Is Rectal MRI Beneficial for Determining the Location of Rectal Cancer with Respect to the Peritoneal Reflection?

Abstract

Purpose: An objective method for determining the location of the cancer with respect to peritoneal reflection would be helpful to decide the treatment mordality for rectal cancer. This study was designed to evaluate the accuracy and usefulness of rectal MRI to determine spatial relations between the peritoneal reflection and rectal cancer and to compare these with operative findings.

Methods: Patients that underwent a rectal cancer operation after a rectal MRI check between November 2008 and June 2010 were considered for the study. The patients that received preoperative concurrent chemoradiation or trans-anal local excision were excluded.

Results: Fifty-four patients constituted the study cohort. By comparing surgical and radiologic findings, the accuracy for predicting tumor location in relation to the peritoneal reflection by rectal MRI in all patients was 90.7%. In terms of tumor location in relation to peritoneal reflection, the accuracy of rectal MRI was 93.5% in patients with a tumor located above the peritoneal reflection, 90.0% in patients with a tumor located on the peritoneal reflection, and 84.6% in patients with a tumor located below the peritoneal reflection (P=0.061). When the cohort was subdivided by gender, body mass index (BMI), operative findings, or tumor size, no significant difference was observed among subgroups.

Conclusions: Rectal MRI could be a useful tool for evaluating the relation between rectal cancer and peritoneal reflection especially when tumor size is less than 8cm. Rectal MRI can provide information regarding the location of rectal cancer in relation to the peritoneal reflection for treatment planning purposes.