Rectal cancer protocol (MRI)

MRI protocol for rectal cancer is a group of MRI sequences put together for imaging staging of primary tumours of the rectum and assessment of response following neoadjuvant therapy. Modified versions of the protocol may also be used for the assessment of local recurrence.

Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols, patient factors (e.g. allergy) and time constraints. 

Bowel preparation

Bowel preparation is usually not necessary for rectal MRI.

Studies are usually performed without rectal distension¹. Rectal distension can be considered for assessmentleads to overestimation of smaller or polypoid lesions, or in post-operative recurrencethe distance between the tumour and the anorectal junction, and can be done by infusion of warm water or warm ultrasound gel into the rectum before the scanerrors in T staging ².

Antispasmodic agents (eg. Buscopan (hyoscine) or glucagon) are commonly prescribed for reducing bowel peristalsis and consequent motion artifacts ¹.

Sequences

A good protocol for this purpose involves at least:

• overviews
  • sagittal T2
  • axial T2
• small FOV T2 through tumour 
  • axial - perpendicular to the plane of the part of the rectum containing the tumour
  • coronal - parallel to the plane of the part of the rectum containing the tumour
  • if the tumour is long, or the part of the rectum bearing the tumour has an angulated course, multiple small field-of-view sequences may be necessary
• optional
  • diffusion-weighted imaging

For restaging after chemoradiotherapy, a similar protocol may be deployed. Diffusion-weighted imaging has a greater role to play in this scenario. 

Contrast enhancement is generally considered unnecessary for primary staging and restaging following chemoradiotherapy, but may be deployed for staging of local recurrences, and for the staging of locally advanced rectal cancers where the relationships to other pelvis structures such as the internal iliac vessels and sacral bone involvement are important factors in determining the surgical approach.

See also

• rectal cancer
• rectal cancer response assessment