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Multimodal imaging evaluation in staging of rectal cancer.

Authors
  • Heo, Suk Hee
  • Kim, Jin Woong
  • Shin, Sang Soo
  • Jeong, Yong Yeon
  • Kang, Heoung-Keun
Type
Published Article
Journal
World Journal of Gastroenterology
Publisher
Baishideng Publishing Group Co
Publication Date
Apr 21, 2014
Volume
20
Issue
15
Pages
4244–4255
Identifiers
DOI: 10.3748/wjg.v20.i15.4244
PMID: 24764662
Source
Medline
Keywords
License
Unknown

Abstract

Rectal cancer is a common cancer and a major cause of mortality in Western countries. Accurate staging is essential for determining the optimal treatment strategies and planning appropriate surgical procedures to control rectal cancer. Endorectal ultrasonography (EUS) is suitable for assessing the extent of tumor invasion, particularly in early-stage or superficial rectal cancer cases. In advanced cases with distant metastases, computed tomography (CT) is the primary approach used to evaluate the disease. Magnetic resonance imaging (MRI) is often used to assess preoperative staging and the circumferential resection margin involvement, which assists in evaluating a patient's risk of recurrence and their optimal therapeutic strategy. Positron emission tomography (PET)-CT may be useful in detecting occult synchronous tumors or metastases at the time of initial presentation. Restaging after neoadjuvant chemoradiotherapy (CRT) remains a challenge with all modalities because it is difficult to reliably differentiate between the tumor mass and other radiation-induced changes in the images. EUS does not appear to have a useful role in post-therapeutic response assessments. Although CT is most commonly used to evaluate treatment responses, its utility for identifying and following-up metastatic lesions is limited. Preoperative high-resolution MRI in combination with diffusion-weighted imaging, and/or PET-CT could provide valuable prognostic information for rectal cancer patients with locally advanced disease receiving preoperative CRT. Based on these results, we conclude that a combination of multimodal imaging methods should be used to precisely assess the restaging of rectal cancer following CRT.

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