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CT Colonography for Follow-Up After Surgery for Colorectal Cancer

Young Jun Choi1, Seong Ho Park1, Seung Soo Lee1, Eugene K. Choi2, Chang Sik Yu3, Hee Cheol Kim3 and Jin Cheon Kim3

1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Gu, Seoul 138-736, Korea.
2 Weill Medical College of Cornell University, New York, NY.
3 Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.


Figure 1
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  		Fig. 1A —66-year-old man with normal ileocolic anastomosis (end-to-side type) after right hemicolectomy. Three-dimensional endoluminal CT colonography image shows normal anastomosis, which appears as smooth, sharp, and circumferential ridge (arrowheads).

 

Figure 2
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  		Fig. 1B —66-year-old man with normal ileocolic anastomosis (end-to-side type) after right hemicolectomy. Optical colonoscopy shows corresponding smooth, sharp anastomotic edge of even thickness (arrowheads).

 

Figure 3
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  		Fig. 2A —68-year-old man with normal colocolic anastomosis (end-to-end type) after low anterior resection. Three-dimensional endoluminal CT colonography image shows normal anastomosis, which presents as smooth, blunted, and circumferential ridge (arrowheads).

 

Figure 4
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  		Fig. 2B —68-year-old man with normal colocolic anastomosis (end-to-end type) after low anterior resection. Optical colonoscopy shows corresponding appearance of normal anastomosis (arrowheads).

 

Figure 5
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  		Fig. 3 —73-year-old man with normal colocolic anastomosis (end-to-end type) after low anterior resection. Three-dimensional endoluminal CT colonography image shows normal anastomosis that presents weblike appearance.

 

Figure 6
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  		Fig. 4A —35-year-old man with 5-mm extruded surgical staple in colocolic anastomosis after low anterior resection. Three-dimensional endoluminal CT colonography (CTC) image shows small polypoid lesion (arrowhead) adjacent to anastomotic edge.

 

Figure 7
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  		Fig. 4B —35-year-old man with 5-mm extruded surgical staple in colocolic anastomosis after low anterior resection. Transverse 2D image at soft-tissue window setting (window width, 400 H; window level, 20 H) from CTC clearly shows high attenuation of corresponding polypoid structure (arrowhead) and intact staple line (arrows).

 

Figure 8
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  		Fig. 4C —35-year-old man with 5-mm extruded surgical staple in colocolic anastomosis after low anterior resection. Optical colonoscopy clearly shows pseudolesion—that is, polyp-mimicking appearance of extruded surgical staple (arrowhead) on 3D CTC.

 

Figure 9
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  		Fig. 5A —79-year-old man with 9-mm inflammatory polyp at ileocolic anastomosis. Three-dimensional endoluminal CT colonography (CTC) image obtained 3 years after surgery shows well-defined sessile polypoid lesion (arrowheads) in anastomosis.

 

Figure 10
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  		Fig. 5B —79-year-old man with 9-mm inflammatory polyp at ileocolic anastomosis. Two-dimensional transverse image at wide window setting (window width, 1,500 H; window level, -400 H) from CTC shows polypoid lesion (arrowhead) of soft-tissue attenuation on anastomotic edge. C = colon, I = ileum.

 

Figure 11
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  		Fig. 5C —79-year-old man with 9-mm inflammatory polyp at ileocolic anastomosis. Follow-up optical colonoscopy shows corresponding polypoid lesion (arrowheads) with overlying erythematous mucosa at site of anastomosis. Colonoscopic biopsy revealed nonspecific inflammatory change with no evidence of neoplasm.

 

Figure 12
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  		Fig. 6A —66-year-old man with cancer recurrence at site of anastomosis after low anterior resection. Three-dimensional endoluminal CT colonography (CTC) image obtained 10 months after surgery shows ill-defined ulcerating, infiltrative (black arrowheads) lesion at site of anastomosis. Rectal tube (white arrowhead) is seen adjacent to lesion. U = ulcer.

 

Figure 13
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  		Fig. 6B —66-year-old man with cancer recurrence at site of anastomosis after low anterior resection. Two-dimensional transverse image at wide window setting (width, 1,500 H; level, -400 H) from CTC shows undulating colonic contour at anastomosis. Undulation is caused by ulcer and mounds (arrowheads).

 

Figure 14
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  		Fig. 6C —66-year-old man with cancer recurrence at site of anastomosis after low anterior resection. Subsequent optical colonoscopy shows corresponding ulcerating, infiltrative lesion (arrowheads) at anastomotic site. Surgical resection was performed, and pathology confirmed recurrence of adenocarcinoma. U = ulcer.

 

Figure 15
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  		Fig. 7A —50-year-old woman with extraluminal anastomotic recurrence in pericolic area after low anterior resection. Two-dimensional transverse image at soft-tissue window setting (width, 400 H; level, 20 H) obtained 25 months after surgery shows moderately enhancing infiltrative soft-tissue mass (arrowheads) located right lateral and posterior to anastomosis.

 

Figure 16
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  		Fig. 7B —50-year-old woman with extraluminal anastomotic recurrence in pericolic area after low anterior resection. Subsequent PET/CT image at corresponding level shows hypermetabolism (arrowheads) of lesion, confirming tumor recurrence.

 

Figure 17
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  		Fig. 7C —50-year-old woman with extraluminal anastomotic recurrence in pericolic area after low anterior resection. Optical colonoscopy performed same day as CT colonography shows no definitive evidence of mucosal recurrence at anastomotic site and adjacent areas.

 

Figure 18
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  		Fig. 8A —73-year-old woman with 9-mm metachronous cancer in distal ascending colon after low anterior resection. Three-dimensional endoluminal CT colonography (CTC) image obtained 30 months after surgery shows sessile polypoid lesion (arrowheads) in distal ascending colon.

 

Figure 19
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  		Fig. 8B —73-year-old woman with 9-mm metachronous cancer in distal ascending colon after low anterior resection. Two-dimensional multiplanar reformatted image at wide window setting (width, 1,500 H; level, -400 H) from CTC shows polypoid lesion (arrowheads) in distal ascending colon.

 

Figure 20
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  		Fig. 8C —73-year-old woman with 9-mm metachronous cancer in distal ascending colon after low anterior resection. Subsequent optical colonoscopy shows corresponding sessile polyp (arrowheads). Colonoscopic polypectomy was performed, and pathology revealed metachronous adenocarcinoma.

 

Figure 21
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  		Fig. 9A —67-year-old man with 8-mm metachronous adenomatous polyp in rectum after right hemicolectomy. Three-dimensional endoluminal CT colonography (CTC) image obtained 15 months after surgery shows sessile polypoid lesion (arrowhead) attached to Houston's valve in distal rectum.

 

Figure 22
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  		Fig. 9B —67-year-old man with 8-mm metachronous adenomatous polyp in rectum after right hemicolectomy. Two-dimensional transverse image of CTC using wide window setting (width, 1,500 H; level, -400 H) shows corresponding polypoid lesion (arrowhead) in distal rectum.

 

Figure 23
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  		Fig. 9C —67-year-old man with 8-mm metachronous adenomatous polyp in rectum after right hemicolectomy. Subsequent optical colonoscopy shows corresponding polypoid lesion (arrowheads) with lobulated surface in distal rectum. Polypectomy was performed, and pathology revealed villotubular adenoma.

 

Figure 24
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  		Fig. 10A —77-year-old woman with recurrence in form of metastases in liver and intraabdominal lymph nodes after low anterior resection. Two-dimensional transverse CT colonography images using soft-tissue window setting (width, 400 H; level, 20 H) obtained at 26 months after surgery show metastatic mass in liver (arrowheads, A) and metastatic lymphadenopathy in paraaortic and retrocaval areas (arrowheads, B). Subsequent optical colonoscopy (not shown) showed no evidence of intraluminal anastomotic recurrence.

 

Figure 25
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  		Fig. 10B —77-year-old woman with recurrence in form of metastases in liver and intraabdominal lymph nodes after low anterior resection. Two-dimensional transverse CT colonography images using soft-tissue window setting (width, 400 H; level, 20 H) obtained at 26 months after surgery show metastatic mass in liver (arrowheads, A) and metastatic lymphadenopathy in paraaortic and retrocaval areas (arrowheads, B). Subsequent optical colonoscopy (not shown) showed no evidence of intraluminal anastomotic recurrence.

 

Figure 26
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  		Fig. 11A —69-year-old woman with sigmoid colostomy after abdominoperineal resection (Mile's operation) for rectal cancer. Three-dimensional reconstruction of ray-sum view shows colon that is optimally dilated with carbon dioxide insufflation using small-caliber catheter with retention balloon placed through colostomy. Balloon was inflated with approximately 30 mL of air.

 

Figure 27
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  		Fig. 11B —69-year-old woman with sigmoid colostomy after abdominoperineal resection (Mile's operation) for rectal cancer. Two-dimensional multiplanar reformatted image at wide window setting (width, 1,500 H; level, -400 H) (B) and 3D endoluminal view (C) of CT colonography show appropriate catheter positioning and ballooning. Rectal catheter (arrowhead) is placed in center of colon without occlusion of tip against colonic wall. B = balloon.

 

Figure 28
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  		Fig. 11C —69-year-old woman with sigmoid colostomy after abdominoperineal resection (Mile's operation) for rectal cancer. Two-dimensional multiplanar reformatted image at wide window setting (width, 1,500 H; level, -400 H) (B) and 3D endoluminal view (C) of CT colonography show appropriate catheter positioning and ballooning. Rectal catheter (arrowhead) is placed in center of colon without occlusion of tip against colonic wall. B = balloon.

 

Figure 29
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  		Fig. 12 —60-year-old woman with sigmoid colostomy after abdominoperineal resection (Mile's operation) for rectal cancer. Two-dimensional multiplanar reformatted image at wide window setting (width, 1,500 H; level, -400 H) shows inappropriate placement of catheter. Catheter tip (arrowhead) is pushing against colonic wall. Retention balloon (B) is also overdistended and superficially located.

 

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