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Thin-Section MRI with a Phased-Array Coil for Preoperative Evaluation of Pelvic Anatomy and Tumor Extent in Patients with Rectal Cancer

Takayuki Akasu1, Gen Iinuma2, Toshiyuki Fujita2, Yukio Muramatsu2, Ukihide Tateishi2, Kunihisa Miyakawa2, Tsutomu Murakami2 and Noriyuki Moriyama2

1 Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
2 Diagnostic Radiology Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.



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  		Fig. 1A. —64-year-old woman with pT3 rectal carcinoma. Unenhanced T2-weighted fast spin-echo image shows rectal mucosa (m) as low-intensity, submucosa (sm) as high-intensity, muscularis propria (mp) as low-intensity, and perirectal fat (pf) as high-intensity layers. Signal intensity of tumor (T) is higher than that of proper muscle layer but lower than that of submucosa. Tumor is seen invading through muscularis propria (arrowheads).

 


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  		Fig. 1B. —64-year-old woman with pT3 rectal carcinoma. Photograph of histologic specimen reveals tumor invading through muscularis propria (stage pT3) (arrows).

 


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  		Fig. 2A. —42-year-old man with pT2 rectal carcinoma. Unenhanced T2-weighted fast spin-echo image shows mesorectal fascia (arrowheads) as fine linear hypointense structure enveloping mesorectum. Tumor (T) is revealed as being confined in muscularis propria (mp) and was staged as T2.

 


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  		Fig. 2C. —42-year-old man with pT2 rectal carcinoma. Unenhanced T2-weighted fast spin-echo image shows internal sphincter muscle (i) and puborectalis muscle (p) as low-intensity layers separated by hyperintense intersphincteric plane.

 


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  		Fig. 3A. —65-year-old man with rectal carcinoma. Unenhanced T2-weighted fast spin-echo images reveal main trunk (A, arrowhead) and first (B, arrowheads), second (C, arrowheads), and third (D, arrowheads) branches of superior rectal artery seen as hypointense vascular structures. e = external iliac artery, i = internal iliac artery.

 


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  		Fig. 3B. —65-year-old man with rectal carcinoma. Unenhanced T2-weighted fast spin-echo images reveal main trunk (A, arrowhead) and first (B, arrowheads), second (C, arrowheads), and third (D, arrowheads) branches of superior rectal artery seen as hypointense vascular structures. e = external iliac artery, i = internal iliac artery.

 


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  		Fig. 3C. —65-year-old man with rectal carcinoma. Unenhanced T2-weighted fast spin-echo images reveal main trunk (A, arrowhead) and first (B, arrowheads), second (C, arrowheads), and third (D, arrowheads) branches of superior rectal artery seen as hypointense vascular structures. e = external iliac artery, i = internal iliac artery.

 


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  		Fig. 3D. —65-year-old man with rectal carcinoma. Unenhanced T2-weighted fast spin-echo images reveal main trunk (A, arrowhead) and first (B, arrowheads), second (C, arrowheads), and third (D, arrowheads) branches of superior rectal artery seen as hypointense vascular structures. e = external iliac artery, i = internal iliac artery.

 


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  		Fig. 3E. —65-year-old man with rectal carcinoma. Unenhanced T2-weighted fast spin-echo image reveals obturator lymph node (arrowhead) and mesorectal lymph node (black arrow), displaying lower signal intensity than that of perirectal fat but higher signal intensity than those of arteries and veins. o = obturator artery.

 


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  		Fig. 4A. —42-year-old man with rectal carcinoma. Comparison of pre- and postoperative MR images show pelvic plexuses are located just outside mesorectal fascia. MR image obtained before surgery (A) shows pelvic plexuses (white arrows). Postoperative MR image (B) shows one of metal hemostatic clips that were applied to inner surfaces of pelvic plexuses during surgery to mark their exact locations (black arrow).

 


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  		Fig. 4B. —42-year-old man with rectal carcinoma. Comparison of pre- and postoperative MR images show pelvic plexuses are located just outside mesorectal fascia. MR image obtained before surgery (A) shows pelvic plexuses (white arrows). Postoperative MR image (B) shows one of metal hemostatic clips that were applied to inner surfaces of pelvic plexuses during surgery to mark their exact locations (black arrow).

 


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  		Fig. 2B. —42-year-old man with pT2 rectal carcinoma. Photograph of histologic specimen shows tumor confined in muscularis propria (stage pT2).

 


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  		Fig. 5A. —44-year-old man with pT3 rectal carcinoma involving mesorectal fascia. Unenhanced T2-weighted fast spin-echo image shows tumor (arrow) involving mesorectal fascia (arrowheads).

 


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  		Fig. 5B. —44-year-old man with pT3 rectal carcinoma involving mesorectal fascia. Photograph of histologic specimen reveals tumor (arrow) involving mesorectal fascia (arrowheads).

 


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  		Fig. 6A. —80-year-old man with pT2 rectal carcinoma. Tumor (T) was overstaged as T3 because spiculation (arrowheads) was interpreted as cancer invasion on unenhanced T2-weighted fast spin-echo image.

 


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  		Fig. 6B. —80-year-old man with pT2 rectal carcinoma. Photograph of histologic specimen reveals tumor confined in muscularis propria (stage pT2). However, reactive changes in connective tissue around tumor, including desmoplastic change and hypervascularity (arrows), can affect MRI findings and mimic tumor invasion.

 


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  		Fig. 7A. —56-year-old woman with pT2 rectal carcinoma. Tumor (T) was overstaged as T3 because site of deepest invasion (arrowheads) was sectioned obliquely on MRI and mimicked cancer invasion beyond muscularis propria (mp).

 


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  		Fig. 7B. —56-year-old woman with pT2 rectal carcinoma. Photograph of histologic specimen reveals tumor confined in muscularis propria (stage pT2).

 

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