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MRI of a male patient with locally advanced rectal cancer. A mid to high rectal cancer is visualized with anterior invasion of the peritoneal reflection (white arrowhead) and posterior nodular tumoral extension into the mesorectal fat and invasion of a vein, indicating a tumor with extramural venous invasion (white arrow). Extramural venous tumor invasion in rectal cancer is known as a poor prognostic risk factor and neoadjuvant therapy is generally indicated when EMVI is suspected on MRI. Source: Locoregional Staging and Restaging of Rectal Cancer, Textbook of Surgical Oncology Citation: Morita SY, Balch CM, Klimberg V, Pawlik TM, Posner MC, Tanabe KK. Textbook of Surgical Oncology; 2016 Available at: http://mhmedical.com/ Accessed: May 06, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved