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Insights into Imaging
Fig. 4 | Insights into Imaging

Fig. 4

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

Fig. 4

Patterns to predict mesorectal fascia involvement after CRT. Example of two morphologic patterns that can aid in predicting MRF involvement after CRT. The male patient in the upper row has a mid-rectal tumor that invades the MRF anteriorly (arrows in a). After CRT (b), the tumor has retracted from the MRF, only some slight fibrotic stranding towards the MRF remains. Subtle fibrotic stranding (or a cleared fat plane) are signs indicating a high chance of a tumor-free MRF, which was indeed confirmed at histopathology after surgery in this patient. The female patient in the bottom row has a mid-rectal tumor with extensive MRF invasion at the left lateral side (white line in c). After CRT (d), the tumor has decreased in volume, but there is still an isointense mass surrounded by hypointense fibrosis that involves the MRF from 1 to 4 o’clock (arrows in d). This type of diffuse MRF infiltration reliably predicts persistent MRF involvement, which was indeed confirmed at histopathology after surgery in this patient

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