Response evaluation after neoadjuvant treatment for rectal cancer using modern MR imaging: a pictorial review

Doenja M. J. Lambregts*, Thierry N. Boellaard, Regina G. H. Beets-Tan

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

38 Citations (Web of Science)

Abstract

In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation. MRI is one of the main tools used to assess response, but has difficulties in assessing response within areas of post-radiation fibrosis. Hence, MR sequences such as diffusion-weighted imaging are increasingly adopted in clinical MR protocols to improve the differentiation between tumor and fibrosis. In this pictorial review, we discuss the strengths and weaknesses of modern MR imaging, including functional imaging sequences such as diffusion-weighted MRI, for response evaluation after chemoradiation treatment and provide the main pearls and pitfalls for image interpretation.

Original languageEnglish
Article number15
Number of pages14
JournalInsights into Imaging
Volume10
Issue number1
DOIs
Publication statusPublished - 13 Feb 2019

Keywords

  • Rectal neoplasms
  • Magnetic resonance imaging
  • Diffusion magnetic resonance imaging
  • Chemoradiotherapy
  • DIFFUSION-WEIGHTED MRI
  • TUMOR-REGRESSION GRADE
  • RADIATION-THERAPY
  • PREOPERATIVE CHEMORADIOTHERAPY
  • CHEMORADIATION THERAPY
  • CHEMOTHERAPY
  • VOLUMETRY
  • PREDICTION
  • IDENTIFICATION
  • CARCINOMA

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