Mri staging in an evolving management paradigm for rectal cancer, from the ajr special series on cancer staging

Harmeet Kaur*, Helena Gabriel, Melissa Taggart, Hyunseon C. Kang, Tsuyoshi Konishi, Gaiane M. Rauch, Sunil Krishnan, George Chang

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


The treatment of rectal cancer centers around the distinct but related goals of management of distant metastases and management of local disease. Optimal local management requires attention to the primary tumor and its anatomic relationship to surrounding pelvic structures, with the goal of minimizing local recurrence (LR). High-resolution MRI is ideally suited for this purpose; application of MRI-based criteria in conjunction with optimized surgical and pathologic techniques has successfully reduced LR rates. This success has led to a shift away from using the TNM-based National Comprehensive Cancer Network (NCCN) guidelines as the sole determinant of whether a patient receives neoadjuvant chemoradiation. The new model uses a hybrid approach for assigning risk categories that combines elements of the TNM staging system with MRI-based anatomic features. These risk categories incorporate tumor proximity to the circumferential resection margin, T category, distance to the anal verge, and presence of extramural venous invasion to classify rectal tumors as low, intermediate, or high risk. This approach has been validated by accumulated data from numerous multiinstitutional studies. This article illustrates key anatomic concepts, depicts common interpretive errors and pitfalls, and discusses ongoing limitations; these insights should guide radiologists in optimal rectal MRI interpretation.

Original languageEnglish (US)
Pages (from-to)1282-1293
Number of pages12
JournalAmerican Journal of Roentgenology
Issue number6
StatePublished - Dec 2021


  • MRI
  • Rectal

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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