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
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).
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.
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.
Available from: Massimo Tonolini
- "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]. "
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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.
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The major objective was to prospectively compare the grade of bowel distension obtained with four different computed tomography (CT) techniques dedicated for the examination of the small intestine (CT enteroclysis [CTE] and enterography [CTe]), of the colon (CT with water enema [CT-WE]), or both (CTe with water enema [CTe-WE]). The secondary objective was to assess patients' tolerance toward each CT protocol.
Materials and methods:
Recruitment was designed to obtain four groups of the same number of patients (30). Each group corresponded to a specific CT technique, for a total of 120 consecutive outpatients (65 male and 55 female, mean age 51.09 ± 13.36 years). CTE was performed after injection of methylcellulose through a nasojejunal tube, while in the CTe protocol a polyethylene glycol electrolyte solution was orally administered to patients prior to the CT acquisition. In the CT-WE protocol intraluminal contrast (water) was administered only by a rectal enema, while CTe-WE technique included both a rectal water enema and oral ingestion of neutral contrast material to obtain a simultaneous distension of small and large bowel. CT studies were reviewed in consensus by two gastrointestinal radiologists who performed a quantitative and qualitative analysis of bowel distension on a per segment basis. The presence and type of adverse effects were recorded.
CTE provided the best distension of jejunal loops (median diameter 27 mm, range 17-32 mm) when compared to all the other techniques (p<0.0001). The frequency of patients with an adequate distension of the terminal ileum was not significantly different among the four groups (p=0.0608). At both quantitative and qualitative analysis CT-WE and CTe-WE determined a greater and more consistent luminal filling of the large intestine than that provided by both CTE and CTe (p<0.0001 for all colonic segments). Adverse effects were more frequent in patients belonging to the CTE group (p<0.0028).
CTE allows an optimal distension of jejunal loops, but it is the most uncomfortable CT protocol. When performing CT-WE, an adequate retrograde distension of the terminal ileum was provided in a particularly high percentage of patients. CTe-WE provides a simultaneous optimal distension of both small and large bowel.
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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.
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