Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion

Figure 2 Images obtained in a 64 years-old man with middle rectal cancer. A: Axial contrast enhanced computed tomography (CE-CT) image shows the tumour as an irregular mural thickening of the anterior rectal wall with possible infiltration into the perirectal fat. The mesorectal fascia is seen as a thin line (arrowhead) surrounding the mesorectal fat and is not involved by the tumor (arrow); B: Multiplanar reconstruction (MPR) para-axial CE CT image of the same patient shows the tumour as an irregular mural thickening of the anterior rectal wall (arrow) with no infiltration into the perirectal fat. The mesorectal fascia (arrowhead) is better defined in MPR para-axial CT image; C: T2 (TSE) MRI image of the same patient shows the tumour as a lesion of the anterior rectal wall, slightly hyperintense compared to the muscle, that extends through the hypo-intense muscle layer into the perirectal fat (arrow) and without mesorectal fascia involvement (arrowhead); D: Orthogonal axial high-resolution T2-weighted MR image of the same patient shows an intraluminal mass (arrows) confined to the intact, hypo-intense muscularis propria (the proper muscle layer is shown as a low intensity band (*). The mesorectal fascia (arrowhead).