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Pitfalls in MRI of rectal cancer: What radiologists need to know and avoid

Published:December 04, 2017DOI:https://doi.org/10.1016/j.clinimag.2017.11.012

      Highlights

      • Axial T2-weighted thin section sequence is a powerful imaging tool that can be used to evaluate rectal cancer and adjacent structures.
      • CRM invasion can be due to tumor deposits, pathological lymph node, and EMVI – not just extension of the main tumor.
      • T2-weighted images can differentiate between non-involved and involved mesorectal fascia.
      • Fat-saturated T2-weighted imaging sequence facilitates the detection of mucinous tumor.
      • MRI is sometimes unable to differentiate between T2 tumor with desmoplastic spiculation and early T3 tumor.

      Abstract

      Preoperative staging of rectal cancer using magnetic resonance imaging (MRI) has become an important component of clinical management. Although MRI is the modality of choice for rectal cancer diagnosis and staging, there are certain inherent potential pitfalls that radiologists need to recognize in order to avoid imaging misinterpretation, including choice of MRI protocol; choice of MRI technique; potential mimickers of rectal cancer; mucinous rectal tumor; differentiation between extramural tumor invasion and desmoplastic reaction; differentiation between low rectal cancer and anal cancer; problems relating to nodal involvement, peritoneal reflection, and mesorectal fascia invasion; and, challenges associated with restaging, post-treatment changes, and complications. The aim of this article was to heighten radiologist awareness of these potential pitfalls in order to improve diagnosis, decision-making, and patient outcomes.
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