The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the "DISTANCE"?

Rectal cancer is a common and serious disease in the Western hemisphere. Optimal treatment of rectal cancer involves a multidisciplinary approach, with collaboration required between radiologists, oncologists, surgeons, and pathologists to achieve local control and decrease the rate of recurrence. Several studies have been published that show the ability to accurately stage rectal cancer with magnetic resonance (MR) imaging. Moreover, advances in preoperative therapies require accurate preoperative staging with MR imaging to select those patients who may benefit from more intensive treatment, without subjecting those who will not benefit to unnecessary treatment. As we enter an era of individualized patient care, stratified according to the risk of both local and distant failure, imaging takes on the same importance as the tumor type and genetic susceptibility. MR imaging is now an essential tool to enable the oncology team to make appropriate treatment decisions. However, rectal cancer evaluation with MR imaging remains a challenge in the hands of nonexperts. This article describes a mnemonic device, "DISTANCE," to enable a systematic approach to the interpretation of MR images, thereby enabling all the clinically relevant features to be adequately assessed: DIS, for Distance from the Inferior part of the tumor to the transitional Skin; T, for T staging; A, for Anal complex; N, for Nodal staging; C, for Circumferential resection margin; and E, for Extramural vascular invasion.