Better techniques can help determine management and predict outcome

O ver the past decade several clinical applications of magnetic resonance imaging have been developed for benign and malignant conditions of the pelvis. The production of easily recognisable multiplanar images of high soft tissue contrast—without the operator dependence of ultrasonography or the ionising radiation of computed tomography—well suit magnetic resonance imaging for such tasks. Attractive though the technique appears, we must demand more from such an expensive—and still scarce—resource.

The applications of magnetic resonance imaging in the pelvis have received great scrutiny. Several large prospective studies have been performed comparing pelvic magnetic resonance with surgical specimens sectioned and analysed in the planes used for imaging. Its diagnostic performance is thus well validated for cancer of the rectum, cervix, and prostate.1^–3 Its key advantage is prediction of local extension of cancer beyond the primary organ. Here, magnetic resonance imaging competes with tried and tested clinical methods such as digital examination, probing, examination under anaesthetic, or alternative imaging tests such as ultrasonography and computed …