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3-T MRI of Rectal Carcinoma: Preoperative Diagnosis, Staging, and Planning of Sphincter-Sparing Surgery

¹ Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Rd., Jinan, Shandong, China 250012.
² Department of Radiology, Weill Medical College of Cornell University, New York, NY.
³ Department of Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Coronal T2-weighted fast-recovery fast spin-echo image.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Sagittal T2-weighted fast-recovery fast spin-echo image.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Axial T2-weighted fast-recovery fast spin-echo image.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Axial T2-weighted fat-suppressed fast-recovery fast spin-echo image.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Axial T1-weighted fast spoiled gradient-recalled echo image.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Axial T1-weighted fat-suppressed fast spoiled gradient-recalled echo image.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1G —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Axial T1-weighted fast spin-echo image.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1H —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Three-dimensional fat-suppressed fast spoiled gradient-recalled echo dynamic gadolinium-enhanced image.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1I —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Two-dimensional MR hydrographic single-shot fast spin-echo image.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1J —75-year-old man with poorly differentiated rectal adenocarcinoma (arrows). Preoperative MRI T category was T2 (smooth outer tumor border within rectal wall and no invasion into fat surrounding rectum), and preoperative 3-T MRI showed tumor had invaded anal sphincter. MRI findings were confirmed at surgery, and patient underwent abdominoperineal resection. Photograph shows surgical specimen.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —57-year-old man with T1 well-differentiated rectal adenocarcinoma (arrow). Coronal T2-weighted MR image shows distance from lower margin of rectal cancer to upper margin of external sphincter, where levator ani muscle (arrowheads) attached to rectum, was 5 cm (double arrow). Patient underwent sphincter-sparing resection of rectum.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —58-year-old man with T2 moderately differentiated rectal adenocarcinoma (arrow). Coronal T2-weighted MR image shows distance from lower margin of rectal tumor to point where levator ani muscle (arrowheads) attaches to rectum is 1.5 cm (double arrow). Patient underwent internal sphincter resection with prolapsing technique to save external sphincter and anus.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —75-year-old man with T3 rectal carcinoma. Axial T2-weighted MR image shows rectal tumor (arrow) and local lymph node metastasis (arrowhead).

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —72-year-old man with T4 rectal adenocarcinoma. Axial T2-weighted MR image shows tumor (arrow) with invasion into prostate gland (arrowhead).

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