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Morphological aspects of the rectal neovascularization in colorectal cancer - anatomical-surgical and imaging implications.

Colorectal neoplasia has an increasing incidence among the population, and this fact compels in achieving an early diagnosis and treatment protocols. The extramural vascular invasion (EMVI) score is a method used for staging cancer. It defines the presence of malignant cells in the blood vessels, outside its own vascular tunic. The purpose of the study is to evaluate the extramural vascular invasion, and thus the impact of this determination in diagnosis, treatment and prognosis of colorectal neoplasia. This was done using magnetic resonance images (MRI) of colonoscopic diagnosed patients with colorectal cancer and subsequently comparing these results with the control group of patients without malignancy. The EMVI criteria taken into account were correlated with the images obtained in patients in the study group. In each of the evaluated patients, we found both, arterial and venous blood vessels in 0 stage - EMVI correlated with T2 or T3 stage tumor. In T3 B stages, we could objectify suggestive images for stage 4 EMVI near and distant from the tumor. Blood and lymph vessels have a high density to their origin area and it decreases anteriorly. This distribution is consistent with a predisposition to the formation of a vascular rectal cancer, especially on the posterior wall. In conclusion, anatomical-imaging staging of colorectal cancers using EMVI score is very close to the colonoscopic diagnosis and to the accuracy of the classic cancer staging. Corroborating EMVI score with a vascular radiology reference pattern improves the accuracy for determining an appropriate treatment and assessment of prognosis.