Published online before print February 27, 2004, 10.1148/radiol.2311021152
Preoperative T and N Staging of Colorectal Cancer: Accuracy of Contrast-enhanced Multi–Detector Row CT Colonography—Initial Experience1
Antonella Filippone, MD,
Roberta Ambrosini, MD,
Maurizio Fuschi, MD,
Tiziana Marinelli, MD,
Domenico Genovesi, MD and
Lorenzo Bonomo, MD
1 From the Department of Clinical Sciences and Bioimages, Section of Radiology (A.F., R.A., M.F., T.M., L.B.), and Department of Radiation Oncology (D.G.), SS Annunziata Hospital, G. D’Annunzio University, Via dei Vestini, 66013 Chieti, Italy. Received September 12, 2002; revision requested December 2; final revision received July 17, 2003; accepted August 6. Supported in part by a grant from CNR-MIUR. Address correspondence to A.F. (e-mail: a.filippone@rad.umich.it).
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Figure 1. Diagram of contrast-enhanced CT colonography criteria for T staging.  T2 = smooth outer border of thickened colorectal wall with a clear surrounding fat plane, T3 = tumor with rounded or nodular advancing margin, T4 = obliteration of fat planes between colorectal tumor and adjacent organs. (Adapted and reprinted, with permission, from reference 15).
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Figure 2. Transverse CT colonographic image. In this patient, the rectal wall thickness (arrow) has a rounded advancing margin without spiculations in perirectal fat. Lesion was assessed as stage T3 tumor, which pathologic findings confirmed.
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Figure 3. Transverse CT colonographic image. In this patient, the rectal wall thickness has fine hyperattenuating spiculations (arrow) in perirectal fat. Lesion was assessed as stage T2 tumor, which pathologic findings confirmed.
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Figure 4a. (a) Transverse CT colonographic image. Obliteration of the fat plane (arrow) between the rectal mass and the cervix is suggestive of local invasion. However, evaluation of the (b) sagittal MPR image showed the presence of a thin fat plane (arrow) between the two organs. Local invasion was not present at surgery.
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Figure 4b. (a) Transverse CT colonographic image. Obliteration of the fat plane (arrow) between the rectal mass and the cervix is suggestive of local invasion. However, evaluation of the (b) sagittal MPR image showed the presence of a thin fat plane (arrow) between the two organs. Local invasion was not present at surgery.
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Figure 5a. (a) Transverse CT colonographic image. In this patient with a tumor (arrow) in the sigmoid colon, the (b) coronal oblique MPR image showed a cluster of more than three small nodes (arrow), which led to staging of the tumor as N2; however, pathologic findings displayed a reactive pattern.
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Figure 5b. (a) Transverse CT colonographic image. In this patient with a tumor (arrow) in the sigmoid colon, the (b) coronal oblique MPR image showed a cluster of more than three small nodes (arrow), which led to staging of the tumor as N2; however, pathologic findings displayed a reactive pattern.
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Figure 6a. The combined evaluation of (a) transverse CT colonographic and (b) MPR images improved overall accuracy by reducing the number of overstaged cases, as in this patient, in whom some hyperattenuating nodular lesions (arrow in a) in perirectal fat were suspicious for lymph node involvement. Sagittal MPR images indicate that these structures are small perirectal vessels (arrow in b).
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Figure 6b. The combined evaluation of (a) transverse CT colonographic and (b) MPR images improved overall accuracy by reducing the number of overstaged cases, as in this patient, in whom some hyperattenuating nodular lesions (arrow in a) in perirectal fat were suspicious for lymph node involvement. Sagittal MPR images indicate that these structures are small perirectal vessels (arrow in b).
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Copyright © 2004 by the Radiological Society of North America.
