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Staging of Rectal Cancer: Diagnostic Potential of Multiplanar Reconstructions with MDCT

C. Kulinna1,2, R. Eibel1, W. Matzek2, H. Bonel1, D. Aust3, T. Strauss4, M. Reiser1 and J. Scheidler1

1 Institute of Clinical Radiology, Ludwig-Maximilians University Grosshadern Munich, Munich, Germany.
2 Present address: Department of Radiology, University of Vienna, Waehringer Guertel 18-20, AKH Vienna, Vienna A-1090, Austria.
3 Institute of Pathology, Ludwig-Maximilians University Grosshadern Munich, Munich, Germany.
4 Department of Surgery, Ludwig-Maximilians University Grosshadern Munich, Munich, Germany.



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  		Fig. 1. —Bar graph shows interobserver variability between reviewers 1 and 2 as indicated by kappa values. UICC = International Union Against Cancer 2002 [8], T = T staging, N = N staging, ax = axial reconstructions, cor = coronal reconstructions, sag = sagittal reconstructions.

 


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  		Fig. 2A. —MDCT scans of 55-year-old woman with stage T2 N0 tumor. Transverse CT slice shows possible small-tumor strands (arrow) infiltrating perirectal fat.

 


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  		Fig. 2B. —MDCT scans of 55-year-old woman with stage T2 N0 tumor. Multiplanar reconstructions in coronal (B) and sagittal (C) views show no neoplastic involvement of perirectal fat in well-distended rectum. No enlarged lymph nodes are visible. Tumor was correctly staged as T2 N0.

 


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  		Fig. 2C. —MDCT scans of 55-year-old woman with stage T2 N0 tumor. Multiplanar reconstructions in coronal (B) and sagittal (C) views show no neoplastic involvement of perirectal fat in well-distended rectum. No enlarged lymph nodes are visible. Tumor was correctly staged as T2 N0.

 


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  		Fig. 3A. —MDCT scans of 74-year-old man with stage T3 N1 tumor. Transverse CT image shows nodular and spiculated configuration of tumor margin (arrow).

 


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  		Fig. 3B. —MDCT scans of 74-year-old man with stage T3 N1 tumor. In corresponding coronal (B) view and especially in sagittal (C) view, delineation of rectal wall also seems to be irregular and shows infiltration into perirectal fat (white arrows). Lymph node larger than 3 mm on short-axis diameter can also be seen (black arrows). Histopathology confirmed stage T3 N1.

 


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  		Fig. 3C. —MDCT scans of 74-year-old man with stage T3 N1 tumor. In corresponding coronal (B) view and especially in sagittal (C) view, delineation of rectal wall also seems to be irregular and shows infiltration into perirectal fat (white arrows). Lymph node larger than 3 mm on short-axis diameter can also be seen (black arrows). Histopathology confirmed stage T3 N1.

 


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  		Fig. 4A. —MDCT scans obtained after preoperative neoadjuvant radiochemotherapy in 66-year-old woman with stage T2 N0 tumor. Axial reconstruction shows nodular and spiculated appearance (arrow), suggestive of infiltration of perirectal fat.

 


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  		Fig. 4B. —MDCT scans obtained after preoperative neoadjuvant radiochemotherapy in 66-year-old woman with stage T2 N0 tumor. On sagittal image, these changes were interpreted as smooth opacities of postradiation fibrosis and partial volume effects. Dorsal wall of rectum shows sharp delineation (arrow). Tumor was correctly staged as T2 N0.

 

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