi M et al. Importance and Qualitative Requirements of Magnetic Resonance Imaging for Therapy Planning in Rectal Cancer – Interdisciplinary Recommendations of AIO, ARO, ACO and the German Radiological Society. Fortschr Röntgenstr 2021; 193: 513 – 520

Key words

MRI - CRM - therapeutic stratification - rectal cancer

Publication History

Received: 25 May 2020

Accepted: 24 September 2020

Article published online:
16 December 2020

• References

• 1 Beets-Tan RG, Beets GL. Rectal cancer: review with emphasis on MR imaging. Radiology 2004; 232: 335-346
• 2 Slater A, Halligan S, Taylor SA. et al Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin. Clin Radiol 2006; 61: 65-70
• 3 Ye F, Zhang H, Liang X. et al JOURNAL CLUB: Preoperative MRI Evaluation of Primary Rectal Cancer: Intrasubject Comparison With and Without Rectal Distention. Am J Roentgenol 2016; 207: 32-39
• 4 Horvat N, Carlos Tavares Rocha C, Clemente OliveiraB. et al MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management. Radiographics 2019; 39: 367-387
• 5 Hamm B, Krestin GB, Laniado M. et al MRT von Abdomen und Becken: 2. Völlig überarbeitete und erweiterte Auflage. Thieme; 2007.
• 6 Group MS. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 2007; 243: 132-139
• 7 Hoeffel C, Mule S, Laurent V. et al Current imaging of rectal cancer. Clin Res Hepatol Gastroenterol 2015; 39: 168-173
• 8 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: 330-344
• 9 Al-Sukhni E, Milot L, Fruitman M. et al Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 2012; 19: 2212-2223
• 10 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 2.1, 2019, AWMF Registrierungsnummer: 021/007OL. http://www.leitlinienprogramm-onkologie.de/leitlinien/ [abgerufen am: 27.01.2020]
• 11 Zhang XY, Wang S, Li XT. et al MRI of Extramural Venous Invasion in Locally Advanced Rectal Cancer: Relationship to Tumor Recurrence and Overall Survival. Radiology 2018; 289: 677-685
• 12 Bipat S, Glas AS, Slors FJ. et al Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis. Radiology 2004; 232: 773-783
• 13 Befundungstemplate für Rektumkarzinom (L2, V1, no JS). 2017 Im Internet (Stand: 20.04.2020): https://www.befundung.drg.de/de-DE/3199/befundvorlagen/041807.00001-mrt_rectalca.html/
• 14 Juchems MS, Wessling J. [Rational staging and follow-up of colorectal cancer: Do guidelines provide further help?]. Radiologe 2019; 59: 820-827