Published online before print August 23, 2006, 10.1148/radiol.2411050942
Rectal Carcinoma: High-Spatial-Resolution MR Imaging and T2 Quantification in Rectal Cancer Specimens1
Jens C. Stollfuss, MD,
Karen Becker, MD,
Andreas Sendler, MD,
Stefan Seidl, MD,
Marcus Settles, PhD,
Florian Auer, MD,
Ambros Beer, MD,
Ernst J. Rummeny, MD and
Klaus Woertler, MD
1 From the Departments of Radiology (J.C.S., M.S., F.A., A.B., E.J.R., K.W.), Pathology (K.B., S.S.), and Surgery (A.S.), Technische Universität München, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675 Munich, Germany. Received June 5, 2005; revision requested August 1; revision received October 5; accepted November 4; final version accepted January 3, 2006.
Address correspondence to J.C.S. e-mail: sto{at}roe.med.tum.de).
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Figure 1a: Small tumor growing adjacent to polyp in 62-year-old man. (a) Transverse thin-section (2-mm) T2-weighted spin-echo MR image (4958/105 [repetition time msec/echo time msec]) demonstrates five rectal wall layers, including the mucosa (muc), muscularis mucosae (black arrow in a and b), submucosa (sub), and circular (m) and longitudinal (M) layers of the muscularis propria. Perirectal fat (F) is also seen. Transition zone (white arrows in a and b) between tumor tissue (T), mucosa, and hyperplastic polyp (P) is demonstrated. No fat plane is visible between circular muscle and tumor because of similar SI. Polyp and mucosal layer show slightly lower SI compared with tumor. Lumen is filled with US gel. (b) Histologic slice confirms T2 tumor. Transition zone between tumor and hyperplastic polyp on one end and normal mucosal layer on other end can be clearly identified. (Hematoxylin-eosin stain; original magnification, x1.)
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Figure 1b: Small tumor growing adjacent to polyp in 62-year-old man. (a) Transverse thin-section (2-mm) T2-weighted spin-echo MR image (4958/105 [repetition time msec/echo time msec]) demonstrates five rectal wall layers, including the mucosa (muc), muscularis mucosae (black arrow in a and b), submucosa (sub), and circular (m) and longitudinal (M) layers of the muscularis propria. Perirectal fat (F) is also seen. Transition zone (white arrows in a and b) between tumor tissue (T), mucosa, and hyperplastic polyp (P) is demonstrated. No fat plane is visible between circular muscle and tumor because of similar SI. Polyp and mucosal layer show slightly lower SI compared with tumor. Lumen is filled with US gel. (b) Histologic slice confirms T2 tumor. Transition zone between tumor and hyperplastic polyp on one end and normal mucosal layer on other end can be clearly identified. (Hematoxylin-eosin stain; original magnification, x1.)
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Figure 2a: Sessile T3 tumor with small portion infiltrating perirectal fat in 48-year-old man. (a) Transverse T2-weighted fast spin-echo MR image (5958/105) demonstrates relatively small (1.8-cm) sessile tumor (T) in dorsal aspect of rectum, with small portion (white arrow in a–c) growing into perirectal fat (F). Longitudinal layer (M) of the muscularis propria shows lower SI than circular layer (m) of the muscularis propria. Circular layer of the muscularis propria and tumor have similar SI. Muscularis mucosae are depicted as a separate layer of low SI (black arrow in a and b). (b) Corresponding intermediate-weighted MR image (1400/42) shows five distinct rectal wall layers. SI difference between tumor and muscularis propria is small compared with that in a. (c) Corresponding T1-weighted MR image (500/22) does not demonstrate separation of muscularis propria into distinct layers; SI of tumor and that of muscularis propria are very similar. (d) Corresponding histopathologic slice shows tumor growing along perivascular spaces (large black arrow); mucularis mucosae is also seen (small black arrow). (Periodic acid–Schiff stain; original magnification, x1.)
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Figure 2b: Sessile T3 tumor with small portion infiltrating perirectal fat in 48-year-old man. (a) Transverse T2-weighted fast spin-echo MR image (5958/105) demonstrates relatively small (1.8-cm) sessile tumor (T) in dorsal aspect of rectum, with small portion (white arrow in a–c) growing into perirectal fat (F). Longitudinal layer (M) of the muscularis propria shows lower SI than circular layer (m) of the muscularis propria. Circular layer of the muscularis propria and tumor have similar SI. Muscularis mucosae are depicted as a separate layer of low SI (black arrow in a and b). (b) Corresponding intermediate-weighted MR image (1400/42) shows five distinct rectal wall layers. SI difference between tumor and muscularis propria is small compared with that in a. (c) Corresponding T1-weighted MR image (500/22) does not demonstrate separation of muscularis propria into distinct layers; SI of tumor and that of muscularis propria are very similar. (d) Corresponding histopathologic slice shows tumor growing along perivascular spaces (large black arrow); mucularis mucosae is also seen (small black arrow). (Periodic acid–Schiff stain; original magnification, x1.)
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Figure 2c: Sessile T3 tumor with small portion infiltrating perirectal fat in 48-year-old man. (a) Transverse T2-weighted fast spin-echo MR image (5958/105) demonstrates relatively small (1.8-cm) sessile tumor (T) in dorsal aspect of rectum, with small portion (white arrow in a–c) growing into perirectal fat (F). Longitudinal layer (M) of the muscularis propria shows lower SI than circular layer (m) of the muscularis propria. Circular layer of the muscularis propria and tumor have similar SI. Muscularis mucosae are depicted as a separate layer of low SI (black arrow in a and b). (b) Corresponding intermediate-weighted MR image (1400/42) shows five distinct rectal wall layers. SI difference between tumor and muscularis propria is small compared with that in a. (c) Corresponding T1-weighted MR image (500/22) does not demonstrate separation of muscularis propria into distinct layers; SI of tumor and that of muscularis propria are very similar. (d) Corresponding histopathologic slice shows tumor growing along perivascular spaces (large black arrow); mucularis mucosae is also seen (small black arrow). (Periodic acid–Schiff stain; original magnification, x1.)
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Figure 2d: Sessile T3 tumor with small portion infiltrating perirectal fat in 48-year-old man. (a) Transverse T2-weighted fast spin-echo MR image (5958/105) demonstrates relatively small (1.8-cm) sessile tumor (T) in dorsal aspect of rectum, with small portion (white arrow in a–c) growing into perirectal fat (F). Longitudinal layer (M) of the muscularis propria shows lower SI than circular layer (m) of the muscularis propria. Circular layer of the muscularis propria and tumor have similar SI. Muscularis mucosae are depicted as a separate layer of low SI (black arrow in a and b). (b) Corresponding intermediate-weighted MR image (1400/42) shows five distinct rectal wall layers. SI difference between tumor and muscularis propria is small compared with that in a. (c) Corresponding T1-weighted MR image (500/22) does not demonstrate separation of muscularis propria into distinct layers; SI of tumor and that of muscularis propria are very similar. (d) Corresponding histopathologic slice shows tumor growing along perivascular spaces (large black arrow); mucularis mucosae is also seen (small black arrow). (Periodic acid–Schiff stain; original magnification, x1.)
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Figure 3a: Dissected specimen from 65-year-old man 6 weeks after combined irradiation and chemotherapy. (a) Transverse T2-weighted fast spin-echo MR image (5958/105) demonstrates tumor clusters (T) embedded in fibrotic bands (white arrow in a–d) that show substantially lower SI than tumor tissue. Fibrosis (black arrow in a–d) is visualized adjacent to rectal wall in perirectal fat (F). (b) On intermediate-weighted MR image (1400/42), fibrotic changes in perirectal fat are obscured because of fat saturation. Tumor clusters are embedded in fibrotic bands. High SI adjacent to rectal wall is most likely the result of increased fluid content in perirectal tissue. (c) On T1-weighted MR image (500/22), differentiation of tumor from fibrosis is difficult because both show low SI relative to perirectal fat. Fibrosis adjacent to wall in perirectal fat is well visualized. (d) Corresponding histopathologic slice. (Hematoxylin-eosin stain; original magnification, x1.)
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Figure 3b: Dissected specimen from 65-year-old man 6 weeks after combined irradiation and chemotherapy. (a) Transverse T2-weighted fast spin-echo MR image (5958/105) demonstrates tumor clusters (T) embedded in fibrotic bands (white arrow in a–d) that show substantially lower SI than tumor tissue. Fibrosis (black arrow in a–d) is visualized adjacent to rectal wall in perirectal fat (F). (b) On intermediate-weighted MR image (1400/42), fibrotic changes in perirectal fat are obscured because of fat saturation. Tumor clusters are embedded in fibrotic bands. High SI adjacent to rectal wall is most likely the result of increased fluid content in perirectal tissue. (c) On T1-weighted MR image (500/22), differentiation of tumor from fibrosis is difficult because both show low SI relative to perirectal fat. Fibrosis adjacent to wall in perirectal fat is well visualized. (d) Corresponding histopathologic slice. (Hematoxylin-eosin stain; original magnification, x1.)
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Figure 3c: Dissected specimen from 65-year-old man 6 weeks after combined irradiation and chemotherapy. (a) Transverse T2-weighted fast spin-echo MR image (5958/105) demonstrates tumor clusters (T) embedded in fibrotic bands (white arrow in a–d) that show substantially lower SI than tumor tissue. Fibrosis (black arrow in a–d) is visualized adjacent to rectal wall in perirectal fat (F). (b) On intermediate-weighted MR image (1400/42), fibrotic changes in perirectal fat are obscured because of fat saturation. Tumor clusters are embedded in fibrotic bands. High SI adjacent to rectal wall is most likely the result of increased fluid content in perirectal tissue. (c) On T1-weighted MR image (500/22), differentiation of tumor from fibrosis is difficult because both show low SI relative to perirectal fat. Fibrosis adjacent to wall in perirectal fat is well visualized. (d) Corresponding histopathologic slice. (Hematoxylin-eosin stain; original magnification, x1.)
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Figure 3d: Dissected specimen from 65-year-old man 6 weeks after combined irradiation and chemotherapy. (a) Transverse T2-weighted fast spin-echo MR image (5958/105) demonstrates tumor clusters (T) embedded in fibrotic bands (white arrow in a–d) that show substantially lower SI than tumor tissue. Fibrosis (black arrow in a–d) is visualized adjacent to rectal wall in perirectal fat (F). (b) On intermediate-weighted MR image (1400/42), fibrotic changes in perirectal fat are obscured because of fat saturation. Tumor clusters are embedded in fibrotic bands. High SI adjacent to rectal wall is most likely the result of increased fluid content in perirectal tissue. (c) On T1-weighted MR image (500/22), differentiation of tumor from fibrosis is difficult because both show low SI relative to perirectal fat. Fibrosis adjacent to wall in perirectal fat is well visualized. (d) Corresponding histopathologic slice. (Hematoxylin-eosin stain; original magnification, x1.)
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Figure 4a: Typical monoexponential curve fits T2 relaxation data for tumor tissue and different rectal wall layers in 62-year-old man. (a) All curves were normalized at an echo time of zero for clarity. Monoexponential function is given in legend. The slope of the best fit line represents R2. Values are given in milliseconds; R2 values in Table 2 are calculated in seconds. (b) Corresponding parametric T2-weighted MR image (3000/15–225) of specimen includes ROIs for tumor (T), mucosa (muc), submucosa (sub), and circular (m) and longitudinal (M) layers of the muscularis propria. Tumor in left lateral aspect of rectal wall was classified as a stage T2 tumor.
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Figure 4b: Typical monoexponential curve fits T2 relaxation data for tumor tissue and different rectal wall layers in 62-year-old man. (a) All curves were normalized at an echo time of zero for clarity. Monoexponential function is given in legend. The slope of the best fit line represents R2. Values are given in milliseconds; R2 values in Table 2 are calculated in seconds. (b) Corresponding parametric T2-weighted MR image (3000/15–225) of specimen includes ROIs for tumor (T), mucosa (muc), submucosa (sub), and circular (m) and longitudinal (M) layers of the muscularis propria. Tumor in left lateral aspect of rectal wall was classified as a stage T2 tumor.
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Figure 5a: Complete tumor remission after combined irradiation and chemotherapy in 44-year-old woman. (a) Transverse in vitro T2-weighted turbo spin-echo MR image (4958/105) shows substantial mass effect in left lateral aspect, with intermediate SI that may be interpreted as residual tumor (white arrow). Fibrotic changes are present and are located adjacent to wall and in perirectal fat (black arrow). (b) Corresponding microscopy slice shows smooth muscle hyperplasia (white arrow), without evidence of tumor (stage T0). Spiculations consisted of desmoplastic reaction (black arrow) without tumor cells. m = circular layer of muscularis propria, M = longitudinal layer of muscularis propria. (Elastica–van Giesson stain; original magnification, x1.)
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Figure 5b: Complete tumor remission after combined irradiation and chemotherapy in 44-year-old woman. (a) Transverse in vitro T2-weighted turbo spin-echo MR image (4958/105) shows substantial mass effect in left lateral aspect, with intermediate SI that may be interpreted as residual tumor (white arrow). Fibrotic changes are present and are located adjacent to wall and in perirectal fat (black arrow). (b) Corresponding microscopy slice shows smooth muscle hyperplasia (white arrow), without evidence of tumor (stage T0). Spiculations consisted of desmoplastic reaction (black arrow) without tumor cells. m = circular layer of muscularis propria, M = longitudinal layer of muscularis propria. (Elastica–van Giesson stain; original magnification, x1.)
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Copyright © 2006 by the Radiological Society of North America.
