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Preoperative MRI of Rectal Cancer With and Without Rectal Water Filling: An Intraindividual Comparison

Myeong-Jin Kim1,2, Joon Seok Lim1, Young Taik Oh1, Joo Hee Kim1, Jae-Joon Chung1, Seung Ho Joo1, Nam Kyu Kim3, Kang Young Lee3, Won Ho Kim4 and Ki Whang Kim1

1 Department of Diagnostic Radiology, Severance Hospital, and Research Institute of Radiological Science, Yonsei University College of Medicine, Seodaemun-ku Shinchondong 134, Seoul 120-752, Republic of Korea.
2 Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
3 Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
4 Department of Internal Medicine, Division of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.



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  		Fig. 1A. —72-year-old man with polypoid rectal carcinoma extending to submucosa. Transverse T2-weighted fast spin-echo MR images (TR/TE 5,000/75) were obtained before (A) and after (B) rectal distention. Three reviewers failed to detect small polypoid mass on nondistended image (A), but polypoid carcinoma (arrow, B) is clearly defined after rectal distention.

 


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  		Fig. 1B. —72-year-old man with polypoid rectal carcinoma extending to submucosa. Transverse T2-weighted fast spin-echo MR images (TR/TE 5,000/75) were obtained before (A) and after (B) rectal distention. Three reviewers failed to detect small polypoid mass on nondistended image (A), but polypoid carcinoma (arrow, B) is clearly defined after rectal distention.

 


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  		Fig. 2A. —65-year-old man with polypoid rectal carcinoma extending beyond proper muscle layer. Transverse T2-weighted fast spin-echo MR images (TR/TE, 4,300/75) were obtained before (A) and after (B) rectal distention. Irregular spiculation and nodular bulging were noted on anterior margin of mass (arrow, A) on nondistended image. All reviewers indicated that tumor penetrated outer wall of rectum. After rectal filling with water, mass separated from anterior wall of rectum, and its outline was clearly defined (B). All reviewers correctly identified mass confined to rectal wall. Note that rectal layers were also better identified on distended image (B).

 


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  		Fig. 2B. —65-year-old man with polypoid rectal carcinoma extending beyond proper muscle layer. Transverse T2-weighted fast spin-echo MR images (TR/TE, 4,300/75) were obtained before (A) and after (B) rectal distention. Irregular spiculation and nodular bulging were noted on anterior margin of mass (arrow, A) on nondistended image. All reviewers indicated that tumor penetrated outer wall of rectum. After rectal filling with water, mass separated from anterior wall of rectum, and its outline was clearly defined (B). All reviewers correctly identified mass confined to rectal wall. Note that rectal layers were also better identified on distended image (B).

 


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  		Fig. 3A. —59-year-old woman with ulcerative carcinoma extending beyond proper muscle layer. Transverse T2-weighted fast spin-echo MR images (TR/TE, 4,000/84) were obtained before (A) and after (B) rectal distention. Nodular bulging outer contour of rectum (arrow, A) was noted on anterolateral aspect of rectum. Three reviewers indicated that tumor penetrated outer wall of rectum. After rectal distention, mass (arrow, B) is clearly identified and outer muscular layer is well delineated with no evidence of disruption. Three reviewers correctly identified mass confined to rectal wall.

 


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  		Fig. 3B. —59-year-old woman with ulcerative carcinoma extending beyond proper muscle layer. Transverse T2-weighted fast spin-echo MR images (TR/TE, 4,000/84) were obtained before (A) and after (B) rectal distention. Nodular bulging outer contour of rectum (arrow, A) was noted on anterolateral aspect of rectum. Three reviewers indicated that tumor penetrated outer wall of rectum. After rectal distention, mass (arrow, B) is clearly identified and outer muscular layer is well delineated with no evidence of disruption. Three reviewers correctly identified mass confined to rectal wall.

 


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  		Fig. 4A. —28-year-old woman with ulcerative rectal carcinoma penetrating outer wall. Transverse T2-weighted fast spin-echo MR images (TR/TE, 4,200/75) were obtained before (A) and after (B) rectal distention. Hypointense layer (arrow, A) was seen on posterior aspect of tumor on nondistended image. All reviewers falsely interpreted that tumor did not penetrate outer rectal wall. Rectal distention image shows that outer margin of tumor (arrow, B) extends to perirectal fat. Three reviewers correctly indicated that mass penetrated outer wall of rectum.

 


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  		Fig. 4B. —28-year-old woman with ulcerative rectal carcinoma penetrating outer wall. Transverse T2-weighted fast spin-echo MR images (TR/TE, 4,200/75) were obtained before (A) and after (B) rectal distention. Hypointense layer (arrow, A) was seen on posterior aspect of tumor on nondistended image. All reviewers falsely interpreted that tumor did not penetrate outer rectal wall. Rectal distention image shows that outer margin of tumor (arrow, B) extends to perirectal fat. Three reviewers correctly indicated that mass penetrated outer wall of rectum.

 

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