Impact of a Structured MRI Reporting Template on the Completeness of Primary Rectal Cancer Staging Reports: A...

High-resolution pelvic magnetic resonance imaging (MRI) is essential for local staging of primary rectal carcinoma and for communicating surgically relevant risk factors before multidisciplinary treatment planning. Free-text MRI reports may describe the primary tumor but may inconsistently document key management-relevant findings, including mesorectal fascia and circumferential resection margin status, depth of extramural spread, extramural vascular invasion, lateral pelvic lymph nodes, and low rectal sphincter complex involvement. This retrospective audit assessed whether use of a structured MRI reporting template was associated with improved completeness of primary rectal cancer staging reports.

This retrospective audit included 60 pelvic MRI reports performed for suspected or biopsy-proven primary rectal carcinoma at a tertiary care radiology department. Thirty consecutive reports prepared before template implementation were assigned to the free-text reporting group, and 30 reports prepared after template implementation were assigned to the structured reporting group. Reports were assessed using a predefined checklist of essential MRI staging elements, including tumor location, distance from the anal verge, craniocaudal tumor length, circumferential tumor position, relationship to the anorectal junction and anterior peritoneal reflection, MRI T category, depth of extramural spread, mesorectal fascia/circumferential resection margin status, extramural vascular invasion, mesorectal nodes, tumor deposits, lateral pelvic lymph nodes, sphincter complex involvement, levator ani involvement, adjacent organ invasion, and final MRI-based risk summary. The primary and only measured outcome was report completeness.

The mean completeness score was higher in the structured reporting group than in the free-text group, with mean scores of 91.3% and 58.6%, respectively. Structured reports showed more complete documentation of several clinically important staging domains that were inconsistently recorded in free-text reports, including mesorectal fascia/circumferential resection margin relationship, depth of extramural spread, extramural vascular invasion, lateral pelvic nodal assessment, and low rectal sphincter complex assessment. Structured reports also more frequently included a concise MRI-based risk summary integrating tumor level, T stage, nodal status, margin risk, extramural vascular invasion, and anticipated surgical relevance. No formal statistical hypothesis testing was performed; therefore, these findings should be interpreted descriptively rather than inferentially.

Implementation of a structured MRI reporting template was associated with higher report completeness in this descriptive retrospective audit of primary rectal cancer staging reports. The structured template was associated with more complete documentation of clinically relevant reporting elements, particularly margin status, extramural spread, extramural vascular invasion, lateral pelvic nodes, and low rectal sphincter complex involvement. However, report completeness was the only measured outcome, and no formal statistical testing was performed. Further studies with statistical testing, reviewer blinding, and assessment of diagnostic accuracy or clinical outcomes are needed.