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Review
. 2025 Feb:183:111937.
doi: 10.1016/j.ejrad.2025.111937. Epub 2025 Jan 20.

Mastering rectal cancer MRI: From foundational concepts to optimal staging

Carolina Augusta Modena Heming  1 , Janet A Alvarez  2 , Joao Miranda  3 , Daniel Cardoso  4 , Caroline Lorenzoni Almeida Ghezzi  5 , Gerda F Nogueira  6 , Luciana Costa-Silva  7 , Rodrigo Sanford Damasceno  8 , Tiago Oliveira Morita  9 , J Joshua Smith  10 , Natally Horvat  11
Affiliations
Review

Mastering rectal cancer MRI: From foundational concepts to optimal staging

Carolina Augusta Modena Heming et al. Eur J Radiol. 2025 Feb.

Abstract

MRI plays a critical role in the local staging, restaging, surveillance, and risk stratification of patients, ensuring they receive the most tailored therapy. As such, radiologists must be familiar not only with the key MRI findings that influence management decisions but also with the appropriate MRI protocols and structured reporting. Given the complexity of selecting the optimal therapy for each patient-which often requires multidisciplinary discussions-radiologists should be well-versed in relevant treatment strategies and surgical terms, understanding their significance in guiding patient care. In this manuscript, we review the most common treatment options for managing patients with rectal adenocarcinoma, emphasizing key MRI principles and protocol characteristics for accurate staging. We also highlight important anatomical landmarks and essential factors to be described during baseline assessment. Additionally, we discuss crucial information for restaging and surveillance.

Keywords: Magnetic Resonance Imaging; Neoadjuvant Therapy; Neoplasm Staging; Rectal Neoplasms; Rectal cancer.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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