RADIOLOGY OF CANCER RECTUM

RADIOLOGY OF CANCER RECTUM

1. MANAGEMENT OF DIFFUSE GLIOMAS 30-Apr-22 1 DR KANHU CHARAN PATRO MD,DNB(RADIATION ONCOLOGY),MBA,FAROI(USA),PDCR,CEPC HOD,RADIATION ONCOLOGY Mahatma Gandhi Cancer Hospital And Research Institute, Visakhapatnam [email protected] M-9160470564 RADIOLOGY OF CANCER RECTUM

2. Slow my flow Staging Normal structures Diseased rectum Post RT picture Treatment algorithm Contouring mesorectum Contouring guidelines References 30-Apr-22 2

3. 30-Apr-22 3

4. Nodal staging 30-Apr-22 4

5. MRI PROTOCOL 30-Apr-22 5

6. 30-Apr-22 6

7. REPORTING STEPS 30-Apr-22 7

8. STRUCTURED MRI REPORTING 30-Apr-22 8

9. STRUCTURED MRI FORMAT 30-Apr-22 9

10. Structure identification PARAMETER 1 Anal verge 2 Anorectal junction 3 Rectosigmoid junction 4 Parts of rectum 5 Mesorectum 6 Mesorectal fascia 7 Mucosa and sub mucosa 8 Levator ani Muscle complex 9 External sphincter 10 Internal sphincter 11 Intersphincteric space 12 Peritoneal reflection 13 Ischiorectal fossa 14 Mesorectal venous plexus 15 Puborectalis 16 Adjacent structures 30-Apr-22 10

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14. 1.IDENTFYING ANAL VERGE 30-Apr-22 14

15. 2.ANORECTAL JUNCTION 30-Apr-22 15

16. 3.RECTOSIGMOID JUNCTION 30-Apr-22 16

17. 4.PARTS OF RECTUM 30-Apr-22 17

18. 30-Apr-22 18

19. 5.Mesorectum 30-Apr-22 19

20. 30-Apr-22 20 6. MRF- mesorectal fascia

21. 7.Mucosa / Submucosa /MP 30-Apr-22 21

22. 8-LEVATOR ANI 30-Apr-22 22

23. 9.10,11 Muscles of rectum- Internal sphincter, Intersphincteric space, External sphincter 30-Apr-22 23

24. 30-Apr-22 24

25. 12.PERITONEL REFLECTION- SEA GULL SIGN 30-Apr-22 25

26. 30-Apr-22 26

27. 30-Apr-22 27

28. Ischiorectal fossa 30-Apr-22 28

29. 14.Mesorectal venous plexuses 30-Apr-22 29

30. 15.Puborectalis 30-Apr-22 30

31. 15.Puborectalis 30-Apr-22 31

32. 16.ADJACENT STRUCTURES 30-Apr-22 32

33. SL NO PARAMETER INFERENCE 1 SITE 2 SIZE 3 CIRUMFERNCE INVOLVEMENT   4 CLOCK POSITION   5 TYPE OF GROWTH 6 MUCINOS VS NON-MUCINOUS   7 DISTANCE FROM ANAL VERGE 8 RELATION WITH PERITONEAL REFLECTION 9 PERIRECTAL FAT STRANDING 10 PROXIMAL OBSTRUCTION 11 DEPTH OF EXTRAMURAL INVASION   12 DISTANCE FROM MESOREACTL FASICA 13 CRM STATUS   14 RETRORECTAL AREA INVOLVEMENT 15 INTERNAL SPHICNCTER INVOLVEMENT   30-Apr-22 33

34. SL NO PARAMETER INFERENCE 16 EXTERNAL SPHINCTER INVOLVEMENT 17 INTERSPHINCTERIC SPACE INVOLVEMENT 18 ISCHIORECTAL FOSSA INVOLVEMENT   19 ISCHIOANAL FOSSA INVOLVEMENT   20 ADAJCENT STRACTURE INVOLVEMENT 21 PERIRECTAL SEEDING   22 EXTRAMURAL VASCULAR INVASION 23 EMVI GRADING 24 MESORECTAL NODE 25 LEFT ILIAC NODE 26 RIGHT ILIAC NODE   27 LEFT INGUINAL NODE 28 RIGHT INGUINAL NODE   29 PARAAORTIC NODE 30 FINAL STAGING   30-Apr-22 34

35. 1,2-Site /Size 30-Apr-22 35

36. 3.Circumference involvement 30-Apr-22 36

37. 4.Clock position 30-Apr-22 37

38. 30-Apr-22 38 4 . Clock position

39. 5.Types of growth 30-Apr-22 39

40. 30-Apr-22 40

41. 6.MUCINOUS VS NON MUCINOUS 30-Apr-22 41

42. Mucinous vs non mucinous growth 30-Apr-22 42

43. 30-Apr-22 43

44. 7.Distance from anal verge 30-Apr-22 44

45. Rectum Rectum 8 .RELATION WITH PERITONEAL REFLECTION 30-Apr-22 45

46. 9.Desmoplastic reaction vs tumor fat stranding 30-Apr-22 46

47. 10.Proximal obstruction 30-Apr-22 47

48. 11.Depth of extramural invasion 30-Apr-22 48

49. 12.DISTANCE FROM MESOREACTL FASICA 30-Apr-22 49

50. Threatened MRF 30-Apr-22 50

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54. 13.DEFINING CRM STATUS 30-Apr-22 54

55. 14.RETRORECTAL SPACE INVOLVEMENT 30-Apr-22 55

56. 15/16/17-SPHINCTER COMPLEX INVOLVEMENT 30-Apr-22 56

57. 30-Apr-22 57

58. 18/19- Ischiorectal fossa involvement 30-Apr-22 58

59. 20.ADAJCENT STRACTURE INVOLVEMENT 30-Apr-22 59

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61. 22.Extramural lympho-vascular invasion 30-Apr-22 61

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66. 23.Extramural lympho-vascular invasion grading 30-Apr-22 66

67. 30-Apr-22 67

68. EMVI-1 30-Apr-22 68

69. EMVI-2 30-Apr-22 69

70. EMVI-3 30-Apr-22 70

71. EMVI-4 30-Apr-22 71

72. 30-Apr-22 72

73. NODAL DRAINAGE IN CANCER RECTUM 30-Apr-22 73

74. 24.MESORECTAL NODE 30-Apr-22 74

75. 30-Apr-22 75

76. 25,26-left ant right iliac node 30-Apr-22 76

77. 27,28-Inguinal node 30-Apr-22 77

78. 29-Paraaortic node 30-Apr-22 78

79. 30.Final Staging 30-Apr-22 79

80. Risk stratification 30-Apr-22 80

81. Decision making 30-Apr-22 81

82. 30-Apr-22 82

83. TME and TME VARIANTS 30-Apr-22 83

84. Restaging 30-Apr-22 84

85. RESPONSE ASSESMENT AFTER NEOADJUVANT TREATMENT IN CANCER RECTUM 30-Apr-22 85

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89. L ow signal on the ADC map, indicating restricted diffusion/RESIDUAL HIGH signal on the DWI, indicating restricted diffusion/RESIDUAL 30-Apr-22 89

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91. Example of a patient with several irregularly enlarged cN+ nodes at primary staging. After chemoradiotherapy, most nodes have disappeared and only a small node of < 5 mm remains, indicative of a ycN0 stage 30-Apr-22 91

92. FLUID 30-Apr-22 92

93. 30-Apr-22 93

94. Contouring mesorectum 30-Apr-22 94 M: Mesorectum, LLN: Lateral Lymph Nodes EIN: External Iliac Nodes, IN: Inguinal Nodes, IRF: Ischio -Rectal Fossae , SC: Sphincter Complex, IMA: inferior mesenteric artery, SA: sigmoid artery, SRA: superior rectal artery

95. 30-Apr-22 95

96. https://pubs.rsna.org/doi/epdf/10.1148/rg.2019180114 30-Apr-22 96

97. https://radiologyassistant.nl/abdomen/rectum/rectal-cancer-mr-staging-1 30-Apr-22 97

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