Elsevier

Clinical Imaging

Volume 33, Issue 6, November–December 2009, Pages 433-438
Clinical Imaging

Original article
Contrast-enhanced CT colonography with 64-slice MDCT compared to endoscopic colonoscopy in the follow-up of patients after colorectal cancer resection

https://doi.org/10.1016/j.clinimag.2009.01.002Get rights and content

Abstract

Background

Seventy percent of newly diagnosed colorectal cancer cases are potential candidates for curative surgery, but after resection, in 30%, the tumor will recur.

Postoperative follow-up includes endoscopic colonoscopy (EC) and computed tomography (CT). There have been only a few publications on the use of contrast-enhanced CT colonography (CECTC) in the follow-up of these patients.

Methods

Twenty-nine consecutive patients after resection of colorectal cancer underwent CECTC and EC on the same day. CECTC studies were reviewed for identification of strictures, recurrence, polyps and metastases.

Results

The anastomosis was identified in 96% of patients on CECTC and in 82% on endoscopic colonoscopy. One stricture was identified by both techniques. One extraluminal recurrence was depicted only on CECTC. Sensitivity in detecting polyps was per polyp 93% and per patient 100%.

Conclusion

CECTC performed on a 64-slice multidetector CT is reliable in imaging the postoperative colon for the follow-up of patients after resection of colorectal cancer.

Introduction

Colorectal cancer has the third highest incidence of all cancers [1] and is the second major cause of death from cancer in Europe and the United States [2], [3]. Seventy percent of all newly diagnosed cases are potential candidates for curative surgery, but after surgical resection, in 30% of cases, the tumor will recur [4].

Computed tomographic colonography (CTC) has been introduced in the last decade for the identification of colorectal lesions, polyps and cancer [5], [6], [7], [8].

Routine postoperative follow-up of patients may include laboratory tests, fiberoptic colonoscopy, and ultrasound or CT. There have been a few publications on the use of CTC in follow-up of these patients after surgery [1], [9], [10], [11]. CTC has the advantage in demonstrating the inner surface of the colon tube simulating the endoscopic colonoscopic view and demonstrating the pericolonic structures at the same time. It has a high accuracy in detecting colonic neoplasia [7], [8], [12], [13], [14].

The aim of this prospective study was to evaluate the feasibility and the role of contrast-enhanced CT colonography (CECTC) using a 64-slice and 3D visualization technique called “perspective filet view” [extended brilliance workspace] as compared to endoscopic colonoscopy (EC) performed the same day in the follow-up of patients after curative resection of colorectal cancer.

Section snippets

Patients

Twenty nine consecutive patients (18 men and 11 women; mean age, 63 years) who had undergone surgery for colorectal cancer were followed up in our hospital and had been referred by their oncologist to undergo both CT and EC. After receiving approval from our institutional review board, we recruited them for CECTC instead of CT. All patients signed an informed consent form and agreed to undergo CECTC followed by EC on the same day.

Patients were referred for routine follow-up. All patients

Patients

Twenty-nine consecutive patients (18 men and 11 women; mean age, 63 years) who had undergone surgery for colorectal cancer—right colectomy, 12 patients; left colectomy, 5 patients; and anterior resection, 12 patients—were included in our study. The patients were followed up for a period of 16–26 months. The average time interval between resection and CECTC was 12±3 months.

Study quality

Colonic preparation was rated as nondiagnostic (one patient), suboptimal (n=7), satisfactory (n=8) and good (n=13). Looking

Discussion

This study aimed to evaluate CECTC in the surveillance of patients after colorectal surgery due to carcinoma and to compare the findings on CECTC and EC.

Our results show that CECTC in this small group of patients was satisfactory regarding the visualization of the anastomotic area. The anastomosis could be clearly identified in all but one case: 96% of patients on CECTC and only in 82% on EC.

Five anastomotic strictures were identified on CECTC; in one case, the stricture could not be passed

Conclusion

Our study shows that CECTC can be useful in the follow-up of patients after colorectal cancer. It can replace CT and can be used as the first study prior to EC, which would facilitate this examination by providing all relevant data pertaining to the colon as well as extraluminal findings.

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