Pre-operative MR assessment of recurrent rectal cancer.

The potential for curative resection of recurrent rectal cancer and the recognized benefits of palliative resection have led to increased numbers of patients being referred for MRI assessment. This study assesses the use of MRI to provide a roadmap of tumour recurrence to allow for appropriate surgical planning. Differentiation of recurrent rectal cancer from post-surgical and post-radiotherapy changes on MR proved particularly problematic when assessing the pelvic sidewalls. Areas of uncertainty on imaging, therefore, need to be discussed on a case by case basis regarding the decision to proceed to curative or explorative surgery.

MRI assessment of the bony pelvis may help predict resectability of rectal cancer.

OBJECTIVE: The outcome after surgical treatment of rectal cancer may be influenced by the technical difficulty of the operation, which is thought to be affected by pelvic size. The aim of this study was to examine the association between bony pelvic dimensions and CRM involvement. PATIENTS AND METHODS: All patients with primary rectal cancer between December 1999 and January 2002 were studied. Staging was performed by pelvic MRI. Nine pelvic dimensions were measured from the MR images on a workstation. Pathology reports were obtained for all patients and the mesorectal specimen was examined. Technical difficulty was assessed by circumferential resection margin (CRM) involvement. RESULTS: Of 126 patients with primary rectal cancer, 88 had staging MRI and rectal excision; there were significant differences between the sexes in all 9 pelvic dimensions (P < 0.05). In females, the interspinous diameter was significantly shorter in patients with CRM involvement compared with patients with a negative CRM. In female patients predicted to have a negative CRM, the anteroposterior diameter of the inlet, the anteroposterior diameter of the midplane and the transverse diameter of the midplane (interspinous distance) were significantly shorter in patients who actually had a positive CRM compared with those in whom the CRM was negative. In male patients, there was no correlation between pelvic dimensions and CRM status. CONCLUSIONS: In certain patients with rectal cancer, CRM positivity may be predicted from pre-operative MRI pelvic measurements. This may influence the choice of adjuvant therapy.

Chest radiography for general practitioners--a low yield investigation.

Of 1,163 chest rediographs requested by general practitioners, 67.5 per cent were normal, 21 per cent revealed an apparently relevant lesion, and 11.5 per cent an apparently irrelevant abnormality. The number of referrals for chest radiography should be reduced to cut costs in an expensive specialty.