随着新型成像技术的快速发展和需求应对罕见癌症不断上升，基于图像的肛门癌分期的角色和方法已经发生了变化。2014年，欧洲医学肿瘤学会规定采用盆腔磁共振成像（MRI）用于肛门癌，随后其他协会如美国国家综合癌症网络也提出了类似建议。然而，不同中心和甚至同一中心之间的差异很大。值得注意的是，这与解剖学上相邻的直肠癌的成像形成了鲜明的对比。作为这种恶性肿瘤的参与团队成员，我们展开了一次全面的肛门癌成像文献综述，以了解这些新技术（如MRI和正电子发射计算机断层扫描（PET/CT））的相对优点。这次文献综述的结果有助于我们进入下一个阶段：关于肛门癌成像的问卷编制。接下来，我们将问卷分发给腹部放射学会（SAR）直肠和肛门疾病专业小组的成员，该小组是由对直肠和肛门癌有特殊兴趣、经验和专业知识的腹部放射学家组成的，以获得专家放射学家对适当的肛门癌成像策略的意见。在我们的专家意见调查中，专家们普遍支持使用MRI（65％的总体支持率和91-100％的主要分期临床情况下）并认为PET/CT对于淋巴结评估具有卓越性（52-56％的同意使用PET/CT进行主要分期临床情况下的比较，而同意使用MRI的比例仅为30％）。因此我们支持MRI和PET的使用，并建议进一步探索PET/MRI作为最佳联合评估方式。我们的问卷调查回答强调了美国众多学术肿瘤中心的成像实践的异质性，并强调了制定最佳成像实践指南以优化肛门癌患者护理的必要性。© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

The role and method of image-based staging of anal cancer has evolved with the rapid development of newer imaging modalities and the need to address the rising incidence of this rare cancer. In 2014, the European Society of Medical Oncology mandated pelvic magnetic resonance imaging (MRI) for anal cancer and subsequently other societies such as the National Comprehensive Cancer Network followed suit with similar recommendations. Nevertheless, great variability exists from center to center and even within individual centers. Notably, this is in stark contrast to the imaging of the anatomically nearby rectal cancer. As participating team members for this malignancy, we embarked on a comprehensive literature review of anal cancer imaging to understand the relative merits of these new technologies which developed after computed tomography (CT), e.g., MRI and positron emission tomography/computed tomography (PET/CT). The results of this literature review helped to inform our next stage: questionnaire development regarding the imaging of anal cancer. Next, we distributed the questionnaire to members of the Society of Abdominal Radiology (SAR) Rectal and Anal Disease-Focused Panel, a group of abdominal radiologists with special interest, experience, and expertise in rectal and anal cancer, to provide expert radiologist opinion on the appropriate anal cancer imaging strategy. In our expert opinion survey, experts advocated the use of MRI in general (65% overall and 91-100% for primary staging clinical scenarios) and acknowledged the superiority of PET/CT for nodal assessment (52-56% agreement for using PET/CT in primary staging clinical scenarios compared to 30% for using MRI). We therefore support the use of MRI and PET and suggest further exploration of PET/MRI as an optimal combined evaluation. Our questionnaire responses emphasized the heterogeneity in imaging practice as performed at numerous academic cancer centers across the United States and underscore the need for further reconciliation and establishment of best imaging practice guidelines for optimized patient care in anal cancer.© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.