High-Resolution MRI of the Anatomy Important in Total Mesorectal Excision of the Rectum

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Abstract
OBJECTIVE. The surgical removal of a rectal carcinoma and the adjacent lymph nodes in an en bloc package lessens the risk of local recurrence due to residual tumor. Heightened awareness of good surgical techniques has created much interest in the anatomy involved in total mesorectal excision surgery, with particular focus on the fascial planes and nerve plexuses and their relationship to the surgical planes of excision. Clear preoperative depiction of these relationships is of value in determining tumor resectability. The aim of this study was to describe the radiologic appearance of these anatomic structures.SUBJECTS AND METHODS. High-spatial-resolution T2-weighted MRI was performed using a 1.5-T system in cadaveric sections and in patients before they underwent total mesorectal excision surgery. Anatomic dissections of sagitally sectioned hemipelves were compared with MRIs obtained in vivo to establish criteria for visualization of the structures relevant to anterior resection of the rectum.RESULTS. Hig...