Synopsis

Despite the major improvements that have been made due to total mesorectal excision (TME) management of rectal cancer still remains a challenge. Optimal treatment of rectal cancer involves a multidisciplinary approach with collaboration between radiologists, oncologists, surgeons and pathologists to achieve local control and decrease recurrence. As we enter the era of personalized medicine with therapies stratified according to the risk of local or distant recurrence, imaging has become an essential tool in the preoperative decision making, to avoid both under- and overtreatment. This requires a full understanding of the disease, as well as a full understanding of what impact false- positive or false-negative findings can have on treatment choices and outcome. MRI assessment of tumor extramural spread, Circumferential Resection Margin or nodal status is critical for rectal cancer staging. Using a standardised reporting enables a systematic approach to the interpretation of the magnetic resonance images, thereby enabling all the clinically relevant features to be adequately assessed. The presentation will be focused on an easy mnemonic: “ DISTANCE “ to help radiologists use a systematic approach to the interpretation of rectal MRI.