Dados do Trabalho

Título

Unveiling the Power of Diffusion in Rectal Cancer MRI: Bridging Theory and Practice

Introdução e objetivo(s)

Rectal cancer is the third most common and the second leading cause of cancer-related death worldwide. Its standard treatment involves a combination of neoadjuvant chemotherapy and radiotherapy (nCRT), followed by total mesorectal excision (TME). In recent years, the non-surgical "watch and wait" (W&W) approach has gained prominence due to its lower morbidity in patients with a complete clinical response (cCR) after nCRT. As a result, the role of magnetic resonance imaging (MRI) in assessing treatment response has expanded, becoming a key guide for therapeutic decision-making. This paper aims to explore the use of diffusion-weighted imaging (DWI) in the diagnosis and treatment of rectal cancer, covering basic physical concepts, common pitfalls, imaging patterns, recent literature developments, and the potential of DWI in improving accuracy in treatment response evaluation and post-treatment management of these patients.

Método(s)

Through case studies and a literature review, we will demonstrate all aspects of DWI in the management of rectal cancer.

Discussão

This work will cover the following key topics:

-Overview of rectal cancer and the role of MRI in its diagnosis, treatment planning, and follow-up.
-The integration of diffusion-weighted imaging (DWI) into diagnostic imaging services for local staging and treatment management.
-Principles of DWI, including optimal acquisition parameters, artifact identification, and its derivatives like Apparent Diffusion Coefficient (ADC) and Intravoxel Incoherent Motion (IVIM).
-Common pitfalls of DWI interpretation and strategies to mitigate misinterpretations.
-The correlation of DWI patterns with T2-weighted imaging and treatment response, aiding in the assessment of treatment efficacy and tumor differentiation.
-Interpretation of diffusion characteristics, particularly in lymph node evaluation.
-Case examples and educational insights into DWI application in rectal cancer management.

Conclusões

DWI has proven valuable in assessing treatment response in rectal cancer, especially after nCRT. Combining MR TRG with DWI patterns allows for a more accurate evaluation of tumor response than using each method alone. Although quantitative DWI analysis shows potential in predicting treatment outcomes, protocol standardization and validation in larger studies are needed. Ongoing development of DWI analysis techniques and post-processing tools is essential to fully establish their clinical utility.

Palavras Chave

Câncer retal; difusão em ressonância magnética; Achados de imagem por ressonância magnética

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