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Fig. 8 | Insights into Imaging

Fig. 8

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

Fig. 8

Pitfall of low ADC in fibrosis. Example of the post-CRT T2-weighted MRI (a), b1000 diffusion-weighted MRI (b), and ADC map (c) of a male patient treated for a low rectal tumor. The patient was a complete responder. A fibrotic wall thickening is present in the anterior rectal wall (arrows). On the ADC map (c), a markedly low signal is observed in the fibrosis, which is due to the high collagen content in fibrosis (that has a short T2 relaxation time) and should not be mistaken for restricted diffusion due to tumor. On DWI (b), the signal in the rectal wall is homogeneously low, indicating that there is no restricted diffusion. Note again the star-shaped shine-through of high T2 signal (*) caused by some fluid in the rectal lumen

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