"a detailed guide to analysing post-chemoradiation MRI rectal studies is presented here"
"The approach below takes recommendations from various major working groups and societies 1-4, as well as personal experiences, into consideration. The key reporting parameters described below may form the basis of a template report."
"nodular extension through the muscularis propria, contiguous with the luminal tumour, is defined as tumour achieving T3 status according to the TNM classification"
"a quirk of the TNM staging system (TNM 8) is that tumour deposits, which are now known to confer a greater risk than involved nodes, present a category of N1c, less than if there were no TDs but many nodes"
"a quirk of the TNM staging system (TNM 8) is that tumour deposits, which are now known to confer a greater risk than involved nodes, present a category of N1c, less than if there were no TDs but many nodes"
"these tumours, if surgically treated, are managed by operations with larger tissue resections such as AP resection or extralevator AP resection (ELAPE)"
"these tumours, if surgically treated, are managed by operations with larger tissue resections such as AP resection or extralevator AP resection (ELAPE)"
"these tumours, if surgically treated, are managed by operations with larger tissue resections such as AP resection or extralevator AP resection (ELAPE)"
"summary stage: longitudinal and axial location, T, N, EMVI, TD, CRM"
"summary stage: longitudinal and axial location, T, N, EMVI, TD, CRM"
"identify the key parameters that define risk - low cancers, T stage, depth of invasion of tumour through muscularis propria, CRM status, EMVI and tumour deposits"
"T stage (and which organs involved if T4b)"
Expected headings
"Clinical information"
"MRI protocol"
"Step-by-step approach"
"Adequacy of imaging"
"Tumour size, location and morphology"
"Relationship to muscularis propria (T stage)"
"Relationship to circumferential resection margin"
"Extramural venous invasion and tumour deposits"
"Mesorectal and pelvic sidewall lymph nodes"
"Mucinous cancers"
"Low rectal cancers"
"Restaging following chemotherapy +/- radiotherapy"
"Template report"
"To sum it up"
"Rectal MRI is a key imaging investigation in the diagnosis, staging and follow up of rectal cancer. An increase in the utility of rectal MRI as been driven by the recognition of the mesorectum as a distinct anatomic compartment containing and limiting the margins of the rectum, and forming a surgical target to enable complete removal of the tumour and associated nodes en bloc. Several parameters need to be reviewed and reported on, and the emphasis on which factors are important has altered with emerging evidence."
"Tumour size, location and morphology"
"the definition of whether a tumour is in the low, mid or upper rectum is widely variable and multiple proposals co-exist"
"appearances vary due to a combination of fibrosis, oedema and mucinous degeneration of tumour"
"identify the key parameters that define risk - low cancers, T stage, depth of invasion of tumour through muscularis propria, CRM status, EMVI and tumour deposits"
"when restaging tumours following chemoradiation, a variety of appearances may be seen due to the combination of fibrosis, oedema and mucinous degeneration, but endoscopic review of the tumour site is essential to confirm complete response"
"Standardised imaging acquisition is important. A combination of T2 and DWI sequences are employed for staging and restaging. There is no role for T1 weighted imaging, with post-contrast T1 weighted imaging reserved for imaging of recurrent rectal cancers in order to plan pelvic exenteration. Please see the article on rectal cancer MRI protocol for more details."
"the distance from the distal edge to the anorectal junction is measured; this is approximately the site where the angle between the rectum and anal canal is identified"
"the relationship of the tumour to the anterior peritoneal reflection is also described; the reflection is off the upper part of the rectum and below this level the rectum is extraperitoneal and the margin of excision is the mesorectal fascia"