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Published on: January 22, 2018
[Rectal cancer - local staging and imaging under neoadjuvant therapy]
1Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland. Martina.Karpitschka@med.uni-muenchen.de
Clinical/Methodical Issue:
Rectal cancer restaging after neoadjuvant therapy is based on two principles: an anatomic definition of the tumor allowing surgical planning and prognostic stage grouping.
Standard Radiological Methods:
Emerging data suggest that reassessment using a combination of different imaging modalities may help to provide valuable prognostic information before definitive surgery.
Methodical Innovations:
Perfusion computed tomography (CT) may provide special information regarding tumor vascularity.
Performance:
Evaluation of therapy response, especially of the circumferential resection margin (CRM) is necessary for surgical planning.
Achievements:
For local staging high-resolution and diffusion-weighted magnetic resonance imaging has proven to be of high diagnostic accuracy.
Practical Recommendations:
The M status should be assessed using multidetector computed tomography (MDCT) according to response evaluation criteria in solid tumors (RECIST) while lymph node evaluation requires either magnetic resonance imaging or positron emission tomography/computed tomography scanning.
