ROLE OF MRI IN STAGING RECTAL CARCINOMA

MAGNETIC RESONANCE IMAGING

Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or magnetic resonance tomography (MRT) is a medical imaging technique used in radiology to visualize internal structures of the body in detail. It does not use radiation (x-rays). Single MRI images are called slices. The images can be stored on a computer or printed on film. One exam produces dozens or sometimes hundreds of images.

Abdominal MRI Chest MRI Cranial MRI Heart MRI Spine MRI

PREPARATION

If we have claustrophobia, we may be given a medicine to help us feel sleepy and less anxious, or doctor may suggest an "open" MRI. Before the test, Artificial heart valves Heart defibrillator or pacemaker Inner ear (cochlear) implants Kidney disease or dialysis or allergic Recently placed artificial joints

Vascular stents

PROCEDURE

We may be asked to wear a hospital gown without zippers or snaps Lie on a narrow table, which slides into a large tunnel-shaped scanner. Some exams require a special dye (contrast). The dye helps the radiologist see certain areas more clearly. Coils may be placed around the head, arm, or leg, or other areas to be studied. These help send and receive the radio waves, and help the quality of the images. The test lasts about 30-60 minutes, but may take longer.

ROLE OF MRI IN STAGING RECTAL CANCER

Rectal cancer is a common malignancy that continues to have a highly variable outcome, with local pelvic recurrence after surgical resection usually leading to incurable disease. The success of tumor excision depends largely upon accurate tumor staging and appropriate surgical technique. Magnetic resonance (MR) imaging is increasingly being used to evaluate tumor resectability in patients with rectal cancer and to determine which patients can be treated with surgery alone and which will require radiation therapy to promote tumor regression.

High-spatial-resolution MR imaging has proved useful in clarifying the relationship between a tumor and the mesorectal fascia, which represents the circumferential resection margin at total mesorectal excision. Phased-array surface coil MR imaging in particular plays a vital role in the therapeutic management of rectal cancer.

At present, phased-array MR imaging best fulfills the clinical requirements for preoperative staging of rectal cancer.

TWO AIMS OF MRI

Comparison between MRI2 and histopathology or between MRI2 and MRI1. Treatment modification - No surgery -Local excision

-Standard TME
-Extended TME

ANATOMICAL LANDMARKS OF RECTUM

The anal verge marks the lowermost portion of the anal canal and begins where the skin stops and where the anal mucosa starts. The dentate line is located about 1.5-2 cm upwards from the anal verge. The surgical anal canal extends about 3-4 cm, being shorter in women (2-3 cm), and ends at the anorectal ring or at the upper portion of the puborectal muscle. The surgical rectum extends for 12-15 cm endoscopically from the anal verge. Surrounding the rectum, there is a layer of fat, the perirectal or the mesorectal fat. The perirectal fat is often referred to as mesorectum.

STAGING OF RECTAL TUMOUR

For optimal preoperative treatment planning of rectal cancer, adequate local staging is of paramount importance. Factors associated with prognosis are tumour height, T-stage, extramural tumour growth, lymph node status, vascular and neural invasion, threatened CRM and overgrowth to adjacent structures.

TNM(TUMOUR-NODE-METASTASIS)

T represent the extend of local spread and there are four grades:

T1-tumour invasion through muscularis mucosae, but not into muscularis propria;
T2-tumour invasion into but not through the muscularis propria; T3-tumour invasion through the muscularis propria, but not through the serosa or mesorectal fascia; T4-tumour invasion through the serosa or mesorectal fascia.

N describes the nodal involvement:

N0-no lymph node involvement;

N1-1 to 3 involved lymph nodes; N2-4 or more involved lymph nodes.

M indicates the presence of distant metastases:

M0-no distant metastases M1-distant metastases

TUMOUR HEIGHT AND SIZE

INDICATIONS FOR MRI IN RECTAL CANCER

To evaluate the local extent of the tumour, before or perhaps also during/after preoperative treatment. Local recurrence can also be an indication for MRI. Finally, sometimes MRI is used for a definitive diagnosis of rectal cancer.

ADVANTAGES OF MRI
The main advantages of magnetic resonance imaging (MRI) scans are:

They do not involve exposure to radiation, so they can be safely used in people who may be vulnerable to the effects of radiation, such as pregnant women and babies. They are particularly useful for showing soft tissue structures, such as ligaments and cartilage, and organs such as the brain, heart and eyes. They can provide information about how the blood moves through certain organs and blood vessels, allowing problems with blood circulation, such as blockages, to be identified.

DISADVANTAGES OF MRI

MRI scanners are very expensive. Some people feel claustrophobic while they are having a MRI scan. MRI scanners can be affected by movement, making them unsuitable for investigating problems such as mouth tumours because coughing or swallowing can make the images that are produced less clear.

REFERENCE

http://radiographics.rsna.org/content/26/3/701.f ull http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 3259411/ BROWSES INTRODUCTION TO THE SYSTEMS AND SIGNS Of SURGICAL DISEASE. BAILEY & LOVES