MRI of Rectal Disorders
Christine C. Hoeffel1,
Louisa Azizi1,
Najat Mourra2,
Maïté Lewin1,
Lionel Arrivé1 and
Jean-Michel Tubiana1
1 Department of Radiology, Université Paris-Descartes Faculté de
Medecine Cochin Port-Royal, Hôpital Saint-Antoine, 184 Rue du Faubourg,
Saint-Antoine 75571, Paris cedex 12, France.
2 Department of Pathology, Hôpital Saint-Antoine, Saint-Antoine 75571,
Paris cedex 12, France.
View larger version (164K):
[in a new window]
|
Fig. 1A —Retrorectal tailgut cyst in 25-year-old woman. Sagittal
T2-weighted (A) and axial fat-suppressed contrast-enhanced T1-weighted
(B) MR images show lesion adherent to rectum (arrow, B)
extending from behind anal canal upward into retrorectal space. Lesion
consists of group of cystic lesions surrounded by unenhanced,
low-signal-intensity, fibrous thick wall (arrowheads). Note that main
cystic lesion displays slightly heterogeneous high signal intensity on
T1-weighted image due to mucoid content.
|
|
View larger version (147K):
[in a new window]
|
Fig. 1B —Retrorectal tailgut cyst in 25-year-old woman. Sagittal
T2-weighted (A) and axial fat-suppressed contrast-enhanced T1-weighted
(B) MR images show lesion adherent to rectum (arrow, B)
extending from behind anal canal upward into retrorectal space. Lesion
consists of group of cystic lesions surrounded by unenhanced,
low-signal-intensity, fibrous thick wall (arrowheads). Note that main
cystic lesion displays slightly heterogeneous high signal intensity on
T1-weighted image due to mucoid content.
|
|
View larger version (116K):
[in a new window]
|
Fig. 1C —Retrorectal tailgut cyst in 25-year-old woman. Photograph of
gross specimen of resected mass shows main cystic component (C) with mucoid
content as well as fibrous wall (F) interspersed with cysts (arrow).
Lesion was found to be adherent to rectal wall, dissociating its muscular
fibers.
|
|
View larger version (156K):
[in a new window]
|
Fig. 2A —Rectal cavernous hemangioma in 21-year-old woman. Sagittal
T2-weighted (A) and axial fat-suppressed contrast-enhanced T1-weighted
(B) MR images show T2-weighted high-signal-intensity concentric rectal
wall thickening. Mesorectal fat is heterogeneous (arrow, A).
Note enhancing rectal wall as well as small enhancing serpiginous structures
in mesorectum (arrowhead, B).
|
|
View larger version (165K):
[in a new window]
|
Fig. 2B —Rectal cavernous hemangioma in 21-year-old woman. Sagittal
T2-weighted (A) and axial fat-suppressed contrast-enhanced T1-weighted
(B) MR images show T2-weighted high-signal-intensity concentric rectal
wall thickening. Mesorectal fat is heterogeneous (arrow, A).
Note enhancing rectal wall as well as small enhancing serpiginous structures
in mesorectum (arrowhead, B).
|
|
View larger version (122K):
[in a new window]
|
Fig. 2C —Rectal cavernous hemangioma in 21-year-old woman. Photograph
of two slices from rectal wall shows multiple vascular lakes (arrows)
in moderately thickened rectal wall.
|
|
View larger version (142K):
[in a new window]
|
Fig. 3 —Acute rectocolic Crohn's disease in 35-year-old man. Sagittal
T2-weighted MR image shows concentric thickening of rectal wall with sinus
tract in the supralevator space (arrow).
|
|
View larger version (148K):
[in a new window]
|
Fig. 4 —Rectocolic Crohn's disease in 43-year-old woman with acute
symptoms. Coronal T2-weighted MR image shows concentric thickening of rectal
wall. Note rectal lumen stenosis (arrowhead) and submucosal edema
(arrow).
|
|
View larger version (159K):
[in a new window]
|
Fig. 5A —Ulcerative colitis in 45-year-old woman with acute symptoms
of proctitis and history of surgical treatment by ileorectal anastomosis.
Axial unenhanced (A) and fat-suppressed contrast-enhanced (B)
T1-weighted MR images show mildly thickened enhancing upper rectal wall
(arrows) compared with normal ileal wall (arrowheads). Note
multiple small lymph nodes.
|
|
View larger version (165K):
[in a new window]
|
Fig. 5B —Ulcerative colitis in 45-year-old woman with acute symptoms
of proctitis and history of surgical treatment by ileorectal anastomosis.
Axial unenhanced (A) and fat-suppressed contrast-enhanced (B)
T1-weighted MR images show mildly thickened enhancing upper rectal wall
(arrows) compared with normal ileal wall (arrowheads). Note
multiple small lymph nodes.
|
|
View larger version (197K):
[in a new window]
|
Fig. 6 —60-year-old woman with history of radiation therapy for tumor
of anal canal 1 year earlier. Axial T2-weighted MR image shows regularly
thickened rectal wall with increased signal intensity of both submucosa and
outer layer (arrows).
|
|
View larger version (151K):
[in a new window]
|
Fig. 7 —Rectal sinus tracts and abscesses in 40-year-old man who had
been treating his headaches with antiinflammatory suppositories for at least
10 years. Axial T2-weighted MR image reveals partial destruction of internal
sphincter (arrow), which is replaced by complex fistulas and sinus
tracts (arrowheads).
|
|
View larger version (163K):
[in a new window]
|
Fig. 8 —Rectal endometriosis in 35-year-old woman. Axial T1-weighted
MR image shows discrete nodule of anterior rectal wall (arrow)
displaying isointensity with respect to pelvic muscle and containing small
foci of high signal intensity.
|
|
View larger version (176K):
[in a new window]
|
Fig. 9 —Rectal endometriosis in 40-year-old woman. Axial T1-weighted
image shows that rectal wall is irregularly thickened anteriorly
(arrowhead) and attracted forward to torus uterinus (arrow).
Note involvement of uterosacral ligaments.
|
|
View larger version (207K):
[in a new window]
|
Fig. 10 —66-year-old man with stage pT3 rectal carcinoma. Axial
T2-weighted MR image shows tumor (T) displaying lower signal than that of
submucosa but higher than that of proper muscle layer. Tumor is seen invading
muscularis propria (arrowhead). Note presence of mesorectal lymph
nodes.
|
|
View larger version (180K):
[in a new window]
|
Fig. 11A —28-year-old man with mucinous rectal adenocarcinoma. Coronal
T2-weighted MR image shows large ill-circumscribed mass involving rectum and
extending downward into anal canal (arrowhead), laterally to left
levator ani muscle (arrow), and into mesorectum and supralevator
space. No extension is visible in ischiorectal fossa. Lesion is brighter than
fat.
|
|
View larger version (159K):
[in a new window]
|
Fig. 11B —28-year-old man with mucinous rectal adenocarcinoma. Axial
fat-suppressed contrast-enhanced T1-weighted image shows poor enhancement of
mass apart from central part around rectal lumen, with extension to seminal
vesicles and to right inferior hypogastric nerve plexuses
(arrow).
|
|
View larger version (154K):
[in a new window]
|
Fig. 11C —28-year-old man with mucinous rectal adenocarcinoma.
Photograph of two slices of rectal wall show circumferential invasive tumor
with predominant gelatinous appearance (arrows).
|
|
View larger version (164K):
[in a new window]
|
Fig. 12A —Large villous tumor in 70-year-old man. Axial fat-suppressed
contrast-enhanced T1-weighted MR image reveals poorly enhancing large mass
filling rectal lumen and displaying frondlike projections in lumen
(arrow).
|
|
View larger version (134K):
[in a new window]
|
Fig. 12B —Large villous tumor in 70-year-old man. Photograph of gross
specimen obtained at surgery shows mass with papillary excrescences
(arrow).
|
|
View larger version (180K):
[in a new window]
|
Fig. 13A —Stromal rectal tumor fistula forming in subperitoneal rectum
in 54-year-old woman. Coronal (A) and axial (B) T2-weighted MR
images show large heterogeneous rectal mass containing signal voids expanding
right side of rectal wall (arrowheads) related to presence of air due
to fistula within digestive tract. Right levator ani muscle is not visible,
whereas left one is normal (arrow, A). No lymph node
enlargement is seen.
|
|
View larger version (193K):
[in a new window]
|
Fig. 13B —Stromal rectal tumor fistula forming in subperitoneal rectum
in 54-year-old woman. Coronal (A) and axial (B) T2-weighted MR
images show large heterogeneous rectal mass containing signal voids expanding
right side of rectal wall (arrowheads) related to presence of air due
to fistula within digestive tract. Right levator ani muscle is not visible,
whereas left one is normal (arrow, A). No lymph node
enlargement is seen.
|
|
View larger version (157K):
[in a new window]
|
Fig. 14A —Rectal lymphoma in 21-year-old woman. Sagittal T2-weighted
(A) and fat-suppressed axial contrast-enhanced T1-weighted (B)
MR images show huge homogeneous rectal mural mass that is isointense with
respect to muscle on A and moderately enhancing. Rectal lumen is still
visible (arrow, B) and there is no bowel distension.
|
|
View larger version (152K):
[in a new window]
|
Fig. 14B —Rectal lymphoma in 21-year-old woman. Sagittal T2-weighted
(A) and fat-suppressed axial contrast-enhanced T1-weighted (B)
MR images show huge homogeneous rectal mural mass that is isointense with
respect to muscle on A and moderately enhancing. Rectal lumen is still
visible (arrow, B) and there is no bowel distension.
|
|
View larger version (143K):
[in a new window]
|
Fig. 15 —Carcinoid rectal tumor in 31-year-old woman. T1-weighted
axial MR image shows small solitary smooth broad-based protrusion into rectal
lumen (arrow).
|
|
View larger version (143K):
[in a new window]
|
Fig. 16A —Prostate adenocarcinoma with metastatic involvement of rectum
in 76-year-old man. Axial fat-suppressed contrast-enhanced T1-weighted MR
image shows hypointense prostatic tumor extending to anterior part of rectal
wall (arrow).
|
|
View larger version (159K):
[in a new window]
|
Fig. 16B —Prostate adenocarcinoma with metastatic involvement of rectum
in 76-year-old man. Axial fat-suppressed contrast-enhanced T1-weighted MR
image obtained at higher level than A shows abnormal concentric
heterogeneous irregular thickening of rectal wall.
|
|
View larger version (128K):
[in a new window]
|
Fig. 16C —Prostate adenocarcinoma with metastatic involvement of rectum
in 76-year-old man. Photograph of gross surgical resection (abdominoperineal
resection and prostatectomy), confirms diffuse involvement of rectal wall seen
as white thickening of wall layers (arrowhead) compared with normal
wall (arrow). Difference between normal rectal mucosa and abnormal
mucosa caudad is also well visualized. P = prostatectomy, M = normal rectal
mucosa.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2006 by the American Roentgen Ray Society.
