Multimodal imaging evaluation in staging of rectal cancer.
Rectal cancer is a common cancer and a major cause of mortality in Western countries. Accurate staging is essential for determining the optimal treatment strategies and planning appropriate surgical procedures to control rectal cancer. Endorectal ultrasonography (EUS) is suitable for assessing the extent of tumor invasion, particularly in early-stage or superficial rectal cancer cases. In advanced cases with distant metastases, computed tomography (CT) is the primary approach used to evaluate the disease. Magnetic resonance imaging (MRI) is often used to assess preoperative staging and the circumferential resection margin involvement, which assists in evaluating a patient's risk of recurrence and their optimal therapeutic strategy. Positron emission tomography (PET)-CT may be useful in detecting occult synchronous tumors or metastases at the time of initial presentation. Restaging after neoadjuvant chemoradiotherapy (CRT) remains a challenge with all modalities because it is difficult to reliably differentiate between the tumor mass and other radiation-induced changes in the images. EUS does not appear to have a useful role in post-therapeutic response assessments. Although CT is most commonly used to evaluate treatment responses, its utility for identifying and following-up metastatic lesions is limited. Preoperative high-resolution MRI in combination with diffusion-weighted imaging, and/or PET-CT could provide valuable prognostic information for rectal cancer patients with locally advanced disease receiving preoperative CRT. Based on these results, we conclude that a combination of multimodal imaging methods should be used to precisely assess the restaging of rectal cancer following CRT.
Suk Hee Heo, Jin Woong Kim, Yong Yeon Jeong, Heoung-Keun Kang, Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do 519-763, South Korea.
Suk Hee
SH
Heo
Suk Hee Heo, Jin Woong Kim, Yong Yeon Jeong, Heoung-Keun Kang, Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do 519-763, South Korea.
Jin Woong
JW
Kim
Suk Hee Heo, Jin Woong Kim, Yong Yeon Jeong, Heoung-Keun Kang, Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do 519-763, South Korea.
Sang Soo
SS
Shin
Suk Hee Heo, Jin Woong Kim, Yong Yeon Jeong, Heoung-Keun Kang, Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do 519-763, South Korea.
Yong Yeon
YY
Jeong
Suk Hee Heo, Jin Woong Kim, Yong Yeon Jeong, Heoung-Keun Kang, Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do 519-763, South Korea.
Heoung-Keun
HK
Kang
D059186:Chemoradiotherapy, Adjuvant; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
Imaging; Multimodality; Rectal cancer; Restaging; Staging