Magnetic resonance imaging of rectal tumours
Author: Blomqvist, Lennart
Date: 1997-12-12
Location: Lars Leksells auditorium, Medicinhistoriska museet, Karolinska sjukhuset
Time: 9.00
Abstract
Magnetic Resonallce Imaging Or Rectal Tumours
by Lennart Blomqvist, M.D. Department of Surgical Sciences,Division for
Diagnostic Radiology, Karolinska Hospital and Institute, S-171 76,
Stockholm,Sweden
Cross sectional imaging techniques introduced during the last two decades
havebeen increasingly used in the evaluation of patients with pelvic
tumours.
The extent of tumour - the tumour stage - at the time of diagnosis
constitutesa guide line for both the immediate treatment and the
follow-up of the patient. Continuousdevelopment of imaging modalities,
such as magnetic resonance imaging (MRI), hasimplications which motivates
a change of the examination routines.
State-of-the-art high resolution MRI was evaluated in patients with
rectal tumoursconsidered as resectable by the surgeon. Tumours considered
to be primarily not resectablewere also evaluated with both computed
tomography (CT) and MRI After surgery, resectedrectal specimens were
examined using similar MR-techniques. In patients who aftersurgery
presented with a clinical suspicion of local recurrence, dynamic
gadoliniumcontrast-enhanced MRI was evaluated in order to differentiate
local tumour recurrencefrom changes in the pelvis related to the
treatment. MRl was also compared to CTand monoclonal antibody
(CEA)-scintigraphy for the diagnosis of local recurrence.
The results demonstrated that tumour penetration through the rectal wall
to theperirectal tissues and the presence of Iymph local Iymph node
metastases could bepredicted in 75 % of patients with resectable rectal
tumours. In patients with unresectablerectal cancer, MRI better predicted
involvement of the uterus and the urinary bladderthan CT. However,
sensitivity of CT and specificity of MRl were both low in termsof
diagnosis of organ involvement. After surgery, no parameters were found
whichhelped to distinguish local recurrent tumours from benign changes in
contrast-enhanceddynamic MRI. When CT, MRI and CEA-scintigraphy were
compared for the diagnosis oflocally recurrent rectal tumours, the
diagnosis was most effectively establishedby MRl.
It is concluded that local excision of rectal tumours can presently not
be performedbased on results of MRI. Sensitivity of CT and specificity of
MRI is not sufficientto allow for general recommendations in the
evaluation unresectable rectal tumours.However, If the cross-sectional
investigation begins with CT, MRl will contributeto a more complete
evaluation, especially if involvement of the bladder and the
internalgenitalia cannot be completely ruled out.
Afler surgery, a tumour-free lateral resection margin can be verfied by
MRI ofrectal specimen if the measured distance is more than one mm. Local
tumour recurrenceand benign changes in the pelvis related to the
treatment of the patient can presentlynot be differentiated on account of
dynamic contrast-enhanced MRI. In the diagnosisof locally recurrent
rectal cancer with cross-sectional evaluation, MRl should beconsidered as
the first choice rather than CT or CEA-scintigraphy.
Key words: Rectum, Neoplasms, Magnetic Resonance Imaging
Stockholm 1997 ISBN-91-628-2797-9
Issue date: 1997-11-21
Publication year: 1997
ISBN: 91-628-2797-9
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