MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF EARLY ANASTOMOSIS
INSUFFICIENCY AFTER SURGICAL TREATMENT OF RECTAL CANCER
Myalina S.A.1, Berezovskaya T.P.1, Nevolskikh A.A.1,4, Ivanov S.A.1,4, Kaprin A.D.2,3,4
1 - A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre. Obninsk, Russia.
2 - National Medical Research Radiological Centre. Obninsk, Russia.
3 - P. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre. Moscow, Russia.
4 - Рeoples Friendship University of Russia. Moscow, Russia.
Purpose. To systematize the MRI features of colorectal anastomotic insufficiency in patients with rectal cancer during the postoperative period, and evaluate their diagnostic and prognostic effectiveness.
Materials and methods. A retrospective study included 74 patients with rectal cancer who underwent surgical or combined treatment at the A. Tsyb Medical Radiological Research Centre, a branch of the Federal State Budgetary Institution "National Medical Research Radiological Centre" of the Ministry of Health of the Russian Federation, from 2014 to 2023, focusing on patients with hardware colorectal anastomosis. The main group consisted of 49 patients with anastomotic failure (AF), which was confirmed by instrumental studies or surgical intervention. The control group included 25 patients without clinical, laboratory and instrumental data. All patients underwent MRI of the pelvic organs using a 1.5 T MRI scanner with a multichannel body coil, which included a standard overview examination of the entire pelvis in T2 and T1 modes. High-resolution T2-weighted images (T2-WI) in three orthogonal planes relative to the anastomosis were used to assess its condition. Post-contrast T1-weighted images (T1-WI) with fat suppression (FS) were obtained before and after intravenous contrast in 27 patients. Additionally, 12 patients had T1 and FS after endorectal contrast with a paramagnetic solution according to a method developed by us.
Results. A direct MRI sign in the postoperative period was the presence of reliably detectable diastasis between the anastomosed intestinal fragments on coronal and sagittal T2-WI, combined with a circumferential defect on axial T2-WI, detected in 78% of patients in the main group. Diastases of 4 mm or greater were reliably identified. In cases of questionable visualization of the defect, the MRI technique with a contrast enema confirmed its presence. Additional MRI signs that increased the likelihood of infection included diffuse edema of the reduced colon, local perianastomotic fluid accumulation, and fluid presence in the pelvic cavity. The diagnostic significance of the presence of air bubbles in the anastomosis zone and pelvic region, as well as hypoperfusion of the lowered intestine, was not confirmed. A prognostic value for relaparotomy was found with a circumferential defect greater than ½. The presence of AF in the postoperative period increased the likelihood of maintaining a permanent stoma.
Discussion. The results indicate the high efficiency of MRI in detecting AF during the postoperative period. Therefore, it is advisable to consider including pelvic MRI in the standard list of diagnostic studies during this period, particularly for patients with a high clinical probability of AF. It is necessary to optimize the pelvic MRI protocol for AF detection in order to reduce scan time and obtain reliable results quickly.
Conclusion. Pelvic MRI is a promising method for detecting AF and related complications of surgical treatment for rectal cancer in the postoperative period, offering advantages such as no radiation exposure and the ability for dynamic monitoring.
Keywords: rectal cancer, anastomosis failure, magnetic resonance imaging.
Corresponding author: Myalina S.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript .
For citation: Myalina S.A., Berezovskaya T.P., Nevolskikh A.A., Ivanov S.A., Kaprin A.D. Magnetic resonance imaging in the diagnosis of early anastomosis insufficiency after surgical treatment of rectal cancer. REJR 2026; 16(2):92-107. DOI: 10.21569/2222-7415-2026-16-2-92-107.
Received: 07.04.26 Accepted: 01.08.26