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Sonography Transmission Gel as Endorectal Contrast Agent for Tumor Visualization in Rectal Cancer

Seung Ho Kim1, Jeong Min Lee1, Min Woo Lee2, Gi Hyeon Kim3, Joon Koo Han1 and Byung Ihn Choi1

1 Department of Radiology, Seoul National University College of Medicine, Yongon-dong 28, Chongno-gu, 110-744 Seoul, Korea.
2 Department of Radiology, Konkuk University School of Medicine, Seoul, Korea.
3 Department of Radiology, Chung-Ang University Hospital, Seoul, Korea.


Figure 1
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  		Fig. 1A —79-year-old man with pathologically proven distal rectal cancer (stage T1). T2-weighted sagittal MR image shows evenly distributed sonography transmission gel throughout entire rectum. Consequently, rectal walls are delineated smoothly and continuously. This endorectal contrast agent shows homogeneously higher signal intensity than urine. Lobulating polypoid mass (arrow) is noted in distal rectum.

 

Figure 2
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  		Fig. 1B —79-year-old man with pathologically proven distal rectal cancer (stage T1). T2-weighted axial MR image shows that depth of invasion of polypoid mass is confined to submucosa (arrow). Intact outer wall is also noted.

 

Figure 3
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  		Fig. 2A —70-year-old man with pathologically confirmed distal rectal cancer (stage T2). T2-weighted sagittal MR image shows optimally distended entire rectum. Focal artifacts are seen at interface between air bubble and gel, but they do not interfere with tumor visualization. Differentiation of rectal wall is well visualized in posterior wall because of enhanced contrast between gel and rectal mucosa. Ulcerofungating mass (arrow) is noted in anterior wall.

 

Figure 4
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  		Fig. 2B —70-year-old man with pathologically confirmed distal rectal cancer (stage T2). T2-weighted axial MR image shows that outer dark signal intensity of rectum is obliterated (arrow), which suggests invasion of muscularis propria.

 

Figure 5
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  		Fig. 3A —25-year-old man with pathologically confirmed distal rectal cancer (stage T3). T2-weighted sagittal MR image shows uniformly distended entire rectum. Ulceroinfiltrative mass (arrow) in the posterior wall is well visualized.

 

Figure 6
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  		Fig. 3B —25-year-old man with pathologically confirmed distal rectal cancer (stage T3). T2-weighted axial MR image shows that mass penetrates muscularis propria. Nodular extension (arrow) to perirectal fat is also seen.

 

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