A primer on rectal MRI in patients on watch-and-wait treatment for rectal cancer

被引:4
作者
Gollub, Marc J. [1 ]
Costello, James R. [2 ]
Ernst, Randy D. [3 ]
Lee, Sonia [4 ]
Maheshwari, Ekta [5 ]
Petkovska, Iva [1 ]
Wasnik, Ashish P. [6 ]
Horvat, Natally [1 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Radiol, New York, NY 10065 USA
[2] Motiff Canc Ctr, Dept Diagnost Imaging & Intervent, Tampa, FL 33612 USA
[3] MD Anderson Canc Ctr, Dept Abdominal Imaging, Div Diagnost Imaging, Houston, TX 77030 USA
[4] Univ Calif Irvine, Dept Radiol, Orange, CA 92868 USA
[5] Univ Pittsburgh, Dept Radiol, Med Ctr, Pittsburgh, PA 15213 USA
[6] Univ MI Michigan Med, Dept Radiol, Ann Arbor, MI 48109 USA
关键词
Rectal cancer; Watch and Wait; Neoadjuvant therapy; Magnetic resonance imaging; PATHOLOGICAL COMPLETE RESPONSE; CLINICAL COMPLETE RESPONSE; TOTAL MESORECTAL EXCISION; SHORT-COURSE RADIOTHERAPY; TUMOR-REGRESSION GRADE; PREOPERATIVE CHEMORADIOTHERAPY; NEOADJUVANT CHEMORADIATION; OPEN-LABEL; SURGERY; MULTICENTER;
D O I
10.1007/s00261-023-03900-6
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Total neoadjuvant treatment (TNT) for rectal cancer is becoming an accepted treatment paradigm and is changing the landscape of this disease, wherein up to 50% of patients who undergo TNT are able to avoid surgery. This places new demands on the radiologist in terms of interpreting degrees of response to treatment. This primer summarizes the Watch-and-Wait approach and the role of imaging, with illustrative "atlas-like" examples as an educational guide for radiologists. We present a brief literature summary of the evolution of rectal cancer treatment, with a focus on magnetic resonance imaging (MRI) assessment of response. We also discuss recommended guidelines and standards. We outline the common TNT approach entering mainstream practice. A heuristic and algorithmic approach to MRI interpretation is also offered. To illustrate management and common scenarios, we arranged the illustrative figures as follows: (I) Clinical complete response (cCR) achieved at the immediate post-TNT "decision point" scan time; (II) cCR achieved at some point during surveillance, later than the first post-TNT MRI; (III) near clinical complete response (nCR); (IV) incomplete clinical response (iCR); (V) discordant findings between MRI and endoscopy where MRI is falsely positive, even at follow-up; (VI) discordant cases where MRI seems to be falsely positive but is proven truly positive on follow-up endoscopy; (VII) cases where MRI is falsely negative; (VIII) regrowth of tumor in the primary tumor bed; (IX) regrowth outside the primary tumor bed; and (X) challenging scenarios, i.e., mucinous cases. This primer is offered to achieve its intended goal of educating radiologists on how to interpret MRI in patients with rectal cancer undergoing treatment using a TNT-type treatment paradigm and a Watch-and-Wait approach.
引用
收藏
页码:2836 / 2873
页数:38
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