Colorectal cancer is the fourth leading cause of death worldwide and the fifth leading cause of cancer death in Colombia. Magnetic resonance imaging is the ideal modality for the evaluation of colorectal cancer, since it allows staging by determining invasion beyond the muscularis propria, extension towards adjacent organs, identification of patients who are candidates for chemotherapy or pre-surgical radiotherapy and planning of the surgical procedure. The key point is based on the differentiation between T2 and T3 stages through the use of sequences with high-resolution T2 information. In addition to this, it allows the assessment of the size and morphology of the lymph nodes, and considerably increases the specificity for the detection of lymph node involvement. MRI is a technique with high specificity and high reproducibility.

1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. A Cancer Journal for Clinicians 2011; 61(2): 69–90.

2. Ferreira EJ, Meléndez HJ. Características clínicas, demográficas e histopatológicas de los pacientes con cáncer colorrectal del Hospital Universitario de Santander (Spanish) [Clinical, demographic and histopathological characteristics of patients with colorectal cancer at the Hospital Universitario de Santander]. Revista Colombiana de Cirugía 2012; 27(3): 213–220.

3. Sanabria Rojas A, Martínez JI, Díaz Rojas JA. Colon cancer: Analysis of disease cost to III and IV stages in Cansercoop IPS. Revista Colombiana de Ciencias Químico-Farmacéuticas 2009; 38(2): 193–214.

4. Piñeros M, Hernández G, Bray F. Increasing mortality rates of common malignancies in Colombia: An emerging problem. Cancer 2004; 101(10): 2285–2292.

5. Muthusamy VR, Chang KJ. Optimal methods for staging rectal cancer. Clinical Cancer Research 2007; 13(22): 6877s–6884s.

6. Hodgman CG, MacCarty RL, Wolff BG, et al. Preoperative staging of rectal carcinoma by computed tomography and 0.15 T magnetic resonance imaging. Diseases of the Colon & Rectum 1986; 29(7): 446–450.

7. Butch RJ, Stark DD, Wittenberg J, et al. Staging rectal cancer by MR and CT. American Journal of Roentgenology 1986; 146(6): 1155–1160.

8. Torkzad MR, Påhlman L, Glimelius B. Magnetic resonance imaging (MRI) in rectal cancer: A comprehensive review. Insights Into Imaging 2010; 1(4): 245–267.

9. Martling A, Holm T, Bremmer S, et al. Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer. Journal of British Surgery 2003; 90(11): 1422–1428.

10. Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: Thin-section MR imaging for staging in 28 patients. Radiology 1999; 211(1): 215–222.

11. LeBlanc JK. Imaging and management of rectal cancer. Nature Clinical Practice Gastroenterology & Hepatology 2007; 4(12): 665–676.

12. Smith NJ, Barbachano Y, Norman AR, et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Journal of British Surgery 2008; 95(2): 229–236.

13. Beets-Tan RGH, Beets GL. Rectal cancer: How accurate can imaging predict the T stage and the circumferential resection margin? International Journal of Colorectal Disease 2003; 18(5): 385–391.

14. Beets-Tan RGH. MRI in rectal cancer: The T stage and circumferential resection margin. Colorectal Disease 2003; 5(5): 392–395.

15. Kaur H, Choi H, You YN, et al. MR imaging for preoperative evaluation of primary rectal cancer: Practical considerations. Radiographics 2012; 32(2): 389–409.

16. 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.

17. Matsuoka H, Masaki T, Sugiyama M, et al. Gadolinium enhanced endorectal coil and air enema magnetic resonance imaging as a useful tool in the preoperative examination of patients with rectal carcinoma. Hepato-Gastroenterology 2004; 51(55): 131–135.

18. Beets-Tan RGH, Beets GL. Rectal cancer: Review with emphasis on MR imaging. Radiology 2004; 232(2): 335–346.

19. Quirke P, Dixon MF. The prediction of local recurrence in rectal adenocarcinoma by histo- pathological examination. International Journal of Colorectal Disease 1988; 3(2): 127–131.

20. Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. British Journal of Surgery 2002; 89(3): 327–334.

21. Nagtegaal ID, Marijnen CAM, Kranenbarg EK, et al. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: Not one millimeter but two millimeters is the limit. The American Journal of Surgical Pathology 2002; 26(3): 350–357.

22. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer. International Journal of Colorectal Disease 2000; 15(1): 9–20.

23. Beets-Tan RGH, Beets GL, Vliegen RFA, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. The Lancet 2001; 357(9255): 497–504.

24. Blomqvist L, Machado M, Rubio C, et al. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. European Radiology 2000; 10(4): 653–660.

25. Rafaelsen SR, Sørensen T, Jakobsen A, et al. Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer: Effect of experience. Scandinavian Journal of Gastroenterology 2008; 43(4): 440–446.

26. Al-Sukhni E, Milot L, Fruitman M, et al. RSNA radiology reporting templates. MR rectum cancer [Internet]. 2014. Available from: http://www.radre-port.org/txt/0000068.

27. Kijima S, Sasaki T, Nagata K, et al. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World Journal of Gastroenterology 2014; 20(45): 16964–16975.

28. Vliegen RFA, Beets GL, von Meyenfeldt MF, et al. Rectal cancer: MR imaging in local staging-is gadolinium-based contrast material helpful? Radiology-Radiological Society of North America 2005; 234(1): 179–188.

29. Suzuki C, Torkzad MR, Tanaka S, et al. The importance of rectal cancer MRI protocols on interpretation accuracy. World Journal of Surgical Oncology 2008; 6(1): 1–9.

30. Vogl TJ, Pegios W, Mack MG, et al. Accuracy of staging rectal tumors with contrast-enhanced transrectal MR imaging. AJR. American Journal of Roentgenology 1997; 168(6): 1427–1434.

31. Brown G, Radcliffe AG, Newcombe RG, et al. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Journal of British Surgery 2003; 90(3): 355–364.

32. Meyenberger C, Böni RAH, Bertschinger P, et al. Endoscopic ultrasound and endorectal magnetic resonance imaging: A prospective, comparative study for preoperative staging and follow-up of rectal cancer. Endoscopy 1995; 27(07): 469–479.

33. Klessen C, Rogalla P, Taupitz M. Local staging of rectal cancer: The current role of MRI. European Radiology 2007; 17(2): 379–389.

34. Bisset IP, Chau KY, Hill GL. Extrafascial excision of the rectum: Surgical anatomy of the fascia propria. Diseases of the Colon & Rectum 2000; 43(7): 903–910.

35. Quirke P, Dixon MF, Durdey P, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: Histopathological study of lateral tumour spread and surgical excision. The Lancet 1986; 328(8514): 996–999.

36. Mathur P, Smith JJ, Ramsey C, et al. Comparison of CT and MRI in the pre-operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI. Colorectal Disease 2003; 5(5): 396–401.

37. Valentini V, Aristei C, Glimelius B, et al. Multidisciplinary rectal cancer management: 2nd European rectal cancer consensus conference (EURECA-CC2). Radiotherapy and Oncology 2009; 92(2): 148–163.

38. Taylor A, Slater A, Mapstone N, et al. Staging rectal cancer: MRI compared to MDCT. Abdominal Imaging 2007; 32(3): 323–327.

39. Kim YW, Kim NK, Min BS, et al. A prospective comparison study for predicting circumferential resection margin between preoperative MRI and whole mount sections in mid-rectal cancer: Significance of different scan planes. European Journal of Surgical Oncology (EJSO) 2008; 34(6): 648–654.

40. Slater A, Halligan S, Taylor SA, et al. Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin. Clinical Radiology 2006; 61(1): 65–70.

41. Smith NJ, Shihab O, Arnaout A, et al. MRI for detection of extramural vascular invasion in rectal cancer. American Journal of Roentgenology 2008; 191(5): 1517–1522.

42. Kapiteijn E, Marijnen CAM, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. New England Journal of Medicine 2001; 345(9): 638–646.

43. Andreola S, Leo E, Belli F, et al. Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm. Cancer 1996; 77(4): 607–612.

44. Mönig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer. Annals of Surgical Oncology 1999; 6(6): 579–581

45. Bipat S, Glas AS, Slors FJM, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—A meta-analysis. Radiology 2004; 232(3): 773–783.

46. Kotanagi H, Fukuoka T, Shibata Y, et al. The size of regional lymph nodes does not correlate with the presence or absence of metastasis in lymph nodes in rectal cancer. Journal of Surgical Oncology 1993; 54(4): 252–254.

47. Dworak O. Number and size of lymph nodes and node metastases in rectal carcinomas. Surgical Endoscopy 1989; 3(2): 96–99.

48. Kim JH, Beets GL, Kim MJ, et al. High-resolution MR imaging for nodal staging in rectal cancer: Are there any criteria in addition to the size? European Journal of Radiology 2004; 52(1): 78–83.

49. Koh DM, Brown G, Husband JE. Nodal staging in rectal cancer. Abdominal Imaging 2006; 31(6): 652–659.

50. Jager GJ, Barentsz JO, Oosterhof GO, et al. Pelvic adenopathy in prostatic and urinary bladder carcinoma: MR imaging with a three-dimensional TI-weighted magnetization-prepared-rapid gradient-echo sequence. American Journal of Roentgenology 1996; 167(6): 1503–1507.

51. Williams AD, Cousins C, Soutter WP, et al. Detection of pelvic lymph node metastases in gynecologic malignancy: A comparison of CT, MR imaging, and positron emission tomography. American Journal of Roentgenology 2001; 177(2): 343–348.

52. Okizuka H, Sugimura K, Ishida T. Preoperative local staging of rectal carcinoma with MR imaging and a rectal balloon. Journal of Magnetic Resonance Imaging 1993; 3(2): 329–335.

53. Chan TW, Kressel HY, Milestone B, et al. Rectal carcinoma: Staging at MR imaging with endorectal surface coil. Work in progress. Radiology 1991; 181(2): 461–467.

54. Indinnimeo M, Grasso RF, Cicchini C, et al. Endorectal magnetic resonance imaging in the preoperative staging of rectal tumors. International Surgery 1996; 81(4): 419–422.

55. McNicholas MMJ, Joyce WP, Dolan J, et al. Magnetic resonance imaging of rectal carcinoma: A prospective study. British Journal of Surgery 1994; 81(6): 911–914.

56. Heriot AG, Grundy A, Kumar D. Preoperative staging of rectal carcinoma. British Journal of Surgery 1999; 86(1): 17–28.

57. Ichikawa T, ENURK SM, Motosugi U, et al. High-B-value diffusion-weighted MRI in colorectal cancer. American Journal of Roentgenology (1976) 2006; 187(1): 181–184.

58. Dzik-Jurasz A, Domenig C, George M, et al. Diffusion MRI for prediction of response of rectal cancer to chemoradiation. The Lancet 2002; 360(9329): 307–308.

59. Hein PA, Kremser C, Judmaier W, et al. Diffusion-weighted magnetic resonance imaging for monitoring diffusion changes in rectal carcinoma during combined, preoperative chemoradiation: Preliminary results of a prospective study. European Journal of Radiology 2003; 45(3): 214–222.

60. Feng Q, Yan YQ, Zhu J, et al. T staging of rectal cancer: Accuracy of diffusion-weighted imaging compared with T2-weighted imaging on 3.0 tesla MRI. Journal of Digestive Diseases 2014; 15(4): 188–194.

61. Mizukami Y, Ueda S, Mizumoto A, et al. Diffusion-weighted magnetic resonance imaging for detecting lymph node metastasis of rectal cancer. World Journal of Surgery 2011; 35(4): 895–899.

62. Sinaei M, Swallow C, Milot L, et al. Patterns and signal intensity characteristics of pelvic recurrence of rectal cancer at MR imaging. Radiographics 2013; 33(5): E171–E187.

63. Palmer G, Martling A, Cedermark B, et al. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Annals of Surgical Oncology 2007; 14(2): 447–454.

64. Lambregts DMJ, Cappendijk VC, Maas M, et al. Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer. European Radiology 2011; 21(6): 1250–1258.

65. Tan PL, Chan CLH, Moore NR. Radiological appearances in the pelvis following rectal cancer surgery. Clinical Radiology 2005; 60(8): 846–855.

66. Pema PJ, Bennett WF, Bova JG, et al. CT vs MRI in diagnosis of recurrent rectosigmoid carcinoma. Journal of Computer Assisted Tomography 1994; 18(2): 256–261.

67. Moore HG, Shoup M, Riedel E, et al. Colorectal cancer pelvic recurrences: determinants of resectability. Diseases of the Colon & Rectum 2004; 47(10): 1599–1606.

68. Messiou C, Chalmers A G, Boyle K, et al. Pre-operative MR assessment of recurrent rectal cancer. The British Journal of Radiology 2008; 81(966): 468–473.