The role of magnetic resonance imaging (MRI) in rectal cancer management has significantly increased over the last decade, in line with more personalized treatment approaches. Total neoadjuvant treatment (TNT) plays a pivotal role in the shift from traditional surgical approach to non-surgical approaches such as ‘watch-and-wait’. MRI plays a central role in this evolving landscape, providing essential morphological and functional data that support clinical decision-making. Key MRI-based biomarkers, including circumferential resection margin (CRM), extramural venous invasion (EMVI), tumour deposits, diffusion-weighted imaging (DWI), and MRI tumour regression grade (mrTRG), have proven valuable for staging, response assessment, and patient prognosis. Functional imaging techniques, such as dynamic contrast-enhanced MRI (DCE-MRI), alongside emerging biomarkers derived from radiomics and artificial intelligence (AI) have the potential to transform rectal cancer management offering data that enhance T and N staging, histopathological characterization, prediction of treatment response, recurrence detection, and identification of genomic features. This review outlines validated morphological and functional MRI-derived biomarkers with both prognostic and predictive significance, while also exploring the potential of radiomics and artificial intelligence in rectal cancer management. Furthermore, we discuss the role of rectal MRI in the ‘watch-and-wait’ approach, highlighting important practical aspects in selecting patients for non-surgical management.
在过去的十年中，随着治疗策略日益个性化，磁共振成像（MRI）在直肠癌诊疗中的作用显著提升。全新辅助治疗（TNT）在推动传统手术模式向“观察等待”等非手术模式转变中发挥着关键作用。在这一发展进程中，MRI通过提供支持临床决策的关键形态学与功能学数据，占据着核心地位。基于MRI的关键生物标志物——包括环周切缘（CRM）、壁外血管侵犯（EMVI）、肿瘤沉积、弥散加权成像（DWI）及MRI肿瘤退缩分级（mrTRG）——已被证实对肿瘤分期、疗效评估及患者预后具有重要价值。功能成像技术如动态对比增强MRI（DCE-MRI），以及基于影像组学与人工智能（AI）的新兴生物标志物，有望通过提供增强T/N分期、组织病理学特征分析、治疗反应预测、复发监测和基因组特征识别的数据，彻底改变直肠癌诊疗模式。本综述系统阐述了具有预后与预测价值的成熟MRI形态学及功能学生物标志物，同时探讨了影像组学与人工智能在直肠癌管理中的应用潜力。此外，我们还讨论了直肠MRI在“观察等待”策略中的作用，重点分析了选择非手术治疗患者时需关注的重要实践要点。
肿瘤(癌症)患者之家