Wk 5, Case 4 - Review

PATIENT HISTORY: Rectal cancer, staging

MRI PELVIS W WO IV CONTRAST

HISTORY: Rectal cancer, staging

COMPARISON: None

Technique: MRI of the pelvis was performed with and without intravenous contrast as per the rectal cancer protocol.

FINDINGS:

1. TUMOR LOCATION AND CHARACTERISTICS

i) Tumor Location (from anal verge): Mid (5.1 - 10.0 cm)

ii) Anal verge to distal tumor margin: 7.1 cm

iii) Tumor at or below the puborectalis sling: No

iv) Distance of lowest extent of tumor from top of anal sphincter: 4.3 cm

v) Relationship to the anterior peritoneal reflection: Invaded.

vi) Craniocaudal length of the tumor: 6.7 cm

vii) Clock face of tumor: 12 o'clock to 10 o'clock

viii) Type (Polypoid/Annular/Semi-annular): Semi-annular with a polypoid
component

ix) Mucinous: No

2. EXTRAMURAL DEPTH OF INVASION AND MR T-CATEGORY

i) Extramural depth of invasion (Use 0 mm for T1 or T2 tumor): 21 mm

ii)T category: T4a

3. RELATIONSHIP OF THE TUMOR TO MESORECTAL FASCIA (MRF)

i) 11 mm

ii) Are there any tumor spiculations closer to the MRF No

4. EXTRAMURAL VENOUS INVASION

i) Extramural Venous Invasion (EMVI): Positive: EMVI is 7 mm from the MRF at
6 o'clock

5. MESORECTAL LYMPH NODES AND TUMOR DEPOSITS

i) Any suspicious mesorectal lymph nodes/tumor deposits: Yes. There are
enlarged perirectal lymph nodes/tumor deposits measuring up to 1.3 cm.

6. EXTRAMESORECTAL LYMPH NODES

(suspicious = mixed signal or irregular borders, and/or short axis =10mm. NB: Size threshold should not be used alone. Assess signal and borders to increase sensitivity)

i) Any suspicious extramesorectal lymph nodes: No

ii) Is the IMA node station in the field of view: Yes, suspicious nodes are present.

7. OTHER FINDINGS (COMPLICATIONS, METASTASES, LIMITATIONS)

There is heterogeneous marrow signal in the pelvis, nonspecific. Non-specific presacral edema and fat stranding is noted.

Small uterine fibroids are seen.


IMPRESSION:

Rectal neoplasm (T4a) with mesorectal adenopathy and extramural venous invasion as described.