The Evolution and Future of Imaging in the Management of Rectal Cancer

• References

In the last two decades, the landscape of rectal cancer management has evolved dramatically, with imaging technologies playing a pivotal role in this evolution. Imaging has become central to the staging, treatment planning, and monitoring of rectal cancer patients.[1] [2]

Patients with locally advanced rectal cancer often require neoadjuvant therapy followed by surgery.[3] Magnetic resonance imaging (MRI) provides superior soft tissue contrast and spatial resolution compared to computed tomography, making it accurate in evaluating the local extent of rectal tumors.[4] The ability to precisely identify the tumor and assess its anatomical relationship including the involvement of the mesorectal fascia and adjacent structures allows for more accurate staging and better-informed surgical decisions.[1] [2] Over the years, MRI techniques have continued to evolve, with innovations such as high-resolution MRI and functional imaging contributing to more precise assessment. High-resolution MRI allows for detailed visualization of the tumor and surrounding structures, aiding in the identification of early local recurrences and guiding surgical planning.[4] [5] Functional MRI techniques, including diffusion-weighted imaging provide additional insights into tumor biology and treatment response.

Moving ahead, novel approaches, such as MRI-guided radiotherapy and the integration of artificial intelligence (AI) in imaging analysis, hold promise for further enhancing diagnostic accuracy and treatment precision. MRI-guided radiotherapy combines the precision of MRI with real-time imaging during radiation therapy, enabling highly targeted treatment while minimizing damage to surrounding healthy tissues. AI-powered imaging tools are being developed to assist in automated tumor detection, segmentation, and response assessment, potentially improving workflow efficiency and diagnostic accuracy.

Conflict of Interest

None declared.

• References

• 1 Bates DDB, Homsi ME, Chang KJ, Lalwani N, Horvat N, Sheedy SP. MRI for rectal cancer: staging, mrCRM, EMVI, lymph node staging and post-treatment response. Clin Colorectal Cancer 2022; 21 (01) 10-18
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• 2 Group MS. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006; 333 (7572): 779
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• 3 Benson AB, Venook AP, Al-Hawary MM. et al. Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20 (10) 1139-1167
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• 4 Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ. MRI of rectal cancer: tumor staging, imaging techniques, and management. Radiographics 2019; 39 (02) 367-387
  CrossrefPubMedSearch in Google Scholar
• 5 Horvat N, El Homsi M, Miranda J, Mazaheri Y, Gollub MJ, Paroder V. Rectal MRI interpretation after neoadjuvant therapy. J Magn Reson Imaging 2023; 57 (02) 353-369
  PubMedSearch in Google Scholar

Address for correspondence

Publication History

Article published online:
24 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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• References

• 1 Bates DDB, Homsi ME, Chang KJ, Lalwani N, Horvat N, Sheedy SP. MRI for rectal cancer: staging, mrCRM, EMVI, lymph node staging and post-treatment response. Clin Colorectal Cancer 2022; 21 (01) 10-18
  CrossrefPubMedSearch in Google Scholar
• 2 Group MS. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006; 333 (7572): 779
  CrossrefPubMedSearch in Google Scholar
• 3 Benson AB, Venook AP, Al-Hawary MM. et al. Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20 (10) 1139-1167
  CrossrefPubMedSearch in Google Scholar
• 4 Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ. MRI of rectal cancer: tumor staging, imaging techniques, and management. Radiographics 2019; 39 (02) 367-387
  CrossrefPubMedSearch in Google Scholar
• 5 Horvat N, El Homsi M, Miranda J, Mazaheri Y, Gollub MJ, Paroder V. Rectal MRI interpretation after neoadjuvant therapy. J Magn Reson Imaging 2023; 57 (02) 353-369
  PubMedSearch in Google Scholar