The accuracy of MRI in diagnosing recurrent disease varies depending on the tumour type and morphological appearance of the recurrence. In locally recurrent prostate cancer the sensitivity and specificity of MRI can be up to 100% when typical signal intensity appearances are seen in a palpable tumour nodule (usually intermediate to high T2-weighted signal for recurrences). However, in rectal cancer, the effects of surgery and radiotherapy make recurrence more difficult to identify and this is often compounded by the infiltrative nature of the disease process. The recurrences may be high, intermediate or low signal intensity on T2-weighted images. High signal intensity inflammation, oedema, and acute or subacute radiotherapy effect may mimic tumour, and low signal established radiation fibrosis may be indistinguishable from tumours with a high fibrotic component. Accuracy of diagnosis of recurrent rectal cancer is 75% using conventional sequences. Dynamic contrast enhanced MRI results in greater enhancement of rectal tumour recurrence than treatment effect and hence improved sensitivity and specificity. In cervical cancer recurrence, accuracy of diagnosis is 74% employing T2-weighted images, with sensitivities and specificities of 90% and 38%. Using dynamic contrast-enhanced MRI and pharmacokinetic analysis accuracy of diagnosing cervical cancer recurrence rises to over 90%. However, this technique requires more sophisticated image analysis.
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