In rectal cancer patient management, quality-of-life compromise due to unnecessary neoadjuvant chemoradiation is a major concern and may be driven by false positive lymph node(LN) staging. We sought to distinguish benign LNs from LNs with different patterns of malignant infiltration by investigating multi-exponential decay in multi-gradient-echo(MGE) MRI ex-vivo, at 16.4T. The experiment was translated to the clinic and performed at 1.5T during rectal cancer staging. We found that the 2-compartment model of T2* decay allows malignant and benign LNs to be distinguished in clinical images with a higher specificity than that of conventional criteria, namely short-axis>5mm, border irregularity and mixed signal intensity.
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