الفهرس 
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Abstract
Rectal cancer is one of the best examples of success of clinical research in the past 40 years. Total mesorectal excision (TME) alone, as opposed to blunt “pelvic rape”, resulted in an increase in the 5-year cancer-specific survival rate from 38 to 68%.
MRI has become one of the key diagnostic tools in the assessment of patients with rectal cancer. The role of MRI in management of patients with rectal cancer is likely to expand and can contribute to treatment planning and response assessment as multidisciplinary teams work together to best serve our patients.
The standard rectal cancer MRI protocol includes thin-slice, high spatial resolution T2-weighted images to encompass the rectal tumor and the surrounding perirectal tissues and mesorectum obtaining images in three planes of view: oblique axial perpendicular to the tumor; sagittal determined by the longitudinal axis; and oblique coronal plane parallel to the anal canal
MRI provides information on tumor size, location, Tumor Stage, relation to the sphincters and peritoneal refection, evidence of EMVI, and, most importantly, on the predicted circumferential resection margin (CRM).
MRI can detect the relationship of the tumor to the Intersphincteric space and levators. Most of superficial tumors (T1 and 2) that have not invaded the Intersphincteric plane are more likely to be resected with clear CRM and thus require a less radical procedure as compared to T3 and T4 tumors that have invaded the Intersphincteric space or levators.
Key features are well defined on MRI, allowing for noninvasive, highly accurate rectal cancer staging. Measurement of the distance from the most caudal aspect of the tumor to the anal verge and the relationship of the tumor to the upper margin of the puborectalis sling are clearly seen, assisting in determination of sphincter preservation.
The location of the tumor relative to the anal sphincter complex in locally advanced low rectal cancer is also clearly seen by MRI, to help identify patients who will benefit from neoadjuvant Chemo-Radioherapy (nCRT), potentially improving sphincter preservation and disease-free survival, and reducing abdomino-perineal resection (APR) rates.
Although MRI remains the best imaging tool for the preoperative assessment of Circumferential Radial Margin (CRM) and should be performed in all patients with rectal cancer, it can overestimate CRM involvement in low and anterior tumors. Consequently, tumor location should be considered.
The aim of the work is to evaluate sensitivity, specificity, accuracy and Value of MRI in pre-operative assessment of rectal Cancers and its impact on Surgical Decision and Intervention.
This prospective study will include 60 patients with rectal Cancers Patients were either collected from the Surgery Outpatient Clinics in Minia University Hospital and National Cancer Institute.
MRI has been shown to have a high accuracy to determine invasion of adjacent organs and may be used to select eligible patients for surgery and as a road map for surgical planning. A classification into seven anatomical compartments according to the fascial limits and the anatomical planes of dissection has been suggested. The same study investigated the performance of MRI detecting invasion of each pelvic compartment and showed that MRI has a sensitivity superior to 93.3% in all except for the lateral compartment where it was 89.3%. Another simplified classification recently proposed has shown that a peri-anastomotic recurrence is associated with better DFS after salvage surgery. The Beyond TME trial is an ongoing multicenter prospective trial that has been studying the role of MRI in selecting and guiding surgery.
The results of our present study can be summarized as follows:
1. There were 27 Cases were males and 33 were females and their ages ranged from 23 to 72 years, only 16 Patients not received Neoadjuvant Chemoradiotherapy (NACRT) {because they were low risk patients (Early stage upper and middle rectal Cancer)} and the rest of patients (44 cases) received long course Neoadjuvant Chemoradiotherapy 5 weeks and MRI done after NACRT.
2. There was Significant correlation between MRI and operative finding of the cases as regard Distance of the tumor from anal verge, The highest correlation (ICC range 0.797–0.812), the least mean difference (range 0.77–0.85 cm) and the least standard deviation (range 4.3-4.5 cm) with MRI as regard distance of the tumor.
3. There was agreement between MRI and operative finding of the cases as regard Location of the tumor with accuracy of MRI was 92.5% in patients with a tumor located at the upper rectum, 90.5% in patients with a tumor located on the middle rectum, and 95.6% in patients with tumor located lower rectum (p=0.061).
4. No Significant difference between the final pathology and MRI as regard Tumor staging and lymph node metastasis.
5. There were significant correlation between MRI and operative finding of the cases as regard MRF involvement, involvement to the sphincters and puborectalis muscle and tumor infiltration to adjacent organs.