Detection of colorectal tumors with water enema-multidetector row computed tomography

Department of Abdominal Imaging, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France, .
Abdominal Imaging (Impact Factor: 1.63). 01/2012; 37(6). DOI: 10.1007/s00261-012-9844-z
Source: PubMed


PURPOSE: To retrospectively determine the diagnostic capabilities of water enema-multidetector row computed tomography (WE-MDCT) in the detection of colorectal tumors. MATERIALS AND METHODS: One hundred and one patients (55 male, 46 female) who had WE-MDCT and videocolonoscopy because of suspected colorectal tumors were included. Results of complete videocolonoscopy, surgery, and histopathologic analysis were used as standard of reference. Sensitivity, specificity, and accuracy, and positive and negative predictive values of WE-MDCT for the diagnosis of colorectal tumors were estimated with 95% confidence intervals (CIs). RESULTS: Ninety-two colorectal tumors (64 malignant, 28 benign) were confirmed in 71 patients (prevalence, 71/101; 70%). Overall sensitivity for colorectal tumor detection was 87% (80/92; 95%CI: 78%-93%) on a per lesion basis. For malignant and benign tumor detection, sensitivity was 100% (64/64; 95%CI: 94%-100%) and 57% (16/28; 95%CI: 37%-76%), respectively. For colorectal tumors ≥10 mm, sensitivity was 99% (76/77; 95%CI: 93%-100%). Seventy-nine of the 83 colorectal tumors ≥6 mm were detected, yielding a sensitivity of 95% (79/83; 95%CI: 88%-99%) for this specific size category. On a per patient basis, WE-MDCT had a sensitivity of 100% (71/71; 95%CI: 94%-100%), a specificity of 100% (30/30; 95%CI: 88%-100%), an accuracy of 100% (101/101; 95%CI: 96%-100%), a positive predictive value of 100% (71/71; 95%CI: 94%-100%), and a negative predictive value of 100% (30/30; 95%CI: 86%-100%) for the diagnosis of colorectal tumor. CONCLUSION: Our results suggest that WE-MDCT is a promising imaging technique for the detection of malignant colorectal tumors. However, our results should be validated by larger and prospective studies.

5 Reads
  • Source
    • "WE-MDCT provides a panoramic multiplanar visualisation of intestinal abnormalities, associated extramural findings or complications, with sub-millimetre spatial resolution reproducing the classical orientation of double-contrast barium enema that is familiar to most surgeons. Currently, WE-MDCT is increasingly proposed as the most accurate imaging technique in patients with suspected or proven colorectal neoplasms [4–7] and to diagnose bowel endometriosis [8, 9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Water enema multidetector computed tomography (WE-MDCT) is currently considered the most accurate imaging modality to provide high-resolution multiplanar visualisation of the colonic wall and surrounding structures. METHODS: This pictorial review presents our experience with WE-MDCT applications outside colorectal tumour staging, particularly for investigating diverticular disease and chronic inflammatory bowel diseases. A detailed explanation of the technique is provided, including patient preparation, the acquisition protocol, and study interpretation. RESULTS: WE-MDCT allows accurate preoperative visualisation of diverticular disease, acute and complicated diverticulitis. Ulcerative, indeterminate, or Crohn's colitis can be assessed including longitudinal distribution, mural thickening and enhancement patterns, pseudopolyps, associated perivisceral changes, adjacent organ involvement, and features suggesting carcinoma. Elective WE-MDCT represents a useful complementary technique in patients with impossible, incomplete, or inconclusive endoscopy, can allow study of a stricture's features and the upstream bowel, and helps planning medical, endoscopic, or surgical treatments. CONCLUSION: Urgent WE-MDCT with limited or no bowel preparation may prove useful in acutely symptomatic patients, as it may obviate a risky or contraindicated endoscopy, can determine disease severity, and allows making correct therapeutic choices. TEACHING POINTS: • Water enema multidetector CT provides high-resolution multiplanar visualisation of the colonic wall. • WE-MDCT allows accurate visualisation of diverticular disease, acute and complicated diverticulitis. • In chronic inflammatory bowel diseases WE-MDCT depicts the distribution, mural and perivisceral changes. • Elective WE-MDCT usefully complements incomplete endoscopy to assess strictures and upstream colon. • Urgent WE-MDCT with limited or no bowel preparation in acute diseases may obviate endoscopy.
    Insights into Imaging 03/2013; 4(3). DOI:10.1007/s13244-013-0239-7
  • [Show abstract] [Hide abstract]
    ABSTRACT: Whilst the diagnosis of colonic cancer is always based on visually guided flexible colonoscopy, which is the only technique that provides a histological diagnosis, the pre-treatment assessment of the cancer involves computed tomography. This can determine the exact site of the cancer in the colon, its dimensions and juxta-colonic extension and is used to investigate for liver, mesenteric or lung metastases.
    Diagnostic and interventional imaging 05/2014; 95(5). DOI:10.1016/j.diii.2014.03.004
  • [Show abstract] [Hide abstract]
    ABSTRACT: Si le diagnostic de cancer colique repose toujours sur la coloscopie optique, seule à pouvoir permettre un diagnostic histologique, le bilan préthérapeutique du cancer se fait en tomodensitométrie. Il permet de préciser le siège précis du cancer sur le cadre colique, ses dimensions, son extension juxta-colique et de rechercher des métastases hépatiques, mésentériques ou pulmonaires.
    05/2014; DOI:10.1016/j.jradio.2014.02.005
Show more