MRI anatomy of rectum and its clinical application in rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Sen ¹ , JIA Jun ¹ , ZHANG Xiao ² , ZHANG Wei ³ , ZENG Hanjiang ⁴ , WU Bing ⁴ , YANG Lie ⁵ , SONG Bin ⁴ ,  HUANG Zixing ⁴

1. Department of Radiology, People’s Hospital of Karamay, Karamay, Xinjiang 834000, P. R. China;
2. Department of Radiology, The People’s Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;
3. Department of Radiology, Sichuan Provincial Corps Hospital, Chinese People’s Armed Police Forces, Leshan, Sichuan 614000, P. R. China;
4. Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
5. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

HUANG Zixing, Email: zixinghuang@hotmail.com

Keywords：

rectum; rectal cancer; magnetic resonance imaging; anatomy; staging

DOI：

10.7507/1007-9424.202101047

Video：

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Objective To help junior radiologists and surgeons better interpret MRI images of rectal cancer.Method The guidelines, expert consensus and research progress on the application of MR imaging in rectal cancer in recent years were reviewed.Results Rectal MR had the ability to accurately evaluate a number of important findings that may impact patient’ management, including distance of the tumor to the mesorectal fascia, presence of extramural vascular invasion, and presence of lymph nodes.Conclusions Rectal MRI is an important basis for clinical staging and multidisciplinary diagnosis and treatment of rectal cancer. Surgeons and radiologists must master the key imaging anatomical basis and clinical practice points in order to accurately interpret the image information of MRI in rectal cancer.

Citation： LIU Sen, JIA Jun, ZHANG Xiao, ZHANG Wei, ZENG Hanjiang, WU Bing, YANG Lie, SONG Bin, HUANG Zixing. MRI anatomy of rectum and its clinical application in rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(3): 385-389. doi: 10.7507/1007-9424.202101047 Copy

1.	中华人民共和国国家卫生健康委员会. 中国结直肠癌诊疗规范(2020年版). 中华外科杂志, 2020, 58(8): 561-585.
2.	中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)结直肠癌诊疗指南. 北京: 人民卫生出版社, 2020: 58-86.
3.	Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(7): 874-901.
4.	Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2017, 28(suppl_4): iv22-iv40.
5.	You YN, Hardiman KM, Bafford A, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the management of rectal cancer. Dis Colon Rectum, 2020, 63(9): 1191-1222.
6.	Beets-Tan RGH, Lambregts DMJ, Maas M, et al. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol, 2018, 28(4): 1465-1475.
7.	Salerno G, Sinnatamby C, Branagan G, et al. Defining the rectum: surgically, radiologically and anatomically. Colorectal Dis, 2006, 8(Suppl 3): 5-9.
8.	Pignon JC, Grisanzio C, Geng Y, et al. p63-expressing cells are the stem cells of developing prostate, bladder, and colorectal epithelia. Proc Natl Acad Sci U S A, 2013, 110(20): 8105-8110.
9.	Simunovic M, Smith AJ, Heald RJ. Rectal cancer surgery and regional lymph nodes. J Surg Oncol, 2009, 99(4): 256-259.
10.	D’Souza N, Balyasnikova S, Tudyka V, et al. Variation in landmarks for the rectum: an MRI study. Colorectal Dis, 2018, 20(10): O304-O309.
11.	D’Souza N, de Neree Tot Babberich MPM, d'Hoore A, et al. Definition of the Rectum: an international, expert-based delphi consensus. Ann Surg, 2019, 270(6): 955-959.
12.	D’Souza N, Lord A, Shaw A, et al. The sigmoid take-off: An anatomical imaging definition of the rectum validated on specimen analysis. Eur J Surg Oncol, 2020, 46(9): 1668-1672.
13.	Li F, Wang B, Lu S, et al. Comparison of the sigmoid take-off with other definitions of the rectosigmoid junction: A retrospective comparative cohort analysis. Int J Surg, 2020, 80: 168-174.
14.	D’Souza N, Lord AC, Shaw A, et al. Ex vivo specimen MRI and pathology confirm a rectosigmoid mesenteric waist at the junction of the mesorectum and mesocolon. Colorectal Dis, 2020, 22(2): 212-218.
15.	Nougaret S, Reinhold C, Mikhael HW, et al. The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the “DISTANCE”? Radiology, 2013, 268(2): 330-344.
16.	Herschorn S. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs. Rev Urol, 2004, 6 Suppl 5(Suppl 5): S2-S10.
17.	Wallner C. Is the puborectalis muscle part of the levator ani muscle? Dis Colon Rectum, 2008, 51(7): 1165-1166.
18.	Gollub MJ, Maas M, Weiser M, et al. Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol, 2013, 200(1): 97-101.
19.	Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, et al. MRI of rectal cancer: tumor staging, imaging techniques, and management. Radiographics, 2019, 39(2): 367-387.
20.	李文睿, 周乐群, 张卫光. 直肠系膜临床解剖学的研究与进展. 中国组织工程研究, 2016, 20(7): 1051-1056.
21.	王雅琴, 陈华成, 李进, 等. 正常直肠系膜和直肠筋膜的MRI表现. 中国中西医结合影像学杂志, 2015, 13(2): 129-131.
22.	任安利, 翁爱婷, 李进, 等. 正常直肠系膜横径的MRI解剖学研究. 中国临床解剖学杂志, 2020, 38(1): 35-38.
23.	Rudisch A, Kremser C, Judmaier W, et al. Dynamic contrast-enhanced magnetic resonance imaging: a non-invasive method to evaluate significant differences between malignant and normal tissue. Eur J Radiol, 2005, 53(3): 514-519.
24.	Smith NJ, Barbachano Y, Norman AR, et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg, 2008, 95(2): 229-236.
25.	Jhaveri KS, Hosseini-Nik H, Thipphavong S, et al. MRI detection of extramural venous invasion in rectal cancer: correlation with histopathology using elastin stain. AJR Am J Roentgenol, 2016, 206(4): 747-755.
26.	Brown G, Radcliffe AG, Newcombe RG, et al. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg, 2003, 90(3): 355-364.
27.	Sohn B, Lim JS, Kim H, et al. MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol, 2015, 25(5): 1347-1355.
28.	Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet, 2001, 357(9255): 497-504.
29.	Canessa CE, Badía F, Fierro S, et al. Anatomic study of the lymph nodes of the mesorectum. Dis Colon Rectum, 2001, 44(9): 1333-1336.
30.	Topor B, Acland R, Kolodko V, et al. Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum, 2003, 46(6): 779-785.
31.	Gröne J, Loch FN, Taupitz M, et al. Accuracy of various lymph node staging criteria in rectal cancer with magnetic resonance imaging. J Gastrointest Surg, 2018, 22(1): 146-153.
32.	Thakur S, Somashekar U, Chandrakar SK, et al. Anatomic study of distribution, numbers, and size of lymph nodes in mesorectum in Indians: a autopsy study. Int J Surg Pathol, 2011, 19(3): 315-320.
33.	Heijnen LA, Lambregts DM, Mondal D, et al. Diffusion-weighted MR imaging in primary rectal cancer staging demonstrates but does not characterise lymph nodes. Eur Radiol, 2013, 23(12): 3354-3360.
34.	Seber T, Caglar E, Uylar T, et al. Diagnostic value of diffusion-weighted magnetic resonance imaging: differentiation of benign and malignant lymph nodes in different regions of the body. Clin Imaging, 2015, 39(5): 856-862.
35.	Wu L, Cao Y, Liao C, et al. Diagnostic performance of USPIO-enhanced MRI for lymph-node metastases in different body regions: a meta-analysis. Eur J Radiol, 2011, 80(2): 582-589.
36.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
37.	Akasu T, Kondo H, Moriya Y, et al. Endorectal ultrasonography and treatment of early stage rectal cancer. World J Surg, 2000, 24(9): 1061-1068.
38.	Lahaye MJ, Engelen SM, Nelemans PJ, et al. Imaging for predicting the risk factors-the circumferential resection margin and nodal disease-of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR, 2005, 26(4): 259-268.
39.	Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg, 2002, 89(3): 327-334.

1. 中华人民共和国国家卫生健康委员会. 中国结直肠癌诊疗规范(2020年版). 中华外科杂志, 2020, 58(8): 561-585.
2. 中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)结直肠癌诊疗指南. 北京: 人民卫生出版社, 2020: 58-86.
3. Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(7): 874-901.
4. Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2017, 28(suppl_4): iv22-iv40.
5. You YN, Hardiman KM, Bafford A, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the management of rectal cancer. Dis Colon Rectum, 2020, 63(9): 1191-1222.
6. Beets-Tan RGH, Lambregts DMJ, Maas M, et al. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol, 2018, 28(4): 1465-1475.
7. Salerno G, Sinnatamby C, Branagan G, et al. Defining the rectum: surgically, radiologically and anatomically. Colorectal Dis, 2006, 8(Suppl 3): 5-9.
8. Pignon JC, Grisanzio C, Geng Y, et al. p63-expressing cells are the stem cells of developing prostate, bladder, and colorectal epithelia. Proc Natl Acad Sci U S A, 2013, 110(20): 8105-8110.
9. Simunovic M, Smith AJ, Heald RJ. Rectal cancer surgery and regional lymph nodes. J Surg Oncol, 2009, 99(4): 256-259.
10. D’Souza N, Balyasnikova S, Tudyka V, et al. Variation in landmarks for the rectum: an MRI study. Colorectal Dis, 2018, 20(10): O304-O309.
11. D’Souza N, de Neree Tot Babberich MPM, d'Hoore A, et al. Definition of the Rectum: an international, expert-based delphi consensus. Ann Surg, 2019, 270(6): 955-959.
12. D’Souza N, Lord A, Shaw A, et al. The sigmoid take-off: An anatomical imaging definition of the rectum validated on specimen analysis. Eur J Surg Oncol, 2020, 46(9): 1668-1672.
13. Li F, Wang B, Lu S, et al. Comparison of the sigmoid take-off with other definitions of the rectosigmoid junction: A retrospective comparative cohort analysis. Int J Surg, 2020, 80: 168-174.
14. D’Souza N, Lord AC, Shaw A, et al. Ex vivo specimen MRI and pathology confirm a rectosigmoid mesenteric waist at the junction of the mesorectum and mesocolon. Colorectal Dis, 2020, 22(2): 212-218.
15. Nougaret S, Reinhold C, Mikhael HW, et al. The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the “DISTANCE”? Radiology, 2013, 268(2): 330-344.
16. Herschorn S. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs. Rev Urol, 2004, 6 Suppl 5(Suppl 5): S2-S10.
17. Wallner C. Is the puborectalis muscle part of the levator ani muscle? Dis Colon Rectum, 2008, 51(7): 1165-1166.
18. Gollub MJ, Maas M, Weiser M, et al. Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol, 2013, 200(1): 97-101.
19. Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, et al. MRI of rectal cancer: tumor staging, imaging techniques, and management. Radiographics, 2019, 39(2): 367-387.
20. 李文睿, 周乐群, 张卫光. 直肠系膜临床解剖学的研究与进展. 中国组织工程研究, 2016, 20(7): 1051-1056.
21. 王雅琴, 陈华成, 李进, 等. 正常直肠系膜和直肠筋膜的MRI表现. 中国中西医结合影像学杂志, 2015, 13(2): 129-131.
22. 任安利, 翁爱婷, 李进, 等. 正常直肠系膜横径的MRI解剖学研究. 中国临床解剖学杂志, 2020, 38(1): 35-38.
23. Rudisch A, Kremser C, Judmaier W, et al. Dynamic contrast-enhanced magnetic resonance imaging: a non-invasive method to evaluate significant differences between malignant and normal tissue. Eur J Radiol, 2005, 53(3): 514-519.
24. Smith NJ, Barbachano Y, Norman AR, et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg, 2008, 95(2): 229-236.
25. Jhaveri KS, Hosseini-Nik H, Thipphavong S, et al. MRI detection of extramural venous invasion in rectal cancer: correlation with histopathology using elastin stain. AJR Am J Roentgenol, 2016, 206(4): 747-755.
26. Brown G, Radcliffe AG, Newcombe RG, et al. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg, 2003, 90(3): 355-364.
27. Sohn B, Lim JS, Kim H, et al. MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol, 2015, 25(5): 1347-1355.
28. Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet, 2001, 357(9255): 497-504.
29. Canessa CE, Badía F, Fierro S, et al. Anatomic study of the lymph nodes of the mesorectum. Dis Colon Rectum, 2001, 44(9): 1333-1336.
30. Topor B, Acland R, Kolodko V, et al. Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum, 2003, 46(6): 779-785.
31. Gröne J, Loch FN, Taupitz M, et al. Accuracy of various lymph node staging criteria in rectal cancer with magnetic resonance imaging. J Gastrointest Surg, 2018, 22(1): 146-153.
32. Thakur S, Somashekar U, Chandrakar SK, et al. Anatomic study of distribution, numbers, and size of lymph nodes in mesorectum in Indians: a autopsy study. Int J Surg Pathol, 2011, 19(3): 315-320.
33. Heijnen LA, Lambregts DM, Mondal D, et al. Diffusion-weighted MR imaging in primary rectal cancer staging demonstrates but does not characterise lymph nodes. Eur Radiol, 2013, 23(12): 3354-3360.
34. Seber T, Caglar E, Uylar T, et al. Diagnostic value of diffusion-weighted magnetic resonance imaging: differentiation of benign and malignant lymph nodes in different regions of the body. Clin Imaging, 2015, 39(5): 856-862.
35. Wu L, Cao Y, Liao C, et al. Diagnostic performance of USPIO-enhanced MRI for lymph-node metastases in different body regions: a meta-analysis. Eur J Radiol, 2011, 80(2): 582-589.
36. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
37. Akasu T, Kondo H, Moriya Y, et al. Endorectal ultrasonography and treatment of early stage rectal cancer. World J Surg, 2000, 24(9): 1061-1068.
38. Lahaye MJ, Engelen SM, Nelemans PJ, et al. Imaging for predicting the risk factors-the circumferential resection margin and nodal disease-of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR, 2005, 26(4): 259-268.
39. Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg, 2002, 89(3): 327-334.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MRI anatomy of rectum and its clinical application in rectal cancer

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