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Congress: ECR24
Poster Number: C-23936
Type: EPOS Radiologist (educational)
DOI: 10.26044/ecr2024/C-23936
Authorblock: J. Goyal, N. Agarwal, P. Garg, S. K. Puri; NEWDELHI/IN
Disclosures:
Jitin Goyal: Nothing to disclose
Nitin Agarwal: Nothing to disclose
Prerna Garg: Nothing to disclose
Sunil Kumar Puri: Nothing to disclose
Keywords: Gastrointestinal tract, Oncology, MR, Contrast agent-intravenous, Cancer
Learning objectives To evaluate the response in rectal adenocarcinoma after neoadjuvant chemoradiotherapy on restaging MRI Identify the expected imaging appearances and the potential pitfalls in the interpretation of MRI
Read more Background Rectal adenocarcinomas constitute about one-third of all colorectal adenocarcinoma cases. MRI (Magnetic resonance Imaging) plays an important role in the initial staging of disease, and nodal involvement, to evaluate circumferential resection margin and extramural vascular invasion due to its superior soft tissue resolution and characterization. Surgery is the mainstay of treatment in localized rectal cancers; however neoadjuvant chemotherapy is indicated in advanced rectal adenocarcinoma due to better local recurrence-free survival. Neoadjuvant chemoradiotherapy is currently recommended for locally advanced (T3 or T4) rectal adenocarcinoma...
Read more Findings and procedure details Post CRT (Chemoradiotherapy )Evaluation in Tumor The imaging findings at T2-weighted imaging after neo-adjuvant therapy include a decrease in tumor extent, interval development of T2 hypointense fibrosis with T2 hyperintense mucin production changes at the tumor bed, and complete normalization of the rectal wall layers without evidence of a tumor or fibrosis (scar). Persistent intermediate T2 signal intensity with or without  T2-hypointense  fibrotic changes at the tumor bed is indicative of residual tumor.  The presence of a dense and thick fibrotic scar at...
Read more Conclusion Restaging MRI is a reliable tool in response assessment after neoadjuvant chemoradiotherapy for rectal adenocarcinoma. MRI features have been shown to correlate better with pathological response and mrTRG has been an important prognostic factor, associated with tumor recurrence and survival outcomes.
Read more References Awiwi MO, Kaur H, Ernst R, Rauch GM, Morani AC, Stanietzky N, Palmquist SM, Salem UI. Restaging MRI of Rectal Adenocarcinoma after Neoadjuvant Chemoradiotherapy: Imaging Findings and Potential Pitfalls. RadioGraphics. 2023 Mar 16;43(4):e220135. Kalisz KR, Enzerra MD, Paspulati RM. MRI evaluation of the response of rectal cancer to neoadjuvant chemoradiation therapy. Radiographics. 2019 Mar;39(2):538-56. Xu Q, Xu Y, Sun H, Jiang T, Xie S, Ooi BY, Ding Y. MRI evaluation of the complete response of locally advanced rectal cancer after Neoadjuvant therapy:...
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