Radiological imaging of rectal cancer

Lidija Lincender-Cvijetić, Maja Banjin-Čardžić, Sandra Vegar-Zubović, Dunja Vrcić


This article discusses the possibilities of diagnosing abdominal imagingin patients with rectal cancer, detecting lesions and assessing thestage of the lesions, in order to select the appropriate therapy. Beforethe introduction of imaging technologies, the diagnosis of colorectalpathology was based on conventional methods of inspecting intestineswith a barium enema, with either a single or double contrast bariumenema. Following the development of endoscopic methods and thewide use of colonoscopy, colonoscopy became the method of choicefor diagnosing colorectal diseases. The improvement of ComputerizedTomography (CT) and Magnetic Resonance Imaging (MRI), gave usnew possibilities for diagnosing colorectal cancer. For rectal cancer,trans-rectal US (TRUS) or endo-anal US (EAUS) have a significantrole. For staging rectal cancer, the Multi Slice Computed Tomography(MSCT) is not the method of choice, but Magnetic Resonance Imaging(MRI) is preferred when it comes to monitoring the rectum. Therole of the MRI in the T staging of rectal cancer is crucial in preoperativeassessment of: thickness – the width of the tumor, the extramuralinvasion, the circumference of resection margin (CRM), andthe assessment of the inclusion of mesorectal fascia. For successful executionof surgical techniques, good diagnostic imaging of the canceris necessary in order to have a low level of recurrence. According tomedical studies, the sensitivity of FDG-PET in diagnosing metastaticnodals is low, but for now it is not recommended in routine diagnosisof metastatic colorectal carcinoma.


Colorectal cancer; TRUS; MSCT; MRI; Staging

Full Text:



Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225-9.

Winawer SJ, Stewart ET, Zauber AG, Bond JH, Ansel H, Waye JD, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National polyp Study Work Group. N Engl J Med. 2000;342:1766-72.

McFarland EG, Levin B, Lieberman DA, Pickhardt PJ, Johnson CD, Glick SN, et al. Revised colorectal screening guidelines: Join effort of the American Cancer Society, U.S. Multisocety Task Force on Colorectal Cancer, and American College of Radiology.

Radiology. 2008;248:717-20.

Punwani S, Halligan S, Tolan D, Taylor SA, Hawkes D. Quantitative assessment of colonic movement between prone and supine patient positions during CT colonography. British Journal of Radiology. 2009;82:475-81.

Mehdy Chadi. CT Colonography (virtual colonoscopy). Guerbet. 2005;12:5.

Zalis ME, Barish MR, Choi JR, Dachman AH, Fenolou HM, Ferrucci JT, et al. For the working group on Virtual Colonoscopy. CT Colonoscopy Reporting and Data System: A Consensus Proposal. Radiology. 2005;236:3-9.

Balchar A, Suosa J. CT colonography (virtual colonoscopy): technique indications and performance. Digestion. 2007;76:34-41.

Sofić A, Bešlić Š, Kocijanić I, Šehović N. CT colonography in detection of the colorectal carcinomas. Radiol Oncol. 2008;42(3):136-42.

Gollub MJ, Schwartz LH, Akhurst T. Up date on colorectal cancer imaging. Radiol Clin North Am. 2007;45:85-118.

Roddie M. CT colonography tools advance in clinical use. Diagnostic Imaging Europe. 2006;10:35-7.

Liedenbaum MH, de Vries AH, Gouw CI, van Rijn AF, Bipat S, Dekker E, Stoker J. CT colonography with minimal bowel preparation; evaluation of tagging quality, patient acceptance and diagnostic accuracy in two iodine-based preparation

schemes. Eur Radiol. 2010;20:367-76.

Luz O, Buchgeister M, Klabunche M, Trabold T, Kopp AF, Claussen CD, et al. Evaluation of dose exposure in 64-slice CT colonography. Eur Radiol. 2007;17:2616-21.

Brown G, Daniels IR, Richardson C, Revell P, Peppercorn

D, Bourne M. Techniques and trouble shooting in high spatial resolution thin slice MRI for rectal cancer. Br J Radiol. 2005;78:245-51.

Salermo G, Daniels IR, Brown G. Magnetic resonance imaging of low rectum. Defining the radiological anatomy. Colorectal Dis. 2006;8(Supp 3):10-3.

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual, 7th ed. New York (etc.): Springer; 2010 [cited 2012 May 31]. Available from:

Iafrate F, Laghi A, Paolantonio P, Rengo M, Mercantini P, Ferri M, et al. Preoperative staging of rectal carcinoma with MRI imaging correlation with surgical and histopathologic findings. Radiographics. 2006;26:701-14.

Kim NK, Kim MJ, Park JK, Park SI, Min JS. Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulness. Ann Surg Oncol. 2000;7:732–7.

Burt S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins.

Br J Cancer. 2006;94(3):351-7.

Maier AG, Kersting-Sommerhoff B, Reeders JW, Judmaier W, Schima W, Annweiller AA, et al. Staging of rectal cancer by double-contrast MR imaging using the rectally administered super paramagnetic iron oxide contrast agent ferristene

and IV gadodiamid injection: results of a multicenter phase II trial. J Magn Reson Imaging. 2000;12:657-60.

Klessen C, Rogalla P, Taupitz M. Local staging of rectal cancer: the current role of MRI. Eur Radiol. 2007;17:379-89.

Berman L, Israel GM, McCarthy SM, Weinreb JC, Longo WE. Utility of the magnetic resonance imaging in anorectal disease. World J Gastroenterol. 2007;13:3153-8.

Sofić A, Šehović N, Prnjavorac B, Bilalović N, Čaluk J, Sofić D. MR rectum imaging with ultrasound gel as instrumental contrast media in tubulovillous adenoma. Radiol Oncol. 2008;42(3):136-42.

Beets-Tan RG, Beets GL, Vliegen RF, Kessels AG, Van Boven H, De Bruine A, et al. Accuracy of magnetic resonance imaging in predicting of tumor-free resection margin in rectal cancer surgery. Lancet. 2001;375:497-504.

Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer.

Br J Surg. 2002;89:327-34.

Taylor SA, Halligan S, Goh V, Morley S, Bassett P, Atkin W, et al. Optimizing colonic distention for multi-detector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter. Radiology. 2003;229(1):99-108.

Beets-Tan RG, Beets GL. Rectal cancer: review with emphasis on MR imaging. Radiology. 2004;232:335-46.

Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer. Int J Colorectal Dis. 2000;15:9-20.

Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of the lymph node involvement with endoluminal US, CT and MR imaging – a

meta analysis. Radiology. 2004;232:773-83.

Geeneu RW, Hussain SM, Cademartiri F, Poley JW, Siersema PD, Krestin GP. CT and MR colonography: scanning techniques, post-processing and emphasis on polyp detection. Radiographics. 2004;24:e18.

Martling A, Holm T, Bremmer S, Lindholm J, Cedermark B, Blomqvist L. Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer. Br J Surg. 2003;90(1):1422-8.

O’Neill BD, Salerno G, Thomas K, Tait DM, Brown G. MR vs CT imaging: low rectal cancer tumour delineation for three-dimensional conformal radiotherapy. Br J Radiol 2009;82:509–13.

Mönig SP, Baldus SE, Zirbes TK, Schröder W, Lindemann DG, Dienes HP, et al. Lymph node size and metastatic infiltration in colon cancer. Ann Surg Oncol. 1999;6:579-81.

Kim JH, Beets GL, Kim MJ, Kessels AG, Beets-Tan RG. High- resolution MR imaging for nodal staging in rectal cancer: Are there any criteria in addition to the size? Eur J Radiol. 2004;52:78-83.

de Bree E, Koops W, Kröger R, van Ruth S, Witkamp AJ, Zoetmulder FA. Peritoneal carcinomatosis from colorectal or appendicle origin: Correlation of preoperative CT with intraoperative findings and evaluation of interobserver agreement. J Surg Oncol. 2004;86:64-73.

Heunedige T, Teo L, Ang B, Cheong WK, Venkatesh SK. Accuracy of preoperative CT for local staging in colorectal carcinomas. Singapore Med J. 2010;51(6):457-80.

Furukawa H, Ikuma H, Seki A, Yokoe K, Yuen S, Aramaki T, et al. Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in preoperative staging of colorectal cancer. Gut. 2006;55:1007-11.


  • There are currently no refbacks.

2016 Department of Medical Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina. All rights reserved.
The full text of articles published in this journal can be used free of charge for personal and educational purposes while respecting authors and publishers’ copyrights. For commercial purposes no part of this journal may be reproduced without the written permission of the publisher.