title: Imaging Advances in Colorectal Cancer.
abstract: The optimal management of rectal cancer is achieved through a shared multidisciplinary decision making process with accurate staging by imaging being critical for treatment planning. Good quality, high-resolution MRI has become the imaging gold standard as it allows consistent staging and stratification of patients into distinct prognostic groups according to MR-findings. Imaging features other than T and N have been proven to influence patient outcomes, and increasingly these features are taken into consideration when determining treatment options: distance of tumour to the potential circumferential margin (CRM), presence of tumour within the extramural rectal vessels (EMVI), discontinuous tumour deposits (N1c), relationship to the intersphincteric plane in low rectal tumours and to pelvic compartments in advanced disease. The presence or absence of proven adverse MR features should be included in the MRI report and shared with the patient when treatment choices are offered. MRI enables the identification of high risk tumours where the use of neoadjuvant therapy is justified and is a robust method of identifying patients with a strong likelihood of complete response after preoperative treatment.
authors.affiliation: Colorectal Imaging Group, The Royal Marsden Hospital, NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK ; Imperial College London, London, SW7 2AZ UK ; The N. N. Blokhin Russian Cancer Research Center, Kashirskoye Shosse 24, Moscow, 15478 Russia ; The State Scientific Center of Coloproctology, ul. Saliama Adilia 2, Moscow, 123423 Russia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Balyasnikova
authors.affiliation: Colorectal Imaging Group, The Royal Marsden Hospital, NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT UK ; Imperial College London, London, SW7 2AZ UK.
authors.forename: Gina
authors.initials: G
authors.lastname: Brown
keywords: Beyond TME; CRM; EMVI; Early rectal cancer; Extramural spread; Imaging biomarkers; Low rectal cancer; MR-defined surgical planes; Mucinous tumours; Rectal cancer; Staging; TRG