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. 2016 Jul 18;3:145–152. doi: 10.1016/j.ejro.2016.06.003

Fig. 2.

Fig. 2

Complete response. MR images of a 70-year old man classified as complete responder on combined set of conventional and DW images and as partial responder on T2-weighted images. (a) Pre-CRT axial T2-weighted image shows neoplastic tissue in the middle rectum (white arrow) with nodal involvement (white arrowhead); the tumor has spread through the rectal wall into the perirectal fat for less than 5 mm (T3a N2 stage). (b) Pre-CRT DW (b = 800 s/mm2) image shows a focal high signal intensity area in the corresponding tumor (white arrow). (c) Pre-CRT ADC map at the same level shows reciprocal low signal intensity area due to the pathological tissue (white arrow). The mean ADC value was 0.752 × 10−3 s/mm2. (d) Post-CRT axial T2-weighted image shows a wall thickening of the rectum with low signal intensity (white arrow), not clearly depicted as fibrosis. (e) Post-CRT DW (b = 800 s/mm2) image shows no residual high signal intensity in the primary tumor bed. (f) Post-CRT ADC map at the same level: the mean ADC value was 1.076 × 10−3 s/mm2. On the basis of qualitative and quantitative DWI analysis the patient should be considered as complete responder. (g) Photomicrograph (H&E x800). Complete response (TRG: 4), absence of tumor remnants; fibrous reaction induced by the treatment and calcifications are evident.