Scientific paper
Preoperative staging by multidetector-row computed tomography in patients with rectal carcinoma

https://doi.org/10.1016/S0002-9610(02)00911-XGet rights and content

Abstract

Background: Multidetector-row computed tomography (MDCT, or multi-slice CT) has been introduced in 2000. So far, there has been no published study on this modality in patients with rectal carcinoma.

Methods: Twenty patients with rectal carcinoma were preoperatively examined by MDCT and conventional CT (CCT). Diagnostic accuracies of both modalities were compared regarding the evaluation of depth of tumor invasion (Tis/T1/T2, T3, T4) and lymph node metastasis based on the pathologic findings.

Results: Although CCT detected a tumor in 13 (65%) of 20 patients, MDCT revealed a tumor in all 20 patients (P = 0.004). Regarding depth of tumor invasion, the concordance rate was significantly higher for MDCT (20/20: 100%) than for CCT (12 of 20: 60%; P = 0.002). Regarding lymph node metastasis, the overall accuracy was 70.0% in CCT, and also 70.0% in MDCT.

Conclusions: MDCT was superior to CCT in the evaluation of depth of tumor invasion, but was equal to CCT in the evaluation of lymph node metastasis.

Section snippets

Patients and methods

This study was conducted from January 2000 to April 2001. Twenty patients with rectal carcinoma underwent both MDCT and CCT preoperatively. There were 14 males and 6 females with a mean age of 62.5 years (range 37 to 83), The tumor was located in the upper rectum in 7 patients, the middle rectum in 4 patients, and the lower rectum in 9 patients. Operative procedures were high anterior resection in 3 patients, low anterior resection in 11 patients, abdominoperineal resection in 3 patients,

Results

All patients tolerated both MDCT and CCT examinations without any complications. The tumor detection rate was 100% (20 of 20) for MDCT, and 65% (13 of 20) for CCT. CCT revealed all 10 tumors occupying more than three quarters of the rectal wall circumference regardless of tumor location, however, it detected 3 of 10 tumors occupying less than half circumference. Furthermore, these 3 tumors were located in the posterior wall of the rectum. CCT could detect only 1 of 5 low T-stage (Tis/T1/T2)

Comments

Thoeni et al [5] reported that CT could detect all tumors in 39 patients examined, whereas none of these patients had stage I (intraluminal mass without wall thickening) tumor. Adalsteinsson et al [6] reported that 74% of 53 tumors was detected without using a rectal balloon, and the tumor detection rate was improved up to 85% by using a rectal balloon with axial slices. Thompson [7] reported that tumor detection with axial planes was possible in 88% of cases, when oral or rectal contrast was

References (20)

  • I.J. Adam et al.

    Role of circumferential margin involvement in the local recurrence of rectal cancer

    Lancet

    (1994)
  • D.F. de Haas-Kock et al.

    Prognostic significance of radial margins of clearance of rectal cancer

    Br J Surg

    (1996)
  • H. Hu et al.

    Four multidetector-row helical CTimage quality and volume coverage speed

    Radiology

    (2000)
  • TNM classification of malignant tumors

  • R.F. Thoeni et al.

    Detection and staging of primary rectal and rectosigmoid cancer by computed tomography

    Radiology

    (1981)
  • B. Adolsteinsson et al.

    Computer tomography in staging rectal carcinoma

    Acta Radiol

    (1985)
  • W.M. Thompson et al.

    Preoperative and postoperative CT staging of rectosigmoid carcinoma

    Am J Roentgenol

    (1986)
  • B.A. Kerner et al.

    Is preoperative computerized tomography useful in assessing patients with colorectal carcinoma?

    Dis Colon Rectum

    (1993)
  • D.J. Hamlin et al.

    New technique to stage early rectal carcinoma by computed tomography

    Radiology

    (1981)
  • W. Zaunbauer et al.

    Computed tomography in carcinoma of the rectum

    Gastrointestinal Radiol

    (1981)
There are more references available in the full text version of this article.

Cited by (39)

  • Cancer of the Rectum

    2019, Abeloff’s Clinical Oncology
  • Predicting rectal cancer T stage using circumferential tumor extent determined by computed tomography colonography

    2016, Asian Journal of Surgery
    Citation Excerpt :

    High cost, lengthy acquisition time, and a limited field of view are other problems associated with MRI. MDCT has superior contrast and spatial resolution and capability for reconstruction in multiple planes, provides better performance than conventional CT,24,25 and is equal to MRI in the preoperative local staging of rectal carcinoma.26 Maras-Simunic et al27 reported that T staging by CTC in patients with obstructive colon cancer showed very high overall accuracy (97.6%).

  • Effect of using endorectal coil in preoperative staging of rectal carcinomas by pelvic MR imaging

    2008, European Journal of Radiology
    Citation Excerpt :

    Role of CT in local staging has diminished with the advent of transrectal ultrasound and MRI due to its inability to distinguish rectal wall layers and the lack of true multiplanar imaging capability [7]. Lately, in a study comparing conventional CT and MDCT, it was shown that multidetector CT (MDCT) was superior to conventional CT in the evaluation of depth of tumor invasion; however, both modalities similarly showed modest diagnostic accuracy in the evaluation of lymph node metastasis [8]. Another preliminary study demonstrated that MDCT is equally accurate in the preoperative staging of locally advanced rectal carcinoma when compared with MRI [9].

View all citing articles on Scopus
View full text