Abstract:MR imaging using currently available techniques can effectively image local tumor extent and distant metastases in patients with colorectal carcinoma. Especially for colon cancer, incomplete depiction of nodal metastases in normal-size lymph nodes remains a limitation of cross-sectional imaging studies.
“…With a larger population, MRI‐EMVI score might become significant in multivariable analysis, in keeping with histological studies identifying EMVI as an independent prognostic feature10, 13. The present finding that MRI‐predicted lymph node status did not correlate with outcome even in univariable analysis emphasizes the well documented difficulties of nodal staging with MRI22, 23.…”
“…With a larger population, MRI‐EMVI score might become significant in multivariable analysis, in keeping with histological studies identifying EMVI as an independent prognostic feature10, 13. The present finding that MRI‐predicted lymph node status did not correlate with outcome even in univariable analysis emphasizes the well documented difficulties of nodal staging with MRI22, 23.…”
Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience.
“…13 The accuracy of lymph node metastasis by CT scan has been reported at 79.2%, with a sensitivity of 88.5%; 15 however, more recent studies using MRI have emerged, which show superior predictability to TRUS or CT, with a diagnostic accuracy of nodal metastasis of 98% and sensitivity of 93%. 16 The report of the National Veterans Administration Randomized Study 17 stated that patients with rectal cancer who had been irradiated preoperatively had an earlier Duke stage than controls. However, it is unclear whether this was a result of the true eradication of cancer in lymph nodes or attributable to failure of accurate assessment of regressed lymph nodes after radiotherapy.…”
Although NAT down-stages rectal cancer, it results in a significantly low yield of lymph nodes, which are also significantly smaller than those in nonirradiated controls. Therefore, surgeons and histopathologists must ensure adequate sampling and accurate staging is done for patients with irradiated rectal cancer.
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