SAR Disease-focused Panel: Restaging Rectal Cancer MRI Synoptic Report-User Guide with Imaging Review

Neoadjuvant therapy (NAT) for patients with rectal cancer is intended to reduce the risk of local recurrence and distant metastasis while preserving quality of life. Choosing the optimal approach after NAT is complex, requiring a personalized plan that considers the unique characteristics of each patient and their tumor, as well as the resources and capabilities of the treating institution. Advances in treatment, guided by insights from randomized clinical trials and increasing acceptance of organ preservation strategies, also known as nonoperative management or the watch-and-wait approach, emphasize the importance of precise treatment response assessment and multidisciplinary communication. A comprehensive evaluation using digital rectal examination, endoscopy, and MRI with a dedicated rectal cancer protocol ensures accurate clinical and locoregional response assessment. This integrative approach enables clinicians to make decisions regarding organ preservation, surgery, treatment de-escalation, or even additional NAT, with MRI having a critical role in surgical planning when resection is needed. The authors provide a comprehensive guide for interpreting postneoadjuvant rectal cancer MRI and applying the Society of Abdominal Radiology Colorectal and Anal Cancer Disease-focused Panel (SAR DFP) synoptic MRI restaging report template. The aim is to improve the quality, consistency, and clarity of MRI interpretations across different readers and institutions. Each section corresponds to the SAR DFP synoptic MRI restaging report template, addressing common areas of confusion and providing essential background material to ensure that clinically relevant information is clearly communicated to the treatment team, supporting effective decision making and enhancing patient outcomes. ^©RSNA, 2025 Supplemental material is available for this article.