Research Areas

Endorectal MRI

Optimization of High-Resolution Display of the Prostate and Rectum

Prostate carcinoma

According to series of examination of biopsy materials about 30% of male population over 50 years of age have non-active prostate carcinoma which shows clinical manifestation in only a small percentage. In Europe carcinoma of prostate is the third common cause of tumour mortality after lung and intestinal tumours. About 95% of malignant carcinoma of prostate are adenocarcinoma. About 70% arise in the peripheral zone, 20% in junctional zone and 10% in central zone. A multifocal infiltration in different anatomical zones is also possible. Carcinoma in the peripheral zone is seen as a hypointense areas in T2 weighted images. The staging of carcinoma of prostate is very good with endorectal coils - exact documentation of the hypointense areas in the peripheral zone, ruling out of infiltration of the capsule, ruling out infiltration of seminal vesicles or urinary bladder. In combination with body coil it allows diagnosis of lymph node metastases in iliac region. The endorectal MRI in combination with MR-spectroscopy allows detection of tumorous formations in the peripheral zone and allows documentation of its extension.

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Hypointense signal area in T2-SE Sequence (TR/TE:4900/90ms) in peripheral zone of left lobe of prostate (*). Infiltration of capsule (arrow) - Tumour stage T3a according to MRI.

 
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Histological correlation: Tumour cells (a) with infiltration of periprostatic fat tissue. Tumour cells in peripheral zone (b).

 
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Prostate carcinoma with low signal intensity in seminal vesicles bilaterally corresponding to tumour metastases (curved arrow).

 
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Coronal Image: Infiltration of seminal vesicles (arrow). Tumour stage T3b.

 

Carcinoma of the Rectum

Colorectal carcinoma is the second most common cause of deaths in most of the industrial nations. In the USA about 131600 new cases of colorectal cancer was reported in 1998. Most of the colorectal carcinomas arise from adenomatous polyps, histologically more than 90% of the tumors are adenocarcinoma. The prevalence of colorectal carcinoma is age-related and increases significantly after the age of 50 with the highest incidence between the age of 65 and 80 years.
The preoperative staging of neoplasias of rectum is of great importance in terms of therapy planning and also in terms of prognosis.
MRI has established itself as the method of choice for diagnosis of tumor in rectum region, especially in the evaluation of architecture likewise the zonal anatomy. Of foremost importance of diagnostic imaging is the exact possible preoperative staging of rectal neoplasias. A further improved evaluation is achieved with the use of endorectal surface coil. This allows better evaluation of pathological structures of the rectum and its relation to perirectal organs. Till date only endorectal ultrasound allowed a proper evaluation of different layers of the rectal wall and likewise better differentiation of tumor stages. Scientific studies show that the sensitivity of endorectal MRI is 80-85% which is similar to that of transrectal ultrasound. The advantages of MRI lie in that that a body coil can be simultaneously used in addition to endorectal coil through which all clinical relevant queries like tumor stage, lymph node metastases, distant metastases can be evaluated.

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Axial image: T2-SE-Sequence (TR/TE=4900/100ms). Lesion in the left circumference of the rectal lumen. There is no penetration of muscularis propria.

 
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Axial image: T1-SE-Sequence (TR/TE=700/15ms) after i.v. contrast application (Gd-DTPA). Inhomogenous contrast enhancement of the rectal lesion with blurred visualisation of muscularis propria.

 
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Coronal image: T1-SE-Sequence (TR/TE=700/15ms) after contrast application (Gd-DTPA). Suspected infiltration of the muscularis propria, however no evidence of penetration into the perirectal fatty tissue.

 
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Histological correlation: Evidence of tumor cells within muscularis propria. No invasion of the perirectal fatty tissue.

 

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