Departments of Medical Imaging and Surgical Oncology, University of Toronto, University Health Network, 190 Elizabeth St, Toronto, ON, Canada M5G 2C4.
Radiographics. 2013 Sep-Oct;33(5):E171-87. doi: 10.1148/rg.335115170.
Magnetic resonance (MR) imaging is becoming the cross-sectional imaging modality of choice for follow-up of patients with previous rectal cancer to diagnose pelvic recurrence and plan for surgery. The authors conducted a retrospective review of MR imaging examinations performed at their institution for evaluation of local recurrence of rectal cancer in 42 patients. Twenty-six patients had undergone rectal anastomosis and 16 had undergone abdominoperineal resection. The mean interval between initial surgery and recurrence was 2.5 years. Recurrence sites were axial (involving the anastomosis) (n = 19); lateral (sidewall) (n = 6); anterior (prostate or seminal vesicle [n = 2], bladder [n = 4], ureter [n = 3], vagina or uterus [n = 5]); or posterior (presacral fascia [n = 11], sacrum [n = 2]). Other recurrence sites included the pelvic floor (n = 7), sciatic nerve (n = 2), obturator nerve (n = 1), perineum (n = 1), abdominal wall (n = 1), or adnexa (n = 1). Recurrence was confirmed at surgery or by evidence of tumor growth at follow-up imaging. Recurrence patterns, signal intensity characteristics, findings of unresectability, potential MR imaging pitfalls, and the role of MR imaging versus other modalities in evaluating recurrent rectal carcinoma are discussed. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg335115170/-/DC1.
磁共振（MR）成像正成为直肠癌患者随访时的首选横断面成像方式，用于诊断盆腔复发并计划手术。作者对在他们机构进行的 42 例直肠癌局部复发的 MR 成像检查进行了回顾性分析。26 例患者行直肠吻合术，16 例患者行腹会阴切除术。初始手术与复发之间的平均间隔时间为 2.5 年。复发部位为轴位（涉及吻合口）（n = 19）；外侧（侧壁）（n = 6）；前位（前列腺或精囊[n = 2]，膀胱[n = 4]，输尿管[n = 3]，阴道或子宫[n = 5]）；或后位（直肠前筋膜[n = 11]，骶骨[n = 2]）。其他复发部位包括骨盆底部（n = 7）、坐骨神经（n = 2）、闭孔神经（n = 1）、会阴（n = 1）、腹壁（n = 1）或附件（n = 1）。复发通过手术或随访影像学检查中肿瘤生长的证据得到证实。讨论了复发模式、信号强度特征、不可切除性的发现、潜在的磁共振成像陷阱，以及 MR 成像在评估复发性直肠癌中的作用与其他方式的比较。补充材料可在 http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg335115170/-/DC1 上获取。
