Computed tomography in carcinoma of the rectum

Zaunbauer, Wolfgang; Haertel, M; Fuchs, W. A.

doi:10.1007/bf01890226

Cited by 80 publications

(22 citation statements)

References 10 publications

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“…Despite numerous previous reports on the value of CT examination of the pelvis for detecting local recurrence after resection of rectal carcinoma [5][6][7][8][9][10][11][12][13], we are aware of only one other series that assesses the appearance of the pelvis on serial CT studies at defined time intervals in asympto matic patients [14]. Our study provides the opportunity to observe the evolution of changes in the operative bed and to detect early local recurrence in asymptomatic patients.…”

Section: Discussionmentioning

confidence: 95%

The pelvis after surgery for rectal carcinoma: serial CT observations with emphasis on nonneoplastic features

Kelvin¹,

Korobkin²,

Heaston³

et al. 1983

American Journal of Roentgenology

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Ten asymptomatic patients who had undergone resection of rectal carcinoma were evaluated prospectively by at least three serial computed tomographic (CT) examina tions of the pelvis within 24 months of surgery. Of the seven patients who had undergone abdominoperineal resection, five were found to have a presacral mass due to normal postoperative changes within the first 4 months. The mass showed a variable diminution between 4 and 9 months after operation and developed a more distinct outline, partial separation from the sacrum, or a change in configuration to a thin transverse sliver. These changes indicate the possibility of CT differentiation of a normal postoperative mass from local recurrence. In the other five patients, no post operative mass was observed. In one patient CT demonstrated a solitary 1.5 cm lymph node metastasis. This patient was asymptomatic and had a normal carcinoembryonic antigen level. From these observations, a baseline CT study of the pelvis within 2-4 months of resection of rectal carcinoma, followed by serial CT examinations at about 6-month intervals is recommended for the detection of early asymptomatic pelvic recurrence and to facilitate differentiation from persistent postoperative changes. Received February 23, 1983; accepted after revision July 13, 1983. The clarity with which CT can demonstrate pelvic anatomy suggests that it may be capable of detecting small recurrences before the development of symptoms.This potential led us to institute a prospective study involving serial CT exami nations of the pelvis in asymptomatic patients after resection of rectal carcinoma.In several of the patients in this study, a nonneoplastic mass in the presacral operative bed was detected by CT. Authors previously have noted the difficulty of distinguishing such a mass after abdominoperineal (AP) resection from local pelvic recurrence on the basis of a single CT study [6,8]. We describe the AJR 141:959-964,

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Section: Discussionmentioning

confidence: 95%

The pelvis after surgery for rectal carcinoma: serial CT observations with emphasis on nonneoplastic features

Kelvin¹,

Korobkin²,

Heaston³

et al. 1983

American Journal of Roentgenology

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“…Preoperative staging using CT scans in rectal cancer patients was first reported in the early 1980s. Early reports with conventional CT mainly focused on locally advanced rectal cancer and the accuracies for the T3 stage were 79 94% (12)(13)(14). Most early studies were performed using nonhelical CT units that were limited by a lack of the high resolution, thin collimation images achievable by the current MDCT instruments.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Assessment of Mesorectal Fascial Involvement in Patients with Rectal Cancer: The Diagnostic Value of MDCT for Measuring the Mesorectal Fascial Thickness

Seo

Yoon

Lee

et al. 2007

J Korean Radiol Soc

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Purpose: To assess the diagnostic value of the use of multi-detector row computed tomography (MDCT) in evaluating mesorectal fascial (MRF) involvement in patients with T3 stage rectal cancer. Materials and Methods: From September 2005 to June 2006, we enrolled 21 patients with T3 stage rectal cancer. In addition, 21 healthy patients were enrolled in a control group. Two radiologists measured the mean MRF thickness independently. We considered positive MRF involvement when the MRF thickness exceeded 4 mm, and then we measured the MRF thickness of patients with T3 rectal cancer. We analyzed interobserver agreement for the measured MRF thickness of the control group and assessed the diagnostic value of 4 mm, 5 mm and 6 mm as references in predicting MRF involvement. Results:The mean MRF thickness of the control group was 3.24 0.50 mm (radiologist 1) and 3.04 0.51 mm (radiologist 2). Using 4 mm, 5 mm and 6 mm as a reference thickness in predicting MRF involvement, sensitivity was 100%, 100% and 28.57%, specificity was 71.43%, 85.71% and 92.86%, the false negative rate (FNR) was 0%, 0% and 71.43%, the false positive rate (FPR) was 28.57%, 14.29% and 7.14%, the negative predictive value (NPV) was 100%, 100% and 72.2%, the positive predictive value (PPV) was 63.64%, 77.78% and 66.7%, and the accuracy was 80.95%, 90.48% and 71.43%. Conclusion: Preoperative assessment of the MRF thickness on MDCT is beneficial in predicting MRF involvement in patients with advanced rectal cancer and a value of 5 mm as a reference MRF thickness was established.

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“…The early results published in the literature [56,58,61] were optimistic and indicated a satisfactory correlation of more than 90% between CT staging and the final histopathologic assessment. A critical analysis of these first reports reveals limitations in stage definitions and demonstrates that, commonly, only advanced lesions were investigated by CT. More recent studies [4,21] indicate that results have improved due to clearer stage definitions, with an accuracy ranging from 47% to 75%.…”

Section: Imaging Modalities Computed Tomographymentioning

confidence: 93%

“…Tumours within the rectal wall and slight invasion through the wall cannot be assessed. Despite some enthusiastic reports [4,61] the results of evaluation of LN with CT are still unacceptable. Accurate assessment of local spread can only be achieved in advanced tumours.…”

Section: Imaging Modalities Computed Tomographymentioning

confidence: 98%