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Oncology in general has seen vast advancements over recent years. Improved und- standing of tumor biology, multidisciplinary team decisions and an individualized therapy are cornerstones of treatment planning for cancer patients today. These dev- opments have challenged the imaging community with ever more specifc questions on tumor detection, staging and therapy control. Whereas this evolution applies to many tumor entities, rectal cancer takes an outstanding role, as it was the recognition of certain anatomical and pathological features of the disease, with the help of magnetic resonance imaging (MRI), that induced radiology not only to aid in disease mana- ment, but in fact to be a powerful engine for new concepts in rectal cancer treatment. The continuous improvement of highly specialized MRI and the groundbreaking scientifc contributions of radiologists all over the world have paved the way for s- stantial refnements of this technique during the last decade. Consequently, dedicated imaging protocols for routine diagnostic work-up of r- tal cancer patients are now available, which can guide multidisciplinary team de- sions and, in combination with optimized surgery and chemoradiotherapy, lead to longer survival and a better quality of life. Besides the scientifc advances, the enduring clinical success of MRI in the feld of rectal cancer is highly contingent upon expertise. To this end, ongoing education and continuous training are vital.
Learning objectives1. To present the adequate image acquisition of the rectal MR Imaging for rectal cancer.2. To display the anatomical landmarks and discuss its clinical implications.3. To educate the interpretation method of rectal MR imaging according to TNM staging.4. To demonstrate the educational cases with rectal MR imaging and whole-mount specimen for radiology-pathology correlation.5. To discuss on-going issues of guidelines of rectal cancer treatment.BackgroundThe role of MR imaging in clinical staging of rectal cancer has been increasing in the initial diagnosis and post-treatment evaluation. An accurate staging and description of tumor location is important for treatment planning. Rectal MRI plays a critical role in post-treatment evaluation for the treatment of choice by the assessment of clinical restaging, treatment response, remaining cancer burdens, and surgical extent.Imaging findings OR procedure findings.Rectal MRI with high-resolution T2WI is a standard of local staging of rectal cancer. Accurate determination of T staging and assessment of surgical plane is essential for treatment planning (primary surgical intervention vs. neoadjuvant CRT). N staging is still challenging even with morphological and size criteria. The presence of positive LNs and their location should be assessed and reported. Reassessment of rectal cancer after preoperative treatment is performed by using TNM staging. mrRECIST criteria, and mrTRG system. DWI can be added to T2WI in order to increase the accuracy of reassessment.Conclusion.To be aware of the advantage and disadvantage of these reassessment methods is important to prevent misinterpretation of rectal cancer status after preoperative treatment.
Role of Magnetic Resonance Imaging in Locally Advanced Rectal Cancer.
Despite lifestyle improvements, the incidence of rectal cancer is increasing in industrialised countries. Rapid advances in technology, growing knowledge of the biological history of the disease and closer attention to patients' quality of life after surgery have led to a less invasive approach. In the last 15 years, the surgical approach has shifted from extended resection to sphincter-saving procedures, featuring a multidisciplinary approach and a high level of specialisation. The experienced surgeon can plan and choose the "right treatment for the right patient" only with the support of the radiologist, endoscopist and pathologist (preoperative staging), oncologist and radiotherapist (neoadjuvant therapy), and psychologist and stomatherapist (rehabilitation). In addition, the difficult problems of salvage procedure and the reconstruction of anal sphincter after abdominal resection are explored. The aim of this book is to clarify the rapid advances and to offer guidelines for doctors dealing with rectal cancer. Taking into account indications, contraindications, risks, benefits and controversies, the authors offer clear and practice-oriented answers for a wide range of specialists and experts, as well as those new to the field.
Editor Mukesh Harisinghani and authors review important areas in MR of the male pelvis. Articles in this issue will include MRI of the Urinary Bladder; Multiparametric MRI Imaging of the Prostate; Diffusion Weighted Imaging of the Male Pelvis; MR Imaging of the Rectum; Penile MR Imaging; MR Imaging of Pelvic Metastases; MR Imaging of Scrotum; Vascular MR Imaging of the Male Pelvis; and more!
Imaging is now central to the investigation and management of anorectal and pelvic floor disorders. This has been brought about by technical developments in imaging, notably, three-dimensional ultrasound and magnetic resonance imaging (MRI), which allow high anatomical resolution and tissue differentiation to be presented in a most usable fashion. Three-dimensional endosonography in anorectal conditions and MRI in anal fistula are two obvious developments, but there are others, with dynamic st- ies of the pelvic floor using both ultrasound and MRI coming to the fore. This atlas provides an easy way to gain a detailed understanding of imaging in this field. The atlas is divided into four sections covering the basic anatomy, anal/perianal disease, rectal/perirectal disease and functional assessment. One of the difficulties with developing an atlas is to strike the right balance - tween text and images. Too much text and it is not an atlas; too little text and the - ages may not be understood. The editors of this atlas are to be congratulated on achi- ing an appropriate balance. The images are all that one expects from an atlas, and the diagrams are excellent. The commentaries at the end of invited chapters are a valuable addition, placing what are relatively short, focussed chapters into context. They add balance and depth to the work and are well worth reading.
Modern Management of Cancer of the Rectum is intended to provide a comprehensive overview of all aspects of rectal neoplasms. It addresses epidemiology, biology, screening and chemoprevention, the role of imaging in diagnosis, staging and prognosis, radiation therapy, medical and surgical treatment, as well as new modalities of therapy, including laparoscopy, and transanal endoscopic surgery. A greater understanding of prognostic factors, patterns of spread and natural history has occurred during the past decade; together with new diagnostic modalities this has led to significant changes in the management of patients with rectal cancer. This book will be invaluable for all those who treat rectal cancer.
Now more streamlined and focused than ever before, the 6th edition of CT and MRI of the Whole Body is a definitive reference that provides you with an enhanced understanding of advances in CT and MR imaging, delivered by a new team of international associate editors. Perfect for radiologists who need a comprehensive reference while working on difficult cases, it presents a complete yet concise overview of imaging applications, findings, and interpretation in every anatomic area. The new edition of this classic reference — released in its 40th year in print — is a must-have resource, now brought fully up to date for today’s radiology practice. Includes both MR and CT imaging applications, allowing you to view correlated images for all areas of the body. Coverage of interventional procedures helps you apply image-guided techniques. Includes clinical manifestations of each disease with cancer staging integrated throughout. Over 5,200 high quality CT, MR, and hybrid technology images in one definitive reference. For the radiologist who needs information on the latest cutting-edge techniques in rapidly changing imaging technologies, such as CT, MRI, and PET/CT, and for the resident who needs a comprehensive resource that gives a broad overview of CT and MRI capabilities. Brand-new team of new international associate editors provides a unique global perspective on the use of CT and MRI across the world. Completely revised in a new, more succinct presentation without redundancies for faster access to critical content. Vastly expanded section on new MRI and CT technology keeps you current with continuously evolving innovations.
This issue of Surgical Oncology Clinics of North America is devoted to the treatment of Colorectal Cancer. Editors Nancy Baxter, MD and Marcus Burnstein, MD have assembled some of the top experts in the field to review this important topic.Articles in this issue include: Colonoscopy: What are we missing?; Imaging in rectal cancer: MRI vs. ERUS; Local Excision for Rectal Cancer; Controversies in Neo-adjuvant treatment for rectal cancer; Management of the complete response; Controversies in laparoscopy for CRC; Colon resection – is standard technique adequate?; Quality Assurance in CRC surgery; Controversies in Abdomino-perineal resection; Functional Consequences of CRC management; Timing of adjuvant therapy for CRC; and Management of Stage IV disease.
Rectal Cancer: International Perspectives on Multimodality Management is a timely analysis of the diagnosis, staging, pathology, and therapy of cancer of the rectum. This book is intended as a useful resource for physicians, scientists, medical students, and allied health personnel in the disciplines of radiology, gastroenterology, surgical oncology, medical onc- ogy, radiation oncology, and pathology. Renowned contributors from different medical d- ciplines have written their chapters in a thoughtful, provocative, and visual fashion. Importantly, these chapters highlight the controversies in the diagnostic, staging, and the- peutic management of patients with rectal cancer while providing practical management recommendations. This book is divided into 18 chapters. Early chapters address the diagnosis and staging of rectal cancer, highlighting the critical role of contemporary imaging in guiding treatment. The remaining chapters focus on the multimodality management of rectal cancer from the vantage points of surgery, pathology, chemotherapy, and radiation therapy. The major dev- opments in surgery are reviewed first, including contemporary roles of local excision, total mesorectal excision, lateral pelvic lymph node dissection, organ preservation approaches, as well as the management of advanced, recurrent, and metastatic disease. Following is a ch- ter describing the pathologic evaluation of rectal cancer specimens, with emphasis on proper methodology and its clinical relevance to overall disease management. The final chapters review the contemporary roles of chemotherapy (including with radiation therapy, adjuvant and neoadjuvant settings without radiation therapy, as well as in metastatic disease) as well as radiation therapy (including adjuvant and neoadjuvant approaches, short vs.
Positioning in MRI is a clinical manual about the creation of magnetic resonance images. This manual focuses upon patient positioning and image planning. The manual is organised by body region and provides valuable insight into - Patient pathology on MRI. Considerations when positioning both the patient and coil. Imaging planes. Anatomical image alignment. This manual is a comprehensive highly visual reference to the planning and positioning of patients and coils in MR imaging. High quality imaging specific to patient pathology is encouraged through the focus on ‘considerations’ specific to coil and patient placement and imaging plane selection. Over 200 MR images Formulaic internal design assist use as clinical manual to MRI planning Evidence base provided where appropriate (cranial neurology) Image selection – assist learning principles that underpin good positioning and anatomical coverage Explores positioning of patient and coils specific to individual treatment requirements Evolve website – image collection (over 200 MR images) and additional case studies
Each volume in the Early Detection and Treatment of Cancer Series is packed with practical, authoritative information designed to cover the full range of diagnostic procedures, including pathologic, radiologic, bronchoscopic, and surgical aspects. You’ll be able to determine the safest, shortest, least invasive way to reach an accurate diagnosis; stage the disease; and choose the best initial treatment for early stages. Based on current evidence in the literature, authors provide clinical, hands-on tools to help you make informed decisions on precisely what tests and imaging studies are needed to diagnose and stage each type of cancer. Practical, authoritative, and highly-illustrated, this volume in the brand new Early Detection and Treatment of Cancer series covers current protocols and the latest advances in diagnostic imaging and molecular and serologic markers for colon cancer. Apply expert advice on the best “next-step plan for different presentations and tips for less invasive protocols. Get clinical, hands-on tools to help you make informed decisions on precisely what tests and imaging studies are needed for accurate diagnosis and staging. Clear figures, tables, and boxes illustrate step-by-step care of the full range of problems encountered. The small size and convenient format make this an ideal purchase for diagnostic reference. Outlines the steps after diagnosis to guide you through formulating a treatment or patient care plan. Emphasizes important points—such as risk-adjusted screening for staging and the use of promising new gene therapies—with “key points boxes at the beginning of each chapter and pedagogic features throughout. Summarizes the process of accurately diagnosing and staging cancer in a logical, almost algorithmic, approach for easy reference. Complements the procedures outlined in the text with full-color photographs and line drawings to reinforce your understanding of the material.
Here’s the multidisciplinary guidance you need for optimal imaging of malignancies. Radiologists, surgeons, medical oncologists, and radiation oncologists offer state-of-the-art guidelines for diagnosis, staging, and surveillance, equipping all members of the cancer team to make the best possible use of today’s noninvasive diagnostic tools. Consult with the best. Dr. Paul M. Silverman and more than 100 other experts from MD Anderson Cancer Center provide you with today's most dependable answers on every aspect of the diagnosis, treatment, and management of the cancer patient. Recognize the characteristic presentation of each cancer via current imaging modalities and understand the clinical implications of your findings. Effectively use traditional imaging modalities such as Multidetector CT (MDCT), PET/CT, and MR in conjunction with the latest advances in molecular oncology and targeted therapies. Find information quickly and easily thanks to a consistent, highly templated format complete with "Key Point" summaries, algorithms, drawings, and full-color staging diagrams. Make confident decisions with guidance from comprehensive algorithms for better staging and imaging evaluation. Access the fully searchable text online, along with high-quality downloadable images for use in teaching and lecturing and online-only algorithms, at
This issue of MRI Clinics of North America focuses on The Gut in MRI: From the Upper to the Lower Digestive Tract, and is edited by Dr. Andrea Laghi. Articles will include: Esophagus and stomach: Is there a role for MRI?; MR of the small bowel: How to do it; MR in Crohn’s Disease: Diagnosis, disease burden and classification; MR in Crohn’s Disease: Imaging biomarkers in assessing response to therapy; MR of malabsorption syndromes, vasculitis, and other uncommon diseases; MR of small bowel tumors; MR enema of the colon in the diagnosis of recto-sigmoid endometriosis; Rectal cancer: Staging; Rectal cancer: Assessing response to neoadjuvant therapy; MR of anal and peri-anal tumors; MR of perianal fistulas; and more!
Written by internationally renowned authors, this title is an invaluable reference for all those required to report on MR examinations, with accurate cancer staging aided by the extensive use of high quality MR images of pelvic cancer. Each chapter gives a short account of every disease and a set of images demonstrating the tumour, node and metastasis stages, based on the 2010 UICC/AJCC staging system.
Abstract : Extramural venous invasion (EMVI) is associated with a poor prognosis and a poor overall survival rate in rectal cancer. It can independently predict local and distant tumor recurrences. Preoperative EMVI detection in rectal cancer is useful for determining the treatment strategy. EMVI status is beneficial for the post‐treatment evaluation and analysis of rectal cancer. Magnetic resonance imaging (MRI) is a non‐invasive diagnostic modality with no radiation effects. High‐resolution MRI can detect EMVI with high accuracy. In addition, MRI results are equal to or even better than pathological results in the detection of medium to large EMVI in rectal cancer. MRI‐detected EMVI (mrEMVI) can be used as a potential biomarker that facilitates treatment methods. This review highlights the importance of MRI before and after rectal cancer treatment. In addition, we analyze the prognostic correlation between mrEMVI and circulating tumor cells (CTC) in rectal cancer. This article may help shed light on the significance of mrEMVI.
Comprehensive and complete, Shackelford’s Surgery of the Alimentary Tract delivers the definitive, clinically oriented, cutting-edge guidance you need to achieve optimal outcomes managing the entire spectrum of gastrointestinal disorders. Make effective use of the latest endoscopic, robotic, and minimally invasive procedures as well as medical therapies with unbeatable advice from a "who’s who" of international authorities! Find expert answers to any clinical question in gastrointestinal surgery, from the esophagus to the colon. See exactly what to look for and how to proceed from an abundance of beautifully detailed intraoperative and laparoscopic photographs.
Background and aim Endoscopy and magnetic resonance imaging (MRI) are used routinely in the diagnostic and preoperative work-up of rectal cancer. We aimed to compare colonoscopy and MRI in determining rectal tumor height. Methods Between 2002 and 2012, all patients with rectal cancer with available MRIs and endoscopy reports were included. All MRIs were reassessed for tumor height by two abdominal radiologists. To obtain insight in techniques used for endoscopic determination of tumor height, a survey among regional endoscopists was conducted. Results A total of 211 patients with rectal cancer were included. Tumor height was significantly lower when assessed by MRI than by endoscopy with a mean difference of 2.5 cm (95% CI: 2.1–2.8). Although the agreement between tumor height as measured by MRI and endoscopy was good (intraclass correlation coefficient (ICC) 0.7 (95% CI: 0.7–0.8)), the 95% limits of agreement varied from –3.0 cm to 8.0 cm. In 45 patients (21.3%), tumors were regarded as low by MRI and middle–high by endoscopy. MRI inter- and intraobserver agreements were excellent with an ICC of 0.8 (95% CI: 0.7–0.9) and 0.9 (95% CI: 0.9–1.0), respectively. The survey showed no consensus among endoscopists as to how to technically measure tumor height. Conclusion This study showed large variability in rectal tumor height as measured by colonoscopy and MRI. Since MRI measurements showed excellent inter- and intraobserver agreement, we suggest using tumor height measurement by MRI for diagnostic purposes and treatment allocation.

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