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. 2021 Aug 9;12:114. doi: 10.1186/s13244-021-01055-w

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 2 — Incomplete/poor tumour response. A 75 year-old male presented with a low mrT3a mrN0 EMVI + (not shown) CRM-rectal cancer (arrows in a–c). He underwent NAT and was re-staged at 12 weeks with MR imaging (d, e) and endoscopy (f). Reduction in size was estimated as < 50%, as may be inferred in d vs a. On T2-WI, the tumour scar was composed largely of intermediate signal intensity tissue (d), classified as mrTRG4 with absent split scar sign. On high b value DWI (e), a thick layer of high signal intensity was apparent at the endoluminal aspect of the tumour bed and a persistent infiltrative lesion was visible on endoscopy (between arrows in f). Patient underwent surgery and specimen was staged as a ypT3 (extension into mesorectal fat visible at macroscopy in g) N1c (not shown) TRG3 R0. At microscopy, viable tumour was predominantly mucosal/submucosal (arrow in h) but there were niches of viable tumour cells within the muscularis propria (arrows in i) and also at perirectal fat (not shown)