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Figure 9.24. Linitis Plastica of the lower rectum.

(a) T2W1 parallel to and (b) T2W1 perpendicular to the lower rectum. In (a) there is mural thickening with a stratified appearance and in (b) a concentric mural ring pattern (arrowheads). There is a superficial resemblance to the intussusception shown in Figure 9.23. However, in this case, the ring pattern is due to undifferentiated tumour infiltrating between the different layers of the rectal wall, with the muscularis propria (MP) remaining essentially intact. Also, a florid desmoplastic response causes low signal in the submucosa (SM). Piriformis muscle (P), ischio-anal fossa (IAF), obturator internus muscle (O), levator ani muscle (arrows). Bladder (B), rectal lumen (asterisk), sacrum (S). (Reproduced with permission of American Journal of Roentgenology.)

Figure 9.25. Appearances following APR in males.

(a) Sagittal T2W1, (b) and (c) transaxial T2W1s in a male following APR.The bladder (B), prostate (P) and seminal vesicles (asterisk) prolapse into the pelvic void left by the excised rectum. A fibrotic band (arrows) binds the prostate and seminal vesicles to the pelvic floor. In (a) note the high signal of the fatty marrow of the lower sacro-coccygeal segments following radiotherapy (X) and the post-surgical changes in the anterior abdominal wall (S).The small area of high signal in the prostate (curved arrow) is secondary to needle biopsy. (Images courtesy of Dr. Carrington, Christie Hospital.)

Figure 9.26. Appearances following APR in females.

(a) Sagittal T2W1 in a female following APR and (b) and (c) transaxial T2W1s in a different female following hysterectomy and APR.The bladder (B), uterus (U) and vagina (asterisk) prolapse into the pelvic void left by the excised rectum. A fibrotic band (arrows) binds the vagina and cervix in (a) and the vagina and bladder in (b) and (c) to the pelvic floor. Note the posterior angulation of the urethra (Ur) in (a). (Images courtesy of Dr. Carrington, Christie Hospital.)

Figure 9.27. Appearances following radiotherapy.

Figure 9.27. Appearances following radiotherapy.

(a) Transaxial T2W1 and (b) sagittal T2W1 in a female 8 months following intra-cavitary treatment for endometrial cancer. There is thickening and increased signal in the mucosa and submucosa of the rectum and sigmoid colon (arrows). The outer muscularis propria (curved arrows) is also thickened. There is abnormal stranding, nodularity and oedema in the pelvic fat (asterisks) and a trace of ascites (A). Radiation change is also present in the cervix and body of the uterus (U), which is of reduced size and almost uniform low signal intensity, and in the bladder (B) which has a thickened wall and mucosal oedema (crossed arrow). (Images courtesy of Dr. Hulse, Christie Hospital.)

Figure 9.28. Recurrent rectal tumour.

T2W1 perpendicular to the lower rectum. This patient had previously had an anterior lower third rectal tumour resected and there was clinical evidence of recurrent disease at the anastomotic site. Repeated biopsies through the left wall of the rectum revealed fibrotic tissue (F) only, which characteristically returns low signal on T2-weighted imaging as shown here. This image however, also shows an intermediate signal mass more anteriorly (asterisk) extending into the prostate gland (PG) which is much more suggestive of recurrent tumour. This allowed a guided biopsy, which confirmed the diagnosis of recurrent disease. Rectal lumen (L), bladder (B), coccyx (C) and right obturator internus muscle (O).

Figure 9.29. Recurrent rectal cancer following APR.

(a) Sagittal T2W1 and (b) transaxial T2W1 showing recurrent rectal tumour (T) following APR. The tumour has traversed the pelvic floor (arrows) and extends into the ischio-anal fossa (IAF), laterally, and the posterior wall of the vagina and vaginal lumen anteriorly (crossed arrow). Note the posterior prolapse of the uterus (U), vagina (V), bladder (B), and urethra (Ur) due to the previous APR (see Figure 9.26). (Images courtesy of Dr. Carrington, Christie Hospital.)

Figure 9.30. Recurrent rectal cancer following APR with haematometria.

(a) Sagittal T2W1 and (b) transaxial T2W1 showing a mixed composition recurrent tumour (T) in the pre-sacral space following APR. Tumour has invaded the vagina (V) and cervix of the uterus with consequent haematometria (H). Note the fluid/fluid level in the endometrial cavity (crossed arrow). There are tumour nodules adherent to the endometrium (arrows). Tumour has also invaded the sacrum (asterisk), Bladder (B). (Images courtesy of Dr. Hulse, Christie Hospital.)

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