Postirradiation changes in the rectum and perirectal tissue were assessed by computed tomography (CT) in 55 patients (total of 60 examinations) and correlated with radiation dose and time elapsed. Thickening of the perirectal fascia, increased density of the perirectal fat, and swelling of the rectal wall occurred in 48, 60, and 8% of patients, respectively, regardless of radiation dose within 30 Gy. However, widening of the presacral space was seen in 8% of patients receiving a rectal dose of less than 45 Gy, a percentage that increased to 16% for patients receiving 45 Gy or more. Thickening of the perirectal fascia, increased density of the perirectal fat, widening of the presacral space, and muscular changes were seen regardless of the time from the start of therapy. CT does not appear to be reliable enough in detecting residual or recurrent tumor in the rectum. However, knowledge of the CT features of postirradiation changes is helpful for diagnosis in patients with pelvic malignancies.
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