Evaluation of spiral CT in staging of colon and rectum carcinoma

Abstract

The purpose of our study was to evaluate the capability of a subsecond spiral-CT scanner using two contrast medium phases in staging of colorectal cancer. In our study we included 37 patients with proven rectum or colon carcinoma. Spiral CT was performed following tap-water enema of the colon in the arterial and venous phases of contrast medium enhancement. Our results were compared with the findings of pathological examination after surgery. The tumor's size and extension were evaluated in the arterial and venous phases, the lymph nodes in the venous phase of the CT scan. The tumor was in the rectum (n = 14), sigma (n = 11), descending colon (n = 6), and cecum (n = 6). Two-phase spiral CT had a sensitivity of 97.2% in the arterial phase and 89.1% in the venous phase in detecting the carcinoma. The staging results were in the arterial phase in 30 of 37 cases (81.0%) and in the venous phase in 24 of 37 cases (64.8%) according to pathology. In 27 of 32 patients (84.3%) lymph nodes were detected. The correct classification of the N-stage was possible in 23 of 34 cases (67.6%). The combined use of arterial and venous phases in staging of colorectal cancer can improve the T- and N-stage classification in comparison with using only one contrast medium phase. The arterial phase is superior compared with the venous phase for local tumor staging and the venous phase is used for lymph node assessment.

Preoperative computed tomography staging of nonmetastatic colon cancer predicts outcome: implications for clinical trials

“…Newer multi-slice/spiral-CT scanners, which are able to collect 1-mm thick slices, within a single breath hold permitting 3D reconstruction, give improved resolution and image quality. Two small series using CT colonography ('virtual colonoscopy') have produced good results, with correct T-staging reported in 26 (78.7%) of 33 and 30 (81%) of 37 colorectal tumours (Hundt et al, 1999;Laghi et al, 2002).…”

“…Previous studies examining the usefulness of preoperative CT for staging of colon cancer have judged its 'accuracy' by comparisons with histology (Freeny et al, 1986;Balthazar et al, 1988;Acunas et al, 1990;Hundt et al, 1999). Although tumour staging has its origins in the histological description of colorectal cancers (Dukes, 1932), its rationale is in the stratification of patients into prognostic categories.…”

Assessment of spiral CT pneumocolon in preoperative colorectal carcinoma

“…Gazelle et al [5] , reported that its sensitivity is 60% and specificity is 79%. Hundt et al [4] , reported that its sensitivity is 84.3%, its specificity being 60% and accuracy being 81.0%. In this present study, its sensitivity, specificity, and accuracy in detecting lymph node involvement were 75.0%, 90.9%, and 85.9%, respectively.…”

“…Otherwise, collapse of the colon and feces can easily be misinterpreted as tumor. Many studies have shown that water enema spiral CT is a useful modality for preoperative staging of patients with colorectal carcinoma [4][5][6][7] . However, water enema can be difficult and distressing in frail elderly patients and has risk of water incontinence.…”

The Potential of Transvaginal Three-dimensional Color/Power Doppler Ultrasound in Detection of Colorectal Cancer

“…14 The sensitivity for detection of distant metastasis is higher (upto 87%) than the sensitivity for detection of nodal involvement (upto 73%) or depth of transmural invasion (upto 50%). 15 Standard practice in the USA is that all patients with stadium 2, 3 or 4 of CRC undergo CT, either prior to or after tumor resection.…”