Recognition of the Anterior Peritoneal Reflection at Rectal MRI

Abstract

The peritoneal reflection was identified on MRI by two radiologists in the majority of patients with rectal cancer.

MR imaging of pelvic extraperitoneal masses: A diagnostic approach

“…have reported that this line can be identified in 74.4% of patients on MR imaging of the pelvis [1]. The tip of the seminal vesicles in men and the uterocervical angle in women were constant landmarks to determine the location of the most inferior point of the peritoneal membrane [1]. The reasons for difficulty in identifying the anterior peritoneal reflection line included postoperative status, poor image quality, motion artifact, a paucity of pelvic fat planes, retroversion of the uterus and presence of a large, exophytic rectosigmoid tumor [1].…”

“…Gollub and al. have reported that this line can be identified in 74.4% of patients on MR imaging of the pelvis [1]. The tip of the seminal vesicles in men and the uterocervical angle in women were constant landmarks to determine the location of the most inferior point of the peritoneal membrane [1].…”

“…The tip of the seminal vesicles in men and the uterocervical angle in women were constant landmarks to determine the location of the most inferior point of the peritoneal membrane [1]. The reasons for difficulty in identifying the anterior peritoneal reflection line included postoperative status, poor image quality, motion artifact, a paucity of pelvic fat planes, retroversion of the uterus and presence of a large, exophytic rectosigmoid tumor [1]. The anterior peritoneal reflection line was particularly well seen in patients who had fluid in the pelvic cul-de-sac (Fig.…”

A structured approach to reporting rectal cancer with magnetic resonance imaging

“…Identification of the anterior peritoneal reflection can be challenging and is best assessed on both axial and sagittal T2 images. In the mid- distance from the anorectal junction to the anterior peritoneal reflection, as measured in a straight line on a sagittal image was 6.7-6.9 cm in a published series [23]. Figure 6 shows examples of the anterior peritoneal reflection in the female and male pelvis on sagittal T2 images.…”

Rectal Cancer and Anal Sphincter Disorders

“…It offers several theoretical advantages over EUS as it reveals a larger field of view and permits the study of stenotic, nontraversable tumors [18,40,41]. Recently, the identification of the anterior peritoneal reflection on MRI in 74 % of patients in one study is important given the impact of this landmark on surgical planning [42]. A meta-analysis of 90 articles (1995-2002) compared the utility of MRI, radial EUS without FNA, and CT for staging with histopathology correlation as the gold standard and came to the following conclusions: For T1/T2 lesions, EUS and MRI had similar sensitivity, but specificity was higher in EUS (86 vs. 69 %); for T3 tumors, the sensitivity of EUS was significantly higher than that of MRI or CT [43].…”