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A correct preoperative stadialization of rectal carcinoma has a direct influence upon its therapeutic strategy, resulting in a significant improvement of the survival rate and life quality after the treatment. The therapeutic strategy refers to the option of undergoing or not preoperative radiochemotherapy before the total mesorectal excision (TME). The technical advances in the magnetic resonance domain makes possible the multiparametric examinations (mp MRI) with medical equipments (3T models are common) good enough to obtain images having an excellent quality, which allow a correct diagnosis of the local tumour spread. These multiparametric examinations include T2 multiplan sequences and T1 sequences, which offer valuable morphological information due to the high resolution of anatomic structures and DWI functional sequences, with a decisive role in tracing residual tumours after post-surgery radiochemotherapy. The functional examination using DWI is the only highly accurate non-invasive diagnostic method which can differentiate the fibrosis from vital tumoral remnants. The dynamic contrast-enhanced examination (DCE) combined with DWI and volumetry can give supplementary information as to the complete and incomplete response to RCT, and is efficient in detecting a local recurrence after TME. Also, MRI is the only diagnostic method which has the necessary accuracy to assess the meso-rectal fascia, which represents the circumferential resection margin (CRM) in the case of TME. With the help of MRI we can measure with a precision similar to histology the minimal distance to the mesorectal fascia, essential in planning the surgical treatment, and more important than the T stadialization. This allows the selection of patients with an unfavourable prognosis factor who would benefit from radiotherapy or from RCT. The evaluation of other prognostic factors as the condition of nodes, their number and primary site, and the extramural venous invasion (EMVI) have an important role in the individualized therapy.

The preoperative imaging diagnosis of rectal cancer lies at the heart of oncological staging and has a crucial influence on patient management and therapy planning. Rectal cancer is common, and accurate preoperative staging of tumors using high-resolution magnetic resonance imaging (MRI) is a crucial part of modern multidisciplinary team management (MDT). Indeed, rectal MRI has the ability to accurately evaluate a number of important findings that maBay impact patient management, including distance of the tumor to the mesorectal fascia, presence of lymph nodes, presence of extramural vascular invasion (EMVI), and involvement of the anterior peritoneal reflection/peritoneum and the sphincter complex. Many of these findings are difficult to assess in non-expert hands. In this chapter, we present currently used staging modalities with focus on MRI, including optimization of imaging techniques, tumor staging, interpretation help as well as essentials for reporting.

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Chirurgia, 112 (2), 2017 97 RezumatÎn ultimele trei decenii am observat o creştere a frecvenţei depistării şi evaluării leziunilor chistice pancreatice (PCL). Acestea prezintă o paletă variată de trăsături imagistice şi clinice. Diagnosticul şi diferenţierea leziunilor chistice pancreatice este deosebit de importantă, din cauza riscului concret de malignizare. Principalul motiv al acestei lucrari este conştientizarea existenţei acestor leziuni şi folosirea extinsă a modalităţilor imagistice cu secţiuni transversale, tehnică aflată într-o continuă dezvoltare (1). De obicei, PCL sunt diagnosticate din întâmplare în timpul investigării unor dureri abdominale independente şi nespecifice folosind proceduri imagistice obişnuite, CT sau IRM. Leziunile chistice pancreatice reprezintă o colecţie eterogenă histologică, care poate avea un spectru larg de diagnostice de la complet benign la potenţial malign, la carcinom in situ şi până la invaziv (2,3). În 1978, Compagno şi Oertel au fost primii care au observat distincţia crucială între neoplaziile chistice seroase şi mucinoase ale pancreasului şi au explicat importanţa identificării neoplaziilor mucinoase din cauza potenţialului lor malign latent sau evident (4,5). De atunci, interesul pentru PCL a crescut semnificativ, mai ales după ce a fost identificată importanţa şi prevalenţa neoplaziilor papilare mucinoase intraductale (IPMN). În prezent, PCL reprezintă o provocare frecventă şi dificilă în practica clinică, datorită creşterii detectării acestora la pacienţi asimptomatici şi a lipsei de înţelegere a aspectelor care ţin de comportamentul biologic al acestor neoplazii. Diferenţele importante în ceea ce priveşte rezultatul lor final şi identificarea acestora tot mai frecventă au plasat neoplaziile în atenţia chirurgilor, anatomopatologilor, gastroenterologilor, Abbreviations: