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* Why MRI ?
** Normal MR Anatomy
*** Preoperative Staging
Tumor
Nodes
Metastasis
**** Post Treatment and Recurrence Evaluation
**** Conclusion
Staging
MRI
ERUS PET CT
Endorectal US (ERUS) has high accuracy in rectal
cancer staging, but several important limitations
opponent to MRI
Biopsy + PH
TRUS
MRI CT
PET-CT
MRI protocol
3 plane MRI slices
T3 CRM+ N1
T3 CRM -
CRM + <1mm
CRM – >1mm
T1W ax
T2W ax
Infiltration of MRF
With lymph node involvement
Long course RT +HT than TME
• The cancer has spread to nearby lymph nodes, but not to other organs
• Surgery is the first treatment, followed by chemotherapy or RT depending on the
size and localization of the tumor.
Stage IV
ax an sag T2W
• Downstaging
• Downsizing
• Same stage
• Upstaging
• Upsizing
Before and after therapy
MRI after RT
T3No ToNo
1. y 50%
2. y 80%
First 4y 93%
MRI follow up :
T2W sagi, ax
* The two major advancements in the treatment of rectal
cancer are total mesorectal excision (TME)
and neoadjuvant radiotherapy and chemotherapy.
* Both have dramatically changed the local recurrence
and survival rates. MRI is the most accurate tool for
the local staging of rectal cancer and is a powerful tool
to select the appropriate treatment-