Predictive Utility of Structured MRI Reporting for Rectal Cancer Outcomes

Abstract

Background/Objectives: This retrospective study evaluates the predictive role of magnetic resonance imaging (MRI) in complications and recurrence in rectal cancer patients undergoing surgery and neoadjuvant therapy, highlighting the impact of structured reporting templates on MRI quality. Compared to traditional free-text reports, structured radiology reports offer a point-by-point evaluation, improving clarity and completeness by thoroughly addressing all relevant findings. MRI is critical in rectal cancer staging, guiding treatment based on tumor characteristics like T stage, sphincter involvement, vascular invasion, and lymph node status. Methods: A retrospective analysis of MRI and reports from 67 rectal cancer patients at the time of diagnosis, who were subsequently treated with neoadjuvant radiochemotherapy and surgery, was conducted. MRI report features, including tumor location, morphology, T stage, sphincter infiltration, mesorectal fascia involvement, lymph nodes, and extramural vascular invasion, were evaluated against European Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations. Multivariate and univariate analyses were performed to correlate MRI findings with postoperative outcomes such as complications, local recurrence, bleeding, and 30-day anastomotic leaks. Results: Sphincter involvement showed a strong association with increased complications (multivariate β = 0.410, univariate r = 0.270). Extramural vascular invasion was linked to higher rates of local recurrence (multivariate β = 0.199, univariate r = 0.127). Lymph node involvement correlated with an elevated risk of postoperative bleeding (multivariate β = 0.133, univariate r = 0.293). Additionally, advanced T staging predicted a higher incidence of 30-day anastomotic leaks (multivariate β = 0.210, univariate r = 0.261). These findings may provide clinically relevant insights to support personalized surgical planning and improve preoperative risk stratification. Conclusions: Detailed MRI reporting, aligned with structured templates, significantly guides surgical and therapeutic strategies in rectal cancer management. However, the retrospective nature of the study and the limited sample size may affect the generalizability of the results.

Keywords: local recurrence; magnetic resonance imaging; outcome; post-operative complications; rectal cancer; structured report.

Figure 1

An example of a polypoid adenocarcinoma of the lower rectum raised upon a stalk shown in axial (A) and sagittal (B) T2-Turbo Spin Echo images; axial (C) and sagittal (D) T1 Turbo Spin Echo fat-saturated images after contrast-agent administration; diffusion-weighted images (E); and ADC map (F). The tumor shows post-contrast enhancement and diffusion signal restriction, but it does not extend beyond the mesorectal fat.

Figure 2

T2-weighted Turbo Spin Echo images in axial (A) and sagittal (B) planes of a mid-upper rectal tumor showing invasion of the mesorectal fascia (arrowhead), perirectal tumor invasion, and desmoplastic stranding (white arrows). An axial T1 Volumetric Interpolated Breath-hold Examination image after contrast agent administration (C).

Figure 3

Example of pathological mesorectal lymph node on axial T2 Turbo Spin Echo image (red arrow).