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Contrast-Enhanced CT Colonography in Recurrent Colorectal Carcinoma

Feasibility of Simultaneous Evaluation for Metastatic Disease, Local Recurrence, and Metachronous Neoplasia in Colorectal Carcinoma

¹ Department of Radiology, Mayo Clinic, East-2B, 200 First St., S.W., Rochester, MN 55905.
² Present address: Department of Internal Medicine, Walter Reed Army Medical Center, 6900 Georgia Ave., N.W., Washington, DC 20307-5001.
³ Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
⁴ Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905.
⁵ Section of Biostatistics, Mayo Clinic, Rochester, MN 55905.

View larger version (120K): [in a new window]   Fig. 1A. —Axial CT images show grades of colonic distention. Grade 0: no distention (i.e., complete collapse) in cephalad rectum (arrow).

View larger version (116K): [in a new window]   Fig. 1B. —Axial CT images show grades of colonic distention. Grade 1: inadequate distention (i.e., partial collapse) of sigmoid colon (arrow).

View larger version (115K): [in a new window]   Fig. 1C. —Axial CT images show grades of colonic distention. Grade 2: submaximal but acceptable distention of rectum.

View larger version (93K): [in a new window]   Fig. 1D. —Axial CT images show grades of colonic distention. Grade 3: maximal distention of rectum.

View larger version (22K): [in a new window]   Fig. 2. —Bar graph shows distention of each colonic segment in patients with prior resection for colorectal cancer followed by reanastomosis, as displayed by contrast-enhanced CT colonogram in supine (gray bars), prone (white bars), and combined (black bars) supine and prone positions. Note.—Asc = Ascending.

View larger version (131K): [in a new window]   Fig. 3A. —Extracolonic recurrence in 52-year-old woman. Axial contrast-enhanced CT colonography image shows nodular soft-tissue recurrence adjacent to surgical clip (arrowhead), posterior to ileotransverse colostomy.

View larger version (134K): [in a new window]   Fig. 3B. —Extracolonic recurrence in 52-year-old woman. Axial contrast-enhanced CT colonography image shows serosal metastasis (arrowhead) adjacent to sigmoid colon.

View larger version (109K): [in a new window]   Fig. 3C. —Extracolonic recurrence in 52-year-old woman. Three-dimensional endoluminal view corresponding to B, shows extrinsic filling defect (arrows) associated with serosal metastasis.

View larger version (130K): [in a new window]   Fig. 4. —Intramural and invasive local recurrence in 74-year-old woman. En bloc exenteration shows intrarectal mass with extension to posterior cervix and left adnexa. Contrast-enhanced CT colonography image shows enhancing circumferential mass at colorectal anastomosis with enhancing tumor surrounding right fornix that contains locule of air (arrowheads).

View larger version (127K): [in a new window]   Fig. 5A. —Indeterminate contrast-enhanced CT colonography for local recurrence in 57-year-old woman. Colonoscopic assessment, biopsy, and follow-up were consistent with benign ulcer and inflammation. Enhancing mass at ileocolic anastomosis (arrows) on supine axial contrast-enhanced CT colonography image.

View larger version (121K): [in a new window]   Fig. 5B. —Indeterminate contrast-enhanced CT colonography for local recurrence in 57-year-old woman. Colonoscopic assessment, biopsy, and follow-up were consistent with benign ulcer and inflammation. Same mass (arrow) is shown on prone axial CT colonography image.

View larger version (113K): [in a new window]   Fig. 6A. —Metachronous tubulovillous adenoma in 71-year-old woman with prior invasive sigmoid adenocarcinoma. Supine axial contrast-enhanced CT colonography image shows focal area of wall thickening along lateral wall of cecum (arrowheads).

View larger version (117K): [in a new window]   Fig. 6B. —Metachronous tubulovillous adenoma in 71-year-old woman with prior invasive sigmoid adenocarcinoma. Three-dimensional endoluminal image shows flat, sessile lesion (small arrowheads). Haustral fold extends superiorly and obliquely from lesion (large arrowhead).

View larger version (82K): [in a new window]   Fig. 7A. —Polypoid appearance at ileocolic anastomosis mimicking metachronous disease or local recurrence in 65-year-old woman. Axial CT colonography image shows polypoid-shaped filling defect at ileotransverse colostomy (arrow).

View larger version (86K): [in a new window]   Fig. 7B. —Polypoid appearance at ileocolic anastomosis mimicking metachronous disease or local recurrence in 65-year-old woman. Three-dimensional endoluminal image also shows apparent polyp (arrowheads) at anastomosis.

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