New applications of MRI in rectal mucinous adenocarcinoma

PENG Ze-hao, MO Zhong-cheng, LIU Xin-sen, LI Jia-wen, LIU Long-fei

Acta Anatomica Sinica ›› 2026, Vol. 57 ›› Issue (1) : 127-140.

PDF(6650 KB)
Welcome to visit Acta Anatomica Sinica! Today is Chinese
PDF(6650 KB)
Acta Anatomica Sinica ›› 2026, Vol. 57 ›› Issue (1) : 127-140. DOI: 10.16098/j.issn.0529-1356.2026.01.018
Review

New applications of MRI in rectal mucinous adenocarcinoma

  • PENG Ze-hao1, MO Zhong-cheng2, LIU Xin-sen1, LI Jia-wen1, LIU Long-fei1*
Author information +
History +

Abstract

Rectal mucinous adenocarcinoma (RMAC) is a relatively rare but highly aggressive type of tumour, and its early diagnosis and accurate staging are highly important for disease prognosis. With the continuous development of medical imaging technology, MRI, a noninvasive imaging tool, is increasingly being used to diagnose rectal cancer. Although there have been several studies on the application of MRI in rectal cancer, there is still a lack of systematic summaries regarding the specific types, imaging characteristics, diagnostic challenges, and potential solutions for RMAC. In this review, we aim to summarize the MRI characteristics of RMAC, explore the current research status and application prospects of emerging technologies in this field, and provide references for clinical practice.

Key words

Rectal mucinous adenocarcinoma / Magnetic resonance imaging / Diagnostic imaging

Cite this article

Download Citations
PENG Ze-hao, MO Zhong-cheng, LIU Xin-sen, LI Jia-wen, LIU Long-fei. New applications of MRI in rectal mucinous adenocarcinoma[J]. Acta Anatomica Sinica. 2026, 57(1): 127-140 https://doi.org/10.16098/j.issn.0529-1356.2026.01.018

References

[1] Huang A, Yang Y, Shi JY, et al. Mucinous adenocarcinoma: a unique clinicopathological subtype in colorectal cancer[J]. World J Gastro Surg, 2021, 13(12): 1567-1583.
[2] Zhang J, Ge Y, Zhang H, et al. Quantitative T2 mapping to discriminate mucinous from nonmucinous adenocarcinoma in rectal cancer: comparison with diffusion-weighted imaging[J]. Magn Reson Med Sci, 2022, 21(4): 593-598.
[3] Berar M, Ciocan A, Moi E, et al. Comprehensive overview of molecular, imaging, and therapeutic challenges in rectal mucinous adenocarcinoma[J]. Int J Mol Sci, 2025, 26(2): 432.
[4] Pilleron S, Withrow DR, Nicholson BD, et al. Age-related differences in colon and rectal cancer survival by stage, histology, and tumour site: an analysis of United States SEER-18 data[J]. Cancer Epidemiol, 2023, 84: 102363.
[5] Lee DW, Han SW, Lee HJ, et al. Prognostic implication of mucinous histology in colorectal cancer patients treated with adjuvant folfox chemotherapy[J]. Br J Cancer, 2013, 108(10): 1978-1984.
[6] Shin US, Yu CS, Kim JH, et al. Mucinous rectal cancer: effectiveness of preoperative chemoradiotherapy and prognosis[J]. Ann Surg Oncol, 2011, 18(8): 2232-2239.
[7] Kim DD, Litow KJ, Lumbra TJ, et al. Failure of 3 different methods and biopsy sites to diagnose a patient with invasive colorectal cancer[J]. Medicine (Baltimore), 2019, 98(19): e15656.
[8] Alshehri KA, Alsulaimani N, Alghamdi WA, et al. Mucinous differentiation in colorectal cancer: a 10-year experience audit at King Faisal specialist hospital and research centre, Jeddah[J]. Cureus, 2024, 16(3): e56722.
[9] Almeida RR, Souza D, Matalon SA, et al. Rectal MRI after neoadjuvant chemoradiation therapy: a pictorial guide to interpretation[J]. Abdom Radiol (NY), 2021, 46(7): 3044-3057.
[10] Stanietzky N, Morani A, Surabhi V, et al. Mucinous rectal adenocarcinoma|challenges in magnetic resonance imaging interpretation[J]. J Comput Assist Tomo, 2024, 48(5): 683-692.
[11] Horvat N, Hope TA, Pickhardt PJ, et al. Mucinous rectal cancer: concepts and imaging challenges[J]. Abdom Radiol (NY), 2029, 44(11): 3569-3580.
[12] Liu J, Miao G, Deng L, et al. Should the baseline MRI staging criteria differentiate between mucinous and classical rectal adenocarcinoma [J]? Acad Radiol, 2024, 31(4): 1378-1387.
[13] Amankulov J, Akhmetova G, Toleshbaev D, et al. Single-centre evaluation and staging of rectal carcinoma on a 3-Tesla magnetic resonance imaging and correlation with histological profile[J]. Pol J Radiol, 2021, 86: e217-e224.
[14] Curcean S, Curcean A, Martin D, et al. The role of predictive and prognostic MRI-based biomarkers in the era of total neoadjuvant treatment in rectal cancer[J]. Cancers (Basel), 2024, 16(17): 3111.
[15] Colakoglu Er H, Erden A. Mean ADC values discriminate rectal mucinous carcinomafrom rectal nonmucinous adenocarcinoma[J]. Turk J Med Sci, 2017, 47(5): 1520-1525.
[16] Nasu K, Kuroki Y, Minami M. Diffusion-weighted imaging findings of mucinous carcinoma arising in the ano-rectal region: comparison of apparent diffusion coefficient with that of tubular adenocarcinoma[J]. Jpn J Radiol, 2012, 30(2): 120-127.
[17] Zhou M, Chen M, Luo M, et al. Pathological prognostic factors of rectal cancer based on diffusion-weighted imaging, intravoxel incoherent motion, and diffusion kurtosis imaging[J]. Eur Radiol, 2024, 35(2): 979-988.
[18] Song M, Wang Q, Feng H, et al. Preoperative grading of rectal cancer with multiple DWI models, DWI-derived biological markers, and machine learning classifiers[J]. Bioengineering, 2023, 10(11): 1298.
[19] Yin H, Liu W, Xue Q, et al. The value of restriction spectrum imaging in predicting lymph node metastases in rectal cancer: a comparative study with diffusion-weighted imaging and diffusion kurtosis imaging[J]. Insights Imaging, 2024, 15(1): 302.
[20] Ma Q, Liu Z, Zhang J, et al. Multi-task reconstruction network for synthetic diffusion kurtosis imaging: predicting neoadjuvant chemoradiotherapy response in locally advanced rectal cancer[J]. Eur J Radiol, 2024, 174: 111402.
[21] Chen H, Jin Z, Dai X, et al. The diagnostic value of histogram analysis of DWI and DKI for the mismatch repair status of rectal adenocarcinoma[J]. Heliyon, 2024, 10(18): e37526.
[22] El Homsi M, Yildirim O, Gangai N, et al. Contrast-enhanced pelvic magnetic resonance imaging (MRI) for the prediction of treatment response in mucinous rectal cancer[J]. Quant Imaging Med Surg, 2024, 14(6): 4110-4122.
[23] Oberholzer K, Menig M, Pohlmann A, et al. Rectal cancer: assessment of response to neoadjuvant chemoradiation by dynamic contrast-enhanced MRI[J]. J Magn Reson Imaging, 2013, 38(1): 119-126.
[24] Sheng L, Yuan E, Yuan F, et al. Amide proton transfer-weighted imaging of the abdomen: current progress and future directions[J]. Magn Reson Imaging, 2024, 107: 88-99.
[25] Li L, Chen W, Yan Z, et al. Comparative analysis of amide proton transfer MRI and diffusion-weighted imaging in assessing p53 and ki-67 expression of rectal adenocarcinoma[J]. J Magn Reson Imaging, 2020, 52(5): 1487-1496.
[26] Chen WC, Li L, Yan ZX, et al. Three-dimension amide proton transfer MRI of rectal adenocarcinoma: correlation with pathologic prognostic factors and comparison with diffusion kurtosis imaging[J]. Eur Radiol, 2021, 31(5): 3286-3296.
[27] Li J, Lin L, Gao X, et al. Amide proton transfer weighted and intravoxel incoherent motion imaging in evaluation of prognostic factors for rectal adenocarcinoma[J]. Front Oncol, 2022, 11: 783544.
[28] Martens MH, Lambregts DM, Papanikolaou N, et al. Magnetization transfer imaging to assess tumour response after chemoradiotherapy in rectal cancer[J]. Eur Radiol, 2016, 26(2): 390-397.
[29] Minicozzi A, Mosconi E, Cordiano C, et al. Proton magnetic resonance spectroscopy: ex vivo study to investigate its prognostic role in colorectal cancer[J]. Biomed Pharmacother, 2013, 67(7): 593-597.
[30] Nguyen ML, Willows B, Khan R, et al. The potential role of magnetic resonance spectroscopy in image-guided radiotherapy[J]. Front Oncol, 2014, 4: 91.
[31] Lv J, Roy S, Xie M, et al. Contrast agents of magnetic resonance imaging and future perspective[J]. Nanomaterials (Basel), 2023, 13(13): 2003.
[32] Cao WT, Li B, Gong JY, et al. Diffusion-weighted magnetic resonance imaging of mucin pools in locally advanced rectal mucinous adenocarcinoma predicts tumor response to neoadjuvant therapy[J]. Eur J Radiol, 2020, 125: 108890.
[33] Barbaro B, Leccisotti L, Vecchio FM, et al. The potential predictive value of MRI and PET-CT in mucinous and nonmucinous rectal cancer to identify patients at high risk of metastatic disease[J]. Br J Radiol, 2017, 90(1069): 20150836.
[34] Liu M, Zheng W, Liu Y, et al. Value of three-dimensional transrectal ultrasound in diagnosis of rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma: a matched case-control study[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(4): 337-343. (in Chinese)
[35] Chan BPH, Patel R, Mbuagbaw L, et al. EUS versus magnetic resonance imaging in staging rectal adenocarcinoma: a diagnostic test accuracy meta-analysis[J]. Gastrointest Endosc, 2019, 90(2): 196-203, e1.
[36] Leufkens AM, Van Den Bosch MA, Van Leeuwen MS, et al. Diagnostic accuracy of computed tomography for colon cancer staging: a systematic review[J]. Scand J Gastroenterol, 2011, 46(7-8): 887-894.
[37] Fitsiori A, Steffen H. Neuroradiology for the ophthalmologist[J]. Klin Monbl Augenheilkd, 2021. doi:10.1055/a-1671-1066.
[38] Li ZH, You DY, Gao DP, et al. Role of CT scan in differentiating the type of colorectal cancer[J]. Onco Targets Ther, 2017, 10: 2297-2303.
[39] National Health Commission of the People’s Republic Of China. Chinese protocol of diagnosis and treatment of colorectal cancer (2020 edition)[J]. Zhonghua Wai Ke Za Zhi, 2020, 58(8): 561-585.
[40] Berger KL, Nicholson SA, Dehdashti F, et al. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features[J]. AJR Am J Roentgenol, 2000, 174(4): 1005-1008.
[41] Dos Anjos DA, Habr-Gama A, Vailati BB, et al. (18)F-FDG uptake by rectal cancer is similar in mucinous and nonmucinous histological subtypes[J]. Ann Nucl Med, 2016, 30(8): 513-517.
[42] Shapiro R, Ali UA, Lavery IC, et al. Endorectal ultrasound does not reliably identify patients with uT3 rectal cancer who can avoid neoadjuvant chemoradiotherapy[J]. Int J Colorectal Dis, 2013, 28(7): 993-1000.
[43] Maksim R, Buczyńska A, Sidorkiewicz I, et al. Imaging and metabolic diagnostic methods in the stage assessment of rectal cancer[J]. Cancers (Basel), 2024, 16(14): 2553.
[44] Qin M, Liu M, Huang R, et al. Preoperative T-staging of colorectal cancer by dual-energy computed tomography: a retrospective study[J]. Curr Med Imaging, 2024, 20: e15734056260218.
[45] Ma Y, Ma D, Xu X, et al. Progress of MRI in predicting the circumferential resection margin of rectal cancer: a narrative review[J]. Asian J Surg, 2024, 47(5): 2122-2131.
[46] Kim SJ, Lee YJ, Park MY, et al. Postchemoradiation magnetic resonance imaging circumferential resection margin predicts treatment failure after multidisciplinary directed sphincter preservation in low rectal cancer[J]. J surg oncol, 2023, 128(8): 1365-1371.
[47] Taylor FGM, Quirke P, Heald RJ, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the mercury study[J]. J Clin Oncol, 2014, 32(1): 34-43.
[48] Engel R, Kudura K, Antwi K, et al. Diagnostic accuracy and treatment benefit of PET/CT in staging of colorectal cancer compared to conventional imaging[J]. Surg Oncol, 2024, 57: 102151.
[49] Hoshino N, Murakami K, Hida K, et al. Diagnostic accuracy of magnetic resonance imaging and computed tomography for lateral lymph node metastasis in rectal cancer: a systematic review and meta-analysis[J]. Int J Clin Oncol, 2019, 24(1): 46-52.
[50] Wang H, Zhang J, Li Y, et al. Deep-learning features based on F18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict preoperative colorectal cancer lymph node metastasis[J]. Clin Radiol, 2024, 79(9): e1152-e1158.
[51] Eglinton T, Luck A, Bartholomeusz D, et al. Positron-emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal cancer[J]. Colorectal Dis, 2010, 12(7): 667-673.
[52] Falconer R, Connor S, Balasingam A, et al. Does positron emission tomography/computed tomography change management in colorectal cancer [J]? Anz J Surg, 2018, 88(4): E248-E251.
[53] Todate Y, Honda M, Takada T, et al. The additional diagnostic impact of positron emission tomography-computed tomography for lymph node metastasis from colorectal cancer: a prospective lymph node level analysis[J]. J surg oncol, 2021, 124(7): 1085-1090.
[54] Lee S, Kassam Z, Baheti AD, et al. Rectal cancer lexicon 2023 revised and updated consensus statement from the society of abdominal radiology colorectal and anal cancer disease-focused panel[J]. Abdom Radiol (NY), 2023, 48(9): 2792-2806.
[55] Cai Z, Xie X, Chen Y, et al. Risk factor analysis for inaccurate pre-operative MRI staging in rectal cancer[J]. BMC Cancer, 2020, 20(1): 253.
[56] Di Costanzo G, Ascione R, Ponsiglione A, et al. Artificial intelligence and radiomics in magnetic resonance imaging of rectal cancer: a review[J]. Explor Target Antitumor Ther, 2023, 4(3): 406-421.
[57] Kagawa Y, Smith JJ, Fokas E, et al. Future direction of total neoadjuvant therapy for locally advanced rectal cancer[J]. Nat Rev Gastroenterol Hepatol, 2024, 21(6): 444-455.
[58] Horvat N, Papanikolaou N, Koh DM. Radiomics beyond the hype: a critical evaluation toward oncologic clinical use[J]. Radiol Artif Intell, 2024, 6(4): e230437.
[59] Catalano V, Loupakis F, Graziano F, et al. Prognosis of mucinous histology for patients with radically resected stage II and III colon cancer[J]. Ann Oncol, 2012, 23(1): 135-141.
PDF(6650 KB)

Accesses

Citation

Detail

Sections
Recommended

/